Integrative Neuroinformatics for Precision Prognostication and Personalized Therapeutics in Moderate and Severe Traumatic Brain Injury

Abstract

Despite changes in guideline-based management of moderate/severe traumatic brain injury (TBI) over the preceding decades, little impact on mortality and morbidity have been seen. This argues against the “one-treatment fits all” approach to such management strategies. With this, some preliminary advances in the area of personalized medicine in TBI care have displayed promising results. However, to continue transitioning toward individually-tailored care, we require integration of complex “-omics” data sets. The past few decades have seen dramatic increases in the volume of complex multi-modal data in moderate and severe TBI care. Such data includes serial high-fidelity multi-modal characterization of the cerebral physiome, serum/cerebrospinal fluid proteomics, admission genetic profiles, and serial advanced neuroimaging modalities. Integrating these complex and serially obtained data sets, with patient baseline demographics, treatment information and clinical outcomes over time, can be a daunting task for the treating clinician. Within this review, we highlight the current status of such multi-modal omics data sets in moderate/severe TBI, current limitations to the utilization of such data, and a potential path forward through employing integrative neuroinformatic approaches, which are applied in other neuropathologies. Such advances are positioned to facilitate the transition to precision prognostication and inform a top-down approach to the development of personalized therapeutics in moderate/severe TBI.

Cerebral Autoregulation Monitoring in Traumatic Brain Injury: An Overview of Recent Advances in Personalized Medicine

“…Further, integrative neuroinformatic approaches will be critical to make sense of such complex data streams, assuredly requiring application of artificial intelligence approaches. 136 Information gleamed from this approach may then be utilized in a "top-down" fashion to inform both cellular/small-animal and large animal pre-clinical platforms for precision pharmaceutical development directed at various pathways of CA dysfunction/failure. Work is currently underway to develop such comprehensive clinical data collection schemes and pipelines, as well as the pre-clinical infrastructure, for such future precision medication approaches in moderate/severe TBI care.…”

Immune modulation after traumatic brain injury

“…The development of the "personalized medicine, " particularly in oncology, made possible to adapt chemotherapy to the tumor and to the genetic characteristics of the patients, thus avoiding the principle of "one size fits all" to a tailored approach (172). In TBI patients, research in this 10.3389/fmed.2022.995044 area is in development (173). In ICU patients, the challenge remains to find biomarkers of occurrence of nosocomial infections in order to develop adapted immunomodulatory treatments.…”

Dynamic structures and emerging trends in the management of major trauma: A bibliometric analysis of publications between 2012 and 2021

“…In cluster #0, the literature largely reported on the management of severe traumatic brain injury (42)(43)(44)(45)(46)(47). The management of traumatic brain injury (TBI) has changed over the past decade; a multimodal approach is now being applied in detecting and treating the pathophysiological derangements.…”