NATIONAL BRAIN INJURY
AWARENESS MONTH
A FRAMEWORK TO ADVANCE
BIOMARKER DEVELOPMENT IN THE
DIAGNOSIS, OUTCOME PREDICTION,
AND TREATMENT OF TRAUMATIC
BRAIN INJURY
JOURNAL OF NEUROTRAUMA. FEBRUARY 2022.
By Elisabeth A. Wilde, Ina-Beate Wanner, Kimbra Kenney, Jessica Gill, James R Stone, Seth
Disner, Caroline Schnakers, Retsina Meyer, Eric M Prager, Magali Haas, and Andreas Jermin
Multi-modal biomarkers (e.g.,
imaging, blood-based, physiological)
of unique traumatic
brain injury (TBI) endophenotypes
are necessary to guide the
development of personalized and targeted
therapies for TBI. Optimal biomarkers will be
specific, sensitive, rapidly and easily accessed,
minimally invasive, cost effective, and
bidirectionally translatable for clinical and research
use. For both uses, understanding how
TBI biomarkers change over time is critical to
reliably identify appropriate time windows for
an intervention as the injury evolves. Biomarkers
that enable researchers and clinicians to
identify cellular injury and monitor clinical improvement,
inflection, arrest, or deterioration
in a patient’s clinical trajectory are needed
for precision healthcare. Prognostic biomarkers
that reliably predict outcomes and
recovery windows to assess neurodegenerative
change and guide decisions for return to
play or duty are also important. TBI biomarkers
that fill these needs will transform clinical
practice and could reduce the patient’s risk
for long-term symptoms and lasting deficits.
This article summarizes biomarkers currently
under investigation and outlines necessary
steps to achieve short- and long-term goals,
including how biomarkers can advance TBI
treatment and improve care for patients with
TBI.
Introduction
Biomarkers are objective, reproducible, and
quantifiable measures reflecting biological
processes. Biomarkers of injury may convey
pathophysiological information, serve as
proxies for injury progression or treatment
response, and guide clinical decision making.
The Food and Drug Administration (FDA) has
described a biomarker as “a defined characteristic
that is measured as an indicator
of normal biological processes, pathogenic
processes, or responses to an exposure or
intervention, including therapeutic interventions.”
As such, traumatic brain injury (TBI)
biomarkers can facilitate diagnosis, interpretation,
and monitoring of the injury course
and thus augment patient support, management,
and recovery.
TBI is characterized by an evolving and
often multi-faceted pathology with many
simultaneous changes occurring over hours,
days, weeks, and years following the insult. For
this reason, biomarker-based diagnosis and
prognosis need to be applied and interpreted
20 | DALLAS MEDICAL JOURNAL • March 2022