In this presentation, Dr. Peul will describe the practice variation in TBI care in Europe. Do differences in surgical & critical care influence outcome? The drawback of observational studies compared to RCT’s can be overthrown by modern mathematical methods. As the observed practice variation in Center-TBI is quite enormous between countries and even within countries there is a great need for evidence-based guidelines. Within this lecture Dr. Peul will present the differences in healthcare infrastructure, timing of surgery and critical care within the Center-TBI cohort of 5400 patients.
Wilco Peul, MD, Ph.D., Professor & Chair, University Neurological Center Holland, UNCH Leiden & The Hague
One Bite at a Time: Clinical Trials for Specific Symptoms and Deficits of TBI
Despite substantial investment of time and resources, over 30 late-phase clinical trials in traumatic brain injury (TBI) have failed to translate a therapeutic. There are very few solutions based on solid scientific evidence for treating patients with TBI. In recent years, there have been several examples of successful clinical trials focused on one symptom or subdomain at a time, in the specific sub-populations of patients most likely to benefit. Dr. Brody will present an overall framework for future clinical trials and discuss advantages of the “one bite at a time” approach to treating TBI. Exemplar trials will be presented to highlight the importance of trial design, domain-specific outcomes, and patient selection.
David Brody, MD, Ph.D., Director, Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences
Clinical Signatures and Neuropathological Correlates of Post Traumatic Neurodegeneration
This talk will provide an updated overview of current knowledge regarding clinical phenotypes of post-TBI functional and neurocognitive decline, neuropathological processes that may (or may not) represent mechanistic contributors to clinical decline, and clinical-pathological associations. Dr. Dams-O'Connor will also share recent findings from the Late Effects of TBI (LETBI) study.
Kristen Dams-O'Connor, Ph.D., Associate Professor, Director, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai
Saliva Biomarkers for Adolescent Concussion
Neuronal exosomes within saliva contain brain-related microRNA that can provide a window into the injured brain. Previously, Dr. Hicks and his team have shown that saliva microRNA profiles reflect cerebrospinal fluid microRNA profiles after traumatic brain injury, and that saliva microRNA can be used to predict the severity and duration of concussion symptoms. Here, he will present results from their follow up study, involving over 650 saliva samples from over 300 participants, which continue to demonstrate the promise of this novel, non-invasive class of biomarkers for assessing and managing adolescent concussion.
Steven Hicks, MD, Ph.D., Assistant Professor of Pediatrics, Penn State College of Medicine
We have lots of questions, but what are the answers?
~5 million annual ER visits, <5% with positive testing? Is this as good as it gets? Questions we should be asking include:
♦ Are you really safe after a negative CT scan of the head?
♦ Can you go home?
♦ Can you go back to work?
♦ What if you get hit again, are you going to be fine?
♦ Are there any other tests that you should be getting?
♦ Do you have acute traumatic encephalopathy?
Objective measures are coming and will change the standard of care for how we currently manage traumatic brain injury. This talk will cover these existing and future directions for acute testing in patients with suspected TBI.
W. Frank Peacock, MD, FACEP, Professor, Vice Chair for Research, Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine
ST266 is a novel, cGMP-produced secretome secreted by Amnion-derived Multipotent Progenitor (AMP) cells. AMP cells are produced by culturing a select population of amnion-derived epithelial cells under proprietary conditions. This cell secretome is anti-inflammatory, anti-apoptotic and neuroprotective. We have successfully demonstrated intranasal delivery of this protein mixture to the brain via the olfactory nerves. Neuroprotection in animal models has now propelled this research to human clinic studies.
Larry Brown, Sc.D., Executive Vice President, Chief Scientific Officer, Noveome Biotherapeutics
Pharmacological Augmentation of KCNQ (“M-type,” Kv7) K+ channels as a Novel Approach to Prevent Brain Damage and Dysfunction After Multiple Types of Traumatic Brain Injury
Dr. Shapiro will present his recent findings from his multi-lab project using mouse models that seeks to use pharmacological enhancement of M-type K+ currents in neurons to prevent the deleterious cascade of events that often lead to brain damage and dysfunction. These include the development of acute seizures and long-term epilepsy, a mal-adaptive inflammatory response characterized by microgliosis, astrogliosis and other inflammatory mediators, the breakdown of the normal blood-brain barrier, the wide-spread death of neurons, and cognitive and motor dysfunction. His team's results suggest that this approach has the potential to become a powerful and widespread therapeutic intervention in the clinic, the emergency room and on the battlefield.
Mark Shapiro, Ph.D., Professor, Department of Cellular and Integrative Physiology, Neuroscience Program, University of Texas Health Science Center
In this presentation, Dr. Slomine will discuss an interdisciplinary specialty clinic model of care for children with mild traumatic brain injury. Recent findings generated from clinic data including course and predictors of time to recovery in school-aged children and unique symptoms in preschool-aged children will be described. Additionally, the new data about the relationship among physical and cognitive activity and symptom resolution will be discussed.
Beth S. Slomine, Ph.D., ABPP, Co-Director, Center for Brain Injury Recovery, Kennedy Krieger Institute, Associate Professor of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
In this presentation, Dr. Bazarian will:
♦ Review the main findings of the Protect III trial, which were negative
♦ Review the biomarker project embedded within this trial (BioProTECT)
♦ Review methods used to re-analyze the Protect data using biomarker values, and the results
♦ Review implications and limitations of results
Jeff Bazarian, MD, MPH, Professor of Emergency Medicine, Neurology, Neurosurgery, and PHS, University of Rochester
New Pharmacological Interventions to Reverse Sex-dependent Behavioral and Cell-specific Deficits After Mild Repetitive Head Trauma
Repetitive mild head trauma can recapitulate higher cognitive deficits observed also in humans such as increased risk-taking behavior. We demonstrated that we can fully and permanently reverses sex-dependent behavioral and cellular deficits after mild, repetitive head trauma. We have behavioral data as well electrophysiology and structural and immunohistochemistry data along with the pharmacological intervention.
Susanna Rosi, Ph.D., Professor & Director of Neurocognitive Research, Brain and Spinal Injury Center, Weill Institute for Neuroscience, University of California San Francisco
Precision Imaging of Neuroinflammation After Traumatic Brain Injury
Dr. Coughlin will present emerging molecular imaging data that may shape the application of precision medicine in TBI. The presentation will review key concepts in imaging inflammation in the living brain, and will highlight recent data from imaging the neuroinflammatory response after repeated TBI in collision sports. Recent findings will be discussed in the context of informing new therapeutic strategies relevant to treating many types of TBI.
Jennifer M. Coughlin, MD, Assistant Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine