Biomarkers associated with Traumatic Brain Injury Outcomes in Children and cell reflection

My general interests revolve around the functions and processes in the brain. I am highly interested in neuropsychology and based my personal research on children as I one day hope to engage with helping them overcome their mental barriers because the children are our future. The research I found is about children who have had traumatic brain injuries (TBI) that could later have effects on the brain’s function.  The article I found deals with findings of biomarkers that indicate if TBI is a risk factor for developing attention deficit hyperactivity disorder (ADHD) and executive functioning complications. The research is conducted by looking at biomarkers, or biological factors, and behaviors.

Researchers for this study recruited children or adolescents between the ages of 2.5 years old through 17 who have been diagnosed with either a mild or severe TBI. However, “TBI is a major cause of chronic disability (Dang et al., 2017).”” Behavioral problems, mood, cognition, particularly memory, attention, and executive function are commonly impaired by TBI (2017).” “Primary and secondary TBIs cause temporary and/or permanent dysfunction in the brain, which limits a patient’s activities, affects participation in society, and lowers quality of life (2017).”

The research consisted of selecting children who scored high on the Glasgow Coma Scale after the incident and before being admitted to the hospital. Table 1 shows demographic information and types of injuries the children endured, as well as the severity. The most common injuries, from Table 1, consisted of: skull fractures, subdural hematoma, and motor vehicle collisions, etc. In total there were about 10 categories for injury in which at least 34 children had a severe form of a TBI.

Parents were given a questionnaire that referred to pre-injury functioning in their child. As the children were sent to the hospital post-injury, serum biomarkers such as S100, neuron-specific enolase (NSE), Interlukin 6 (IL-6), Interleukin 8 (IL-8), soluble vascular cell adhesion molecule-1 (sVCAM-1), souble neuron cell adhesion molecule (sNCAM) proteins were collected, as well as daily blood work which was taken daily for two weeks. However, immunoassays were ran on the blood in comparison to the biomarkers from the initial incident day as a proxy, representative sample levels at time of injury. For levels of the proteins within the blood that were drawn are found in Table 2, which sNCAM had the highest levels in the blood when tested by the hour. According to Figure 2, NSE had much fewer changes after injury than sNCAM over the first week of the study.

As health care providers assessed them in accordance to certain abilities, their parents were to assess their child’s current functioning abilities by taking a Pediatric Injury Functional Outcome Scale (PIFOS) questionnaire which included the Behavior Rating Inventory of Executive Function(BRIEF) assessment which had divided parts which contained the Behavioral Regulation Index (BRI) and the Metacognition Index (MI). Regarding BRI, Table 3 gave results showing that the area of executive functioning/ behavior was reduced in children when it came to working memory. Working memory had a t-score of 60.30 which was slightly higher than other areas such as planning and organizing, the MI section, and executive composition, etc which indicated complications with regions of the brain that interacts with the protein sNCAM.  The parents also took the Conners 3rd Edition Rating Scales (Conners-3) which was a questionnaire used to assess ADHD in ages 6–18 years. The results were shown in Table 4 which indicated that inattention (t-score, 63.09) was most prominent in children with TBI over hyperactivity/impulsivity (61.04), learning problems (58.70), executive functioning (59.73), defiance/aggression (57.74), and peer relations (57.70).

The results showed that the higher protein levels of NSE and lower protein levels of sNCAM were associated with higher scores on the Conners-3 indicating signs of ADHD and executive functioning complications. The proteins were also significant with the MI portion of the BRIEF assessment questionnaire.

TBI in children are related to cell biology because children are still at a stage of mental development in which their neural connections are minimal in comparison to adults. According to the University of Rochester Medical Center, the brain does not fully develop until about age 25. Meaning that “adults think with the prefrontal cortex, the brain’s rational part” and children do not (Sather and Shelat, 2018). The prefrontal cortex “orchestrates high-level functioning: maintaining attention, organization, and executive function (Silver, 2018).” “A deficiency of norepinephrine within this brain region might cause inattention, problems with organization, and/or impaired executive functioning (Silver, 2018).” However, the lack of norepinephrine among neurotransmitters are leading factors in individuals who have the disorder ADHD. In relation to class material learned in chapter 7, the extracellular matrices throughout the body can be degraded by matrix metalloproteinases which can influence diseases and disorders in an individual. Specifically, neural cell adhesion molecules (NCAM) which are a part of the immunoglobulin superfamily, are key factors in binding to the surface of neurons as a glycoprotein. Without the proper binding of these molecules, this will leave executive functioning problems such as learning and memory, along with synaptic plasticity.

References

Dang, B., Chen, W., He, W. and Chen, G. (2017). Rehabilitation Treatment and Progress of Traumatic Brain Injury Dysfunction.

Sather, R. and Shelat, A. (2018). Understanding the Teen Brain – Health Encyclopedia – University of Rochester Medical Center. [online] Urmc.rochester.edu. Available at: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=3051 [Accessed 11 Dec. 2018].

Silver, L. (2018). The ADHD Brain: Neuroscience Behind Attention Deficit. [online] Additudemag.com. Available at: https://www.additudemag.com/neuroscience-101/ [Accessed 11 Dec. 2018].