Update on protein biomarkers in traumatic brain injury with emphasis on clinical use in adults and pediatrics

Abstract

We conclude that only S-100B in severe traumatic brain injury has consistently demonstrated the ability to predict injury and outcome in adults. The number of studies with protein degradation products is insufficient especially in the pediatric care. Cohort studies with well-defined end points and further neuroproteomic search for biomarkers in mild injury should be triggered. After critically reviewing the study designs, we found that large homogenous patient populations, consistent injury, and outcome measures prospectively determined cutoff values, and a combined use of different predictors should be considered in future studies.

Mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions

“…133 S100B may, therefore, be an inadequate marker to distinguish between symptomatic and asymptomatic children with concussion, 133 and the utility of S100B in diagnostics and outcome prognosis is questionable. [134][135][136] Neuron-specific enolase (NSE) is a marker of neuronal injury, but its usefulness as a serum or CSF biomarker remains uncertain. [133][134][135][136][137] Elevated serum NSE levels have been observed after head impacts in boxers, 124 but were also seen in ice hockey players after a match where no concussions occurred.…”

“…[134][135][136] Neuron-specific enolase (NSE) is a marker of neuronal injury, but its usefulness as a serum or CSF biomarker remains uncertain. [133][134][135][136][137] Elevated serum NSE levels have been observed after head impacts in boxers, 124 but were also seen in ice hockey players after a match where no concussions occurred. 126 Serum NSE levels failed to predict recovery time after concussion, 126 and might not correlate with injury severity in children.…”

Matrix metalloproteinase-9 in the ventricular cerebrospinal fluid correlated with the prognosis of traumatic brain injury

“…Despite there being a number of biomarkers that have been shown to correlate with injury magnitude and survivability (5,13), there are few reliable methods to predict the clinical outcomes for TBI patients; therefore, there is a desperate need to identify more specific and sensitive biomarkers to serve as parameters for TBI management and prognosis.…”

Multimodal neuromonitoring

“…S100B is a cerebral protein found in peripheral blood. Concentration above 0.5 μg/L is considered as abnormal and reflects astrocite death (34). This marker could be used as an early and reliable poor neurological outcome predictor (33).…”

“…The half-life is significantly higher as compared to S100B (48 hours), making continuous monitoring unreasonable. On the other hand, the subsequent peak may reflect a secondary cerebral damage (34). The American Academy of Neurology claims that NSE >33 μg/L is associated with a poor neurological outcome in coma patients (35).…”