Immune biomarkers for the diagnosis of mild traumatic brain injury.
Ashley B Petrone, Valerie Gionis, Richard Giersch and 1 others
PMID 28222567WHAT IT FOUND
In 28 people, blood immune-gene patterns separated all 9 TBI patients from all 19 controls, and white blood cell ratios changed over 48 hours.
This was a small pilot, not a tested clinical triage test.
Key findings
01In 9 TBI patients, blood expression of ARG1, LY96, MMP9 and s100a12 was increased and CCR7 was decreased within 24 hours of injury compared with 19 controls.
02A pattern of ARG1, LY96 and MMP9 classified all TBI patients and all controls into separate clusters in this small pilot.
03Neutrophil and lymphocyte percentages and the neutrophil-lymphocyte ratio changed over 0-6 hours, 24 hours, 48 hours and discharge, and mild and severe TBI groups followed different patterns.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only 28 subjects were studied, including 9 TBI patients and 19 controls, so the results are a pilot signal and not a clinical test. The study did not collect outcome data, so it cannot show whether these immune changes predict recovery, work fitness, or long-term care needs. Controls were hospital visitors, and complete medical records were not available, so their health status may not be fully known. NLR was not calculated for controls because no white blood cell differential was performed, so neutrophil-lymphocyte results are limited to TBI patients. Blood gene expression was measured within 24 hours of injury in TBI patients, so the findings may not apply to later presentation or chronic symptoms. The paper says additional clinical studies are needed to determine thresholds of immune related genes and the NLR for clinical use.
Declared interests
T. Barr, V. Gionis, and R. Giersch receive salary support from Valtari Bio Inc.; T. Barr and R. Giersch are co-inventors on two provisional patent applications for multi-omic biomarkers to identify stroke and brain injury.
The easy way to misread this
Do not use the gene panel or neutrophil-lymphocyte ratio to diagnose mild TBI or make return-to-duty decisions. It is a pilot with 28 subjects, no outcome data, and the authors say more studies are needed.