School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia.
Research and Development Service, John D. Dingell VA Medical Center, Detroit, MI, USA.
Biomarkers. 2020 May;25(3):213-227. doi: 10.1080/1354750X.2020.1735521. Epub 2020 Mar 12.
Mild traumatic brain injuries (mTBI) are prevalent and can result in significant debilitation. Current diagnostic methods have implicit limitations, with clinical assessment tools reliant on subjective self-reported symptoms or non-specific clinical observations, and commonly available imaging techniques lacking sufficient sensitivity to detect mTBI. A blood biomarker would provide a readily accessible detector of mTBI to meet the current measurement gap. Suitable options would provide objective and quantifiable information in diagnosing mTBI, in monitoring recovery, and in establishing a prognosis of resultant neurodegenerative disease, such as chronic traumatic encephalopathy (CTE). A biomarker would also assist in progressing research, providing suitable endpoints for testing therapeutic modalities and for further exploring mTBI pathophysiology. This review highlights the most promising blood-based protein candidates that are expressed in the central nervous system (CNS) and released into systemic circulation following mTBI. To date, neurofilament light (NF-L) may be the most suitable candidate for assessing neuronal damage, and glial fibrillary acidic protein (GFAP) for assessing astrocyte activation, although further work is required. Ultimately, the heterogeneity of cells in the brain and each marker's limitations may require a combination of biomarkers, and recent developments in microRNA (miRNA) markers of mTBI show promise and warrant further exploration.
轻度创伤性脑损伤（mTBI）较为常见，可导致严重的身体残疾。目前的诊断方法存在固有局限性，临床评估工具依赖于主观的自我报告症状或非特异性的临床观察，而常用的成像技术则缺乏足够的敏感性来检测 mTBI。血液生物标志物将为 mTBI 提供一种易于获取的检测手段，以弥补当前的测量空白。合适的选择将为 mTBI 的诊断、恢复监测以及退行性神经疾病（如慢性创伤性脑病，CTE）的预后提供客观和可量化的信息。生物标志物还将有助于推进研究，为测试治疗模式提供合适的终点，并进一步探索 mTBI 的病理生理学。本综述重点介绍了在 mTBI 后在中枢神经系统（CNS）中表达并释放到全身循环中的最有前途的基于血液的蛋白候选物。迄今为止，神经丝轻链（NF-L）可能是评估神经元损伤最适合的候选物，而胶质纤维酸性蛋白（GFAP）可能是评估星形胶质细胞激活最适合的候选物，尽管还需要进一步的研究。最终，大脑中细胞的异质性和每个标志物的局限性可能需要组合使用生物标志物，而最近在 mTBI 的 microRNA（miRNA）标志物方面的进展显示出了希望，并值得进一步探索。
