Traumatic Brian Injury; Secondary Injury in the Brain in Children
A recent scholarly article described studies on nerve growth factor in children who have suffered traumatic brain injury. In plain language, when there is a TBI, the brain produces cytokines, cells in the brain to protect the brain in time of injury. However, there are within the brain at this time too much fluid buildup because of a number of secretions, that is neuro inflammatory mechanisms. This inflammation in turn can cause damage in the brain. The relationship between all of these secretions is not well understood.
Nerve growth factor expression correlates with severity and outcome of traumatic brain injury in children Antonio Chiarettia, 
, 
, Alessia Antonellia, Riccardo Riccardib, Orazio Genovesea, Patrizio Pezzottic, Concezio Di Roccod, Luca Tortoroloa and Giovanni Piedimontee
aPaediatric Intensive Care Unit, Catholic University School of Medicine, Rome, Italy
bDepartment of Paediatrics, Catholic University School of Medicine, Rome, Italy
cAgency for Public Health of Lazio Region, Rome, Italy
dPaediatric Neurosurgery, Catholic University School of Medicine, Rome, Italy
eDepartment of Paediatrics, West Virginia University School of Medicine, Morgantown, WV, USA
Received 26 January 2007; revised 26 June 2007; accepted 30 July 2007. Available online 18 September 2007.
Abstract
Background
Secondary brain damage after traumatic brain injury (TBI) involves neuro-inflammatory mechanisms, mainly dependent on the intracerebral production of cytokines. In particular, interleukin 1β (IL-1β) is associated with neuronal damage, while interleukin 6 (IL-6) exerts a neuroprotective role due to its ability to modulate neurotrophins biosynthesis. However, the relationship between these cytokines and neurotrophins with the severity and outcome of TBI remains still controversial.
Aims
To determine whether the concentration of IL-1β and IL-6 and neurotrophins (nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF)) in the cerebrospinal fluid (CSF) of children with TBI correlates with the severity of the injury and its neurologic outcome.
Methods
Prospective observational clinical study in a university hospital. CSF samples were collected from 27 children at 2 h (Time T1) and 48 h (Time T2) after severe TBI, and from 21 matched controls. Severity of TBI was evaluated by GCS and neurologic outcome by GOS. CSF concentrations of cytokines and neurotrophins were measured by immunoenzymatic assays.
Results
Early NGF and IL-1β concentrations (T1) correlated significantly with the severity of head injury, whereas no correlation was found for IL-6, BDNF, and GDNF. Furthermore, higher NGF and IL-6 and lower IL-1β expression at T2 were associated with better neurologic outcomes. No significant association was found between BDNF or GDNF expression and neurologic outcome.
Conclusions
NGF concentration in CSF is a useful marker of brain damage following severe TBI and its up-regulation, in the first 48 h after head injury together with lower IL-1β expression, correlates with a favorable neurologic outcome. Clinical and prognostic information may also be obtained from IL-6 expression.
Keywords: Children; Cytokines; Neuroprotection; Neurotrophic factors; Traumatic brain injury
Nerve growth factor expression correlates with severity and outcome of traumatic brain injury in children Antonio Chiarettia, , , Alessia Antonellia, Riccardo Riccardib, Orazio Genovesea, Patrizio Pezzottic, Concezio Di Roccod, Luca Tortoroloa and Giovanni Piedimontee
aPaediatric Intensive Care Unit, Catholic University School of Medicine, Rome, Italy
bDepartment of Paediatrics, Catholic University School of Medicine, Rome, Italy
cAgency for Public Health of Lazio Region, Rome, Italy
dPaediatric Neurosurgery, Catholic University School of Medicine, Rome, Italy
eDepartment of Paediatrics, West Virginia University School of Medicine, Morgantown, WV, USA
Received 26 January 2007; revised 26 June 2007; accepted 30 July 2007. Available online 18 September 2007.
Abstract
Background
Secondary brain damage after traumatic brain injury (TBI) involves neuro-inflammatory mechanisms, mainly dependent on the intracerebral production of cytokines. In particular, interleukin 1β (IL-1β) is associated with neuronal damage, while interleukin 6 (IL-6) exerts a neuroprotective role due to its ability to modulate neurotrophins biosynthesis. However, the relationship between these cytokines and neurotrophins with the severity and outcome of TBI remains still controversial.
Aims
To determine whether the concentration of IL-1β and IL-6 and neurotrophins (nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF)) in the cerebrospinal fluid (CSF) of children with TBI correlates with the severity of the injury and its neurologic outcome.
Methods
Prospective observational clinical study in a university hospital. CSF samples were collected from 27 children at 2 h (Time T1) and 48 h (Time T2) after severe TBI, and from 21 matched controls. Severity of TBI was evaluated by GCS and neurologic outcome by GOS. CSF concentrations of cytokines and neurotrophins were measured by immunoenzymatic assays.
Results
Early NGF and IL-1β concentrations (T1) correlated significantly with the severity of head injury, whereas no correlation was found for IL-6, BDNF, and GDNF. Furthermore, higher NGF and IL-6 and lower IL-1β expression at T2 were associated with better neurologic outcomes. No significant association was found between BDNF or GDNF expression and neurologic outcome.
Conclusions
NGF concentration in CSF is a useful marker of brain damage following severe TBI and its up-regulation, in the first 48 h after head injury together with lower IL-1β expression, correlates with a favorable neurologic outcome. Clinical and prognostic information may also be obtained from IL-6 expression.
Keywords: Children; Cytokines; Neuroprotection; Neurotrophic factors; Traumatic brain injury
Hickey Law Firm handles severe, moderate, and mild traumatic brain injury from both open head injuries and closed head injuries. John H. (Jack) Hickey has been involved in this field for almost as long as he has practiced law, 27 years. He is a Board Certified Civil Trial Lawyer, is rated A/V by Martindale Hubbell, and is rated by his peers as a Superlawyer in Superlawyer.com, and the insurance companies and cruise lines know it. Call toll free: 1.800.215.7117. See us at www.hickeylawfirm.com.
