Puvenna Vikram, Brennan Chanda, Shaw Gerald, Yang Cui, Marchi Nicola, Bazarian Jeffrey J, Merchant-Borna Kian, Janigro Damir
Cerebrovascular Research, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States of America; Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States of America; Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States of America.
Cerebrovascular Research, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States of America; Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States of America; Department of Clinical-Bioanalytical Chemistry, Cleveland State University, Cleveland, Ohio, United States of America.
PLoS One. 2014 May 7;9(5):e96296. doi: 10.1371/journal.pone.0096296. eCollection 2014.
The impact of sub-concussive head hits (sub-CHIs) has been recently investigated in American football players, a population at risk for varying degrees of post-traumatic sequelae. Results show how sub-CHIs in athletes translate in serum as the appearance of reporters of blood-brain barrier disruption (BBBD), how the number and severity of sub-CHIs correlate with elevations of putative markers of brain injury is unknown. Serum brain injury markers such as UCH-L1 depend on BBBD. We investigated the effects of sub-CHIs in collegiate football players on markers of BBBD, markers of cerebrospinal fluid leakage (serum beta 2-transferrin) and markers of brain damage. Emergency room patients admitted for a clinically-diagnosed mild traumatic brain injury (mTBI) were used as positive controls. Healthy volunteers were used as negative controls. Specifically this study was designed to determine the use of UCH-L1 as an aid in the diagnosis of sub-concussive head injury in athletes. The extent and intensity of head impacts and serum values of S100B, UCH-L1, and beta-2 transferrin were measured pre- and post-game from 15 college football players who did not experience a concussion after a game. S100B was elevated in players experiencing the most sub-CHIs; UCH-L1 levels were also elevated but did not correlate with S100B or sub-CHIs. Beta-2 transferrin levels remained unchanged. No correlation between UCH-L1 levels and mTBI were measured in patients. Low levels of S100B were able to rule out mTBI and high S100B levels correlated with TBI severity. UCH-L1 did not display any interpretable change in football players or in individuals with mild TBI. The significance of UCH-L1 changes in sub-concussions or mTBI needs to be further elucidated.
近期，研究人员对美国橄榄球运动员进行了次震荡性头部撞击（sub-CHIs）影响的调查，该人群存在不同程度创伤后后遗症风险。结果显示，运动员身上的次震荡性头部撞击在血清中表现为血脑屏障破坏（BBBD）报告物的出现，而次震荡性头部撞击的次数和严重程度与脑损伤假定标志物升高之间的关联尚不清楚。血清脑损伤标志物如泛素羧基末端水解酶L1（UCH-L1）依赖于血脑屏障破坏。我们研究了大学橄榄球运动员的次震荡性头部撞击对血脑屏障破坏标志物、脑脊液漏出标志物（血清β2-转铁蛋白）和脑损伤标志物的影响。因临床诊断为轻度创伤性脑损伤（mTBI）而入院的急诊患者作为阳性对照。健康志愿者作为阴性对照。具体而言，本研究旨在确定UCH-L1在辅助诊断运动员次震荡性头部损伤中的作用。对15名赛后未发生脑震荡的大学橄榄球运动员在赛前和赛后测量了头部撞击的程度和强度以及S100B、UCH-L1和β-2转铁蛋白的血清值。在经历次震荡性头部撞击最多的运动员中，S100B升高；UCH-L1水平也升高，但与S100B或次震荡性头部撞击无相关性。β-2转铁蛋白水平保持不变。在患者中未检测到UCH-L1水平与mTBI之间的相关性。低水平的S100B能够排除mTBI，而高S100B水平与TBI严重程度相关。UCH-L1在橄榄球运动员或轻度TBI个体中未显示任何可解释的变化。次震荡或mTBI中UCH-L1变化的意义需要进一步阐明。
