Update on protein biomarkers in traumatic brain injury with emphasis on clinical use in adults and pediatrics.
OBJECTIVE
This review summarizes protein biomarkers in mild and severe traumatic brain injury in adults and children and presents a strategy for conducting rationally designed clinical studies on biomarkers in head trauma.


METHODS
We performed an electronic search of the National Library of Medicine's MEDLINE and Biomedical Library of University of Pennsylvania database in March 2008 using a search heading of traumatic head injury and protein biomarkers. The search was focused especially on protein degradation products (spectrin breakdown product, c-tau, amyloid-beta(1-42)) in the last 10 years, but recent data on "classical" markers (S-100B, neuron-specific enolase, etc.) were also examined.


RESULTS
We identified 85 articles focusing on clinical use of biomarkers; 58 articles were prospective cohort studies with injury and/or outcome assessment.


CONCLUSIONS
We conclude that only S-100B in severe traumatic brain injury has consistently demonstrated the ability to predict injury and outcome in adults. The number of studies with protein degradation products is insufficient especially in the pediatric care. Cohort studies with well-defined end points and further neuroproteomic search for biomarkers in mild injury should be triggered. After critically reviewing the study designs, we found that large homogenous patient populations, consistent injury, and outcome measures prospectively determined cutoff values, and a combined use of different predictors should be considered in future studies.
Kövesdi
Erzsébet
E
Department of Neurosurgery, University of Pécs, Rét u. 2., 7623, Pécs, Hungary.
Lückl
János
J
Bukovics
Péter
P
Farkas
Orsolya
O
Pál
József
J
Czeiter
Endre
E
Szellár
Dóra
D
Dóczi
Tamás
T
Komoly
Sámuel
S
Büki
András
A
D016229:Amyloid beta-Peptides / Q000097:blood; D000818:Animals; D001057:Apolipoproteins E / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000097:blood* / Q000503:physiopathology; D002648:Child; D006259:Craniocerebral Trauma / Q000097:blood; D005904:Glial Fibrillary Acidic Protein / Q000097:blood; D006801:Humans; D009104:Multiple Trauma / Q000097:blood; D009414:Nerve Growth Factors / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010751:Phosphopyruvate Hydratase / Q000097:blood; D011237:Predictive Value of Tests; D011506:Proteins / Q000378:metabolism*; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood; D012720:Severity of Illness Index; D013049:Spectrin / Q000378:metabolism; D055815:Young Adult; D016875:tau Proteins / Q000097:blood / Q000737:chemistry
D016229:Amyloid beta-Peptides; D001057:Apolipoproteins E; D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; D009414:Nerve Growth Factors; D010446:Peptide Fragments; D011506:Proteins; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C075222:amyloid beta-protein (1-42); D016875:tau Proteins; D013049:Spectrin; D010751:Phosphopyruvate Hydratase