Distinguishing and phenotype monitoring of traumatic brain injury and post-concussion syndrome including chronic migraine in serum of Iraq and Afghanistan war veterans

PLoS One. 2019 Apr 26;14(4):e0215762. doi: 10.1371/journal.pone.0215762. eCollection 2019.

Abstract

Traumatic Brain Injury (TBI) and persistent post-concussion syndrome (PCS) including chronic migraine (CM) are major health issues for civilians and the military. It is important to understand underlying biochemical mechanisms of these conditions, and be able to monitor them in an accurate and minimally invasive manner. This study describes the initial use of a novel serum analytical platform to help distinguish TBI patients, including those with post-traumatic headache (PTH), and to help identify phenotypes at play in these disorders. The hypothesis is that physiological responses to disease states like TBI and PTH and related bodily stresses are reflected in biomolecules in the blood in disease-specific manner. Leave one out (serum sample) cross validations (LOOCV) and sample randomizations were utilized to distinguished serum samples from the following TBI patient groups: TBI +PTSD + CM + severe depression (TBI "most affected" group) vs healthy controls, TBI "most affected" vs TBI, TBI vs controls, TBI + CM vs controls, and TBI + CM vs TBI. Inter-group discriminatory p values were ≤ 10-10, and sample group randomizations resulted in p non-significant values. Peptide/protein identifications of discriminatory mass peaks from the TBI "most affected" vs controls and from the TBI plus vs TBI minus CM groups yielded information of the cellular/molecular effects of these disorders (immune responses, amyloidosis/Alzheimer's disease/dementia, neuronal development). More specific biochemical disease effects appear to involve blood brain barrier, depression, migraine headache, autoimmunity, and autophagy pathways. This study demonstrated the ability for the first time of a novel, accurate, biomarker platform to monitor these conditions in serum, and help identify biochemical relationships leading to better understanding of these disorders and to potential therapeutic approaches.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Afghan Campaign 2001-
  • Brain Injuries, Traumatic / complications*
  • Chronic Disease
  • Depression / blood
  • Depression / diagnosis
  • Depression / etiology
  • Diagnosis, Differential
  • Female
  • Humans
  • Iraq War, 2003-2011
  • Male
  • Middle Aged
  • Migraine Disorders / blood
  • Migraine Disorders / diagnosis*
  • Migraine Disorders / etiology
  • Post-Concussion Syndrome / blood
  • Post-Concussion Syndrome / diagnosis*
  • Post-Concussion Syndrome / etiology
  • Retrospective Studies
  • Stress Disorders, Post-Traumatic / blood
  • Stress Disorders, Post-Traumatic / diagnosis
  • Stress Disorders, Post-Traumatic / etiology
  • United States
  • Veterans*
  • War-Related Injuries / complications*

Grants and funding

This study was supported by a grant from the Department of Defense (W81XWH-16-1-0295, to JRC and JSH), and the Veterans Administration Research and Education Fund (829-VREF, to JSH and JRC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.