title: Blood-Brain Barrier Disruption Is an Early Event That May Persist for Many Years After Traumatic Brain Injury in Humans.
abstract: Traumatic brain injury (TBI) is a risk factor for dementia. Mixed neurodegenerative pathologies have been described in late survivors of TBI, but the mechanisms driving post-TBI neurodegeneration remain elusive. Increasingly, blood-brain barrier (BBB) disruption has been recognized in a range of neurologic disorders including dementias, but little is known of the consequences of TBI on the BBB. Autopsy cases of single moderate or severe TBI from the Glasgow TBI Archive (n = 70) were selected to include a range from acute (10 hours-13 days) to long-term (1-47 years) survival, together with age-matched uninjured controls (n = 21). Multiple brain regions were examined using immunohistochemistry for the BBB integrity markers fibrinogen and immunoglobulin G. After TBI, 40% of patients dying in the acute phase and 47% of those surviving a year or more from injury showed multifocal, abnormal, perivascular, and parenchymal fibrinogen and immunoglobulin G immunostaining localized to the gray matter, with preferential distribution toward the crests of gyri and deep neocortical layers. In contrast, when present, controls showed only limited localized immunostaining. These preliminary data demonstrate evidence of widespread BBB disruption in a proportion of TBI patients emerging in the acute phase and, intriguingly, persisting in a high proportion of late survivors.
authors.affiliation: From the University of Glasgow (JRH, WS); and Department of Neuropathology, Queen Elizabeth University Hospital (JRH, AMHY, WS), Glasgow, United Kingdom; and Penn Centre for Brain Injury and Repair and Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (VEJ, DHS).
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Hay
authors.forename: Victoria E
authors.initials: VE
authors.lastname: Johnson
authors.forename: Adam M H
authors.initials: AM
authors.lastname: Young
authors.forename: Douglas H
authors.initials: DH
authors.lastname: Smith
authors.forename: William
authors.initials: W
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001344:Autopsy; D018916:Blood-Aqueous Barrier / Q000503:physiopathology*; D001930:Brain Injuries / Q000401:mortality / Q000473:pathology*; D002648:Child; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D015600:Glasgow Coma Scale; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D005340:Fibrinogen