2023 Conference Agenda

Utilization of a TBI Biomarker Test in the ED
Recently, the first rapid turn around time, biomarker test was FDA cleared and approved for use to rule out the need for Head CT in mild and moderate TBI. While the sample requires some processing (plasma sample, centrifuge), the potential ability to rule out the need for advanced imaging in a hospital setting has significant implications in the emergency department and pre-hospital setting. Here, we review 1 year of real world, real patient data from a large level-1 academic quaternary care ED that has used the GFAP/UCLH-1 binary diagnostic biomarker test to potentially rule out the need for Head CT. We consider impacts on patient safety, care progression and patient throughput. In addition, we hypothesize future ways that new data might expand test use in currently non-approved populations, such as pediatrics, as well as the utilization of the test in clinical spaces downstream of an acute event.
Jason Wilson, MD, FACEP, Associate Professor, Research Director, Division of Emergency Medicine; Division Chief, Emergency Medicine, USF Health Morsani College of Medicine; Tampa General

Characterization of Inflammatory and Immune-related Markers in Ferret and Human after Blast TBI.
As the smallest mammal with a convoluted cerebral cortex, the ferret is an excellent animal to study TBI. Because of the distinctive pattern of astrocytic reactivity seen in both human and ferret cerebral cortex after blast injury, we compared inflammatory and immune-related markers in both the ferret and human after blast exposure. Although many similarities link ferret and human pathology, we found distinct populations of astrocytes immunoreactive for either GFAP or Aquaporin 4, or both, in humans, which altered their expression pattern after TBI, but was not observed in ferrets. Additional substances related to the immune system were strongly present and colocalized with astrocytes in human cerebral cortex, but not ferret, after blast TBI. Injured human tissue showed a distinctive beaded, intermittent and vacuolated pattern in astrocytes, coincident with immune system related markers, also not seen in ferrets after blast injury.
Sharon Juliano, Ph.D., Professor of Neuroscience & Molecular Biology, Program Leader, Center for Neuroscience & Regeneration, Uniformed Services University

Imaging of Neurovascular Unit Dysfunction in TBI
This talk provides an overview of neuroimaging techniques used to examine dysfunction of the neurovascular unit in clinical TBI patients. Recent insights from neuroimaging on the role of microvascular injury and dysfunction in the pathophysiology of chronic TBI are reviewed. Future research directions and potential for clinical translation of these techniques are discussed.
Jeffrey Ware, MD, Assistant Professor of Radiology, Neuroradiology Division, University of Pennsylvania

Prehospital Treatment of TBI with Mitochondria-Targeted Therapeutics
Traumatic brain injury (TBI) is a heterogeneous disorder characterized by high mortality, which is associated with mitochondria-centric post-injury responses. This presentation aims to cover recent advances in understanding of mitochondria-centric secondary injury mechanisms following penetrating traumatic brain injury. Our recent findings also demonstrated that mitochondria targeted therapeutics rescued the acute mitochondrial pathological responses, and providing novel insights into neuroprotective efficacy of drugs following severe TBI.
Jignesh Pandya, Ph.D., Director, TBI Bioenergetics Metabolism & Neurotherapeutics, Brain Trauma Neuroprotection Branch, Walter Reed Army Institute of Research

Bench to Bedside Research in Neurocritical Care
In Canada, more than 50,000 patients annually suffer cardiac arrest from which global hypoxic ischemic brain injury (HIBI) is the predominant determinant of adverse outcome. Only 5-15% of HIBI survivors experience full neurological recovery with the remaining experiencing cognitive and psychiatric disabilities with annual healthcare costs encompassing > $1 billion dollars CAD. Classically, HIBI pathophysiology is characterized by primary ischemic injury during circulatory arrest (cerebral ischemia) and secondary injury following return of spontaneous circulation (ROSC) (cerebral reperfusion). This presentation will discuss the use of blood biomarkers to better understand the complex pathophysiologic mechanisms triggered by brain hypoxia.
Cheryl Wellington, Ph.D., Professor, Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia

The US Department of Defense Warfighter Brain Health Initiative
The US DoD Warfighter brain health initiative represents a unified approach to better address the brain health needs of Service members, their families, line leaders, commanders and their communities at large. The initiative is a prevention, detection, mitigation effort that addresses brain exposures and injuries in all military environments. This presentation will review the areas and activities that are part of the DoD’s roadmap to optimize brain health in all military operating environments.
Katherine Lee, MS, CRNP, ANPBC, CNRN, Director, Casualty Management, US Department of Defense

Previous Traumatic Brain Injury and Risks of Dementia and Alzheimer’s disease: Evidence from the Military Health System Data Repository
The goals of this study are to: 1) investigate whether previous traumatic brain injury (TBI) during military service increases the risks of being diagnosed with dementia and Alzheimer's disease (AD) later in life; and 2) quantify the duration between the TBI diagnosis and the onset of dementia and AD for patients who are diagnosed with these conditions. This analysis aims to advance our understanding of this potential association between previous TBI and dementia and AD by using data from the Military Health System Data Repository (MDR). The MDR is a rich data set that contains information on injuries on both military (active duty or military retirees) and their civilian dependents, spouses or survivors receiving care either in military treatment facilities (MTFs) or in private care settings. Findings from this study will provide credible information to DoD decision makers, congressional policymakers, clinicians, public health professionals, and other key stakeholders about the association between TBI and AD while accounting for the unique risk factors of TBI and comorbidities in the MHS.
Patrick Richard, Ph.D., Professor & Director of Health Services Administration Division , Uniformed Services University

Defining the Cellular Landscape of Chronic Subclinical Brain Injuries Through Imaging Mass Cytometry
State-of-the-art, high-dimensional imaging techniques enable an unprecedented look into how cellular communities respond to, and resolve, pathology. When combined with precision anatomical mapping, these techniques can inform how different brain regions manage these relationships, defining areas of resiliency or risk. Here, Dr. James Meabon will discuss the application of Imaging Mass Cytometry (IMC) towards a deeper understanding of the cumulative effects of highly repetitive low-intensity blast (LIB) exposures such as those during military training. IMC is a highly-multiplexed tissue imaging solution, using upwards of 40+ different antibodies, to visualize diverse targets and complex cellular phenotypes using standard tissue sections. Through combining IMC with anatomical mapping and open source computational approaches, Dr. Meabon will discuss how these new methods can be leveraged to discover novel mechanisms in blast injury using unbiased means.
James Meabon, Ph.D., Research Health Scientist, VA Puget Sound Health Care System, University of Washington

Geriatric TBI: Progress, Challenges, and Future Directions
In this presentation Dr. Lazarus will address the current state of the science in geriatric traumatic brain injury (TBI). Current challenges regarding clinical research and evidence-informed clinical guidelines will be discussed, as well as consideration of the unique clinical presentation and needs of this particularly at-risk population.
Rachel Lazarus, Ph.D., Neuroscientist AARP