BETHESDA, MD — Recent projects being overseen or funded at NIH hope to shed light on the biology of traumatic brain injury (TBI) and give physicians and future researchers better tools to understand, diagnose and treat the condition.
According to NIH, more than 1.7 million Americans sustain a TBI each year, mostly from common causes. This includes the more than 200,000 servicemembers who have been diagnosed with TBI over the last 12 years — most of those injuries being combat-related.
No two brain injuries look or act exactly alike. The damage to the brain and its location is unique, as are the mix of symptoms that go with it. For example, research has shown that blast-related TBI, such as that suffered in combat, can present very differently than other types of TBI.
With this variability in mind, DoD and NIH are partnering on the creation of a central TBI database. The hope is that by collecting uniform data on as many types of these injuries as possible, the database will be a boon to research into the injury and help accelerate comparative effectiveness research on brain injury treatment and diagnosis.
The Federal Interagency Traumatic Brain Injury (FITBIR) database is being funded at $10 million over the next four years. NIH’s Center for Information Technology has been tapped to build it, having gained useful experience when building the National Database on Autism Research.
The National Institute of Neurological Disorders and Stroke and the U.S. Army Medical Research and Materiel Command will partner in providing program support for the project and help fill the database with useful information. Researchers will be provided with exactly what kind of information FITBIR is looking for and will be encouraged to participate at the time they submit proposals for new TBI studies.DoD, NIH Partner to Create TBI Research Database Cont.
Even diagnosing a TBI can be a difficult proposition, with sufferers going weeks or months before physicians discover that an injury has occurred.
Researchers at the Emory University School of Medicine in Atlanta may help provide a tool to quickly and accurately assess the severity of TBI and help deliver proper therapy.
With a new $2.2 million, five-year grant from NIH, Michael Frankel, MD, director of Grady Memorial Hospital’s Marcus Stroke and Neuroscience Center, and his team are studying biomarkers in the blood of TBI patients. If TBI results in a predictable pattern of biomarkers that changes with injury severity, then a simple blood test could tell clinicians if a patient has suffered a TBI and how severe it is.
One of the consequences of TBI is the breakdown of tissue and a release of proteins into the bloodstream. Previous studies have shown that the presence of such proteins can correlate with outcome after TBI. This suggests that such biomarkers can potentially help determine the severity of the injury.
Preliminary studies have shown this could be the case, with blood levels of four types of biomarkers doing better at predicting the extent of injury than the standard Glasgow Coma Scale combined with CT scan.
Frankel and his team hope to validate the use of such biomarkers with the current study. Their patients will already be enrolled in an ongoing NIH-funded study — the Progesterone for Traumatic Brain Injury, Experimental Clinical Treatment (ProTECT) III trial. This Phase III study is assessing the use of progesterone in 1,140 TBI patients at 17 centers nationwide.
The Emory team will study the biomarkers in patient blood samples while they are being treated with progesterone. By studying the relationship between progesterone levels, serum biomarkers, and the injury itself, researchers hope they will find ways to better treat and understand TBI.
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