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URMC / Emergency Medicine / Research / Traumatic Brain Injury Research

Traumatic Brain Injury Research

Goals & Description

The overarching goal of our laboratory is to reduce the morbidity and mortality associated with traumatic brain injury.

To accomplish this goal we rely on a translational approach: both clinical and basic studies are used to identify and solve relevant research questions that might lead to improved diagnosis and therapeutics for this disease. Relevant questions are identified through studies of large numbers of human patients and examined in detail in animal models. Mechanistic insights gleaned through this approach may then allow for novel therapeutics that can then be developed for clinical trials.

J Bazarian

Our clinical research infrastructure includes the emergency departments of the University of Rochester Medical Center (URMC) and 5 other major medical centers in upstate New York (totaling 300,000 patients per year), the URMC Burn Trauma ICU, and undergraduate athletes from the University of Rochester and Rochester Institute of Technology. Clinical studies are coordinated by the division of Emergency Medicine Research located in the URMC Clinical and Translational Science Institute in the Saunders Research Building.

Our basic science research infrastructure consists of state of the art bench research facilities within the Center for Neural Development and Disease located in the URMC Medical Research Building. This lab is equipped with a temperature controlled ultra-centrifuge, microcentrifuge, -80C and -20C freezers, orbital shaker, vortexer, full set up to run western blots and DNA gels. Shared equipment includes pH meters, chemical, cell culture and biosafety hoods, cold rooms, a fully equipped dark room (with developer), confocal microscope set up, plate reader for ELISAs, DNA gel imager, 2D gel equipment and imagers, and a full set up (instruments, rooms) for the small animal surgery.

Check out THINKS (Traumatic Head injury Network for Kids in Sports), a social network group with the purpose of bringing people together concerned with the increasing incidence of head injuries in children's sports.

Ongoing Projects

Diffusion Tensor Imaging

Diffusion Tensor Imaging (DTI) is a type of Magnetic Resonance Imaging (MRI) that our group employs to look for changes within the brain related to brain injury. Using a Siemens Trio 3T magnet to scan research subjects, our research team is able to analyze these images to measure subtle changes in the white matter tracts among ED patients and subject-athletes following mTBI or repetitive sub-concussive blows to the head.

NCAA/DOD

This research is part of the landmark $30 million NCAA-U.S. Department of Defense initiative to fund the most comprehensive study of concussion and head impact exposure ever conducted.

The study will enroll an estimated 25,000 male and female NCAA student-athletes and military cadets over the three-year study period. Participants will receive a comprehensive preseason evaluation for concussion and will be monitored in the event of an injury.

The Longitudinal Clinical Study Core of the study, led by the University of Michigan, is a prospective, multi-institution clinical research protocol that aims to study the natural history of concussion among NCAA student-athletes. This investigation will be the largest ever of its type.

Learn more about the NCAA/DOD study

Previous Research Studies

Use of the BrainScope EEG for the Identification and Prognostication of Emergency Department Patients with Traumatic Brain Injury

The objective of this study is to build a database of EEG data collected from patients with traumatic brain injury (TBI) presenting to the ED. This data will be collected for hypothesis generating analysis. This data will be utilized to test the utility of BrainScope as an objective marker of patients diagnosed with TBI defined by CT findings and/or neurocognitive testing. Intercalation of the BrainScope device into the management of the ED MTBI patient has the potential to provide an objective measure for patients destined for post-concussive syndrome and to provide a screening tool that may delineate those patients requiring neuroimaging.

Learn more about the BrainScope EEG

BrainScope Ahead® Technology (B-AHEAD II Trial)

This is a multisite, prospective, non-randomized trial for the validation of the BrainScope Ahead® M-100 in support of an FDA marketing application. Patients suspected of a traumatically induced brain injury and non-head injured controls undergo standard clinical assessments, neurocognitive evaluation, and electrophysiological assessment with the Ahead® M-100.  The goal of this trial is to validate the safety and effectiveness of the BrainScope Ahead® M-100 system when used to aid in the triage of patients who are suspected of a traumatically induced structural brain injury.

Learn more about Brain Scope

Evaluation of Biomarkers of Mild, Moderate and Severe Traumatic Brain Injury (ALERT):

This prospective, open label, multi-center FDA clinical trial will evaluate the utility of the Banyan Biomarkers Test in TBI detection. Development of valid biomarkers for TBI will have a major impact on diagnosis, management and treatment of brain injured patients. The test is to be used, in conjunction with standard clinical assessment, as an aid in the diagnosis of traumatic brain injury.

Learn more about ALERT

Defining the Unique Serum Proteome of Mild Brain Trauma

The goal of this project is to identify proteins unique to axonal injury after mild traumatic brain injury (TBI) among collegiate athletes using proteomic analysis of serum.  In identifying proteins that are present in the blood after brain injury the potential for the development of an objective diagnostic test for concussions exists.  The eventual goal is to develop a diagnostic test that would predict outcome after mild brain trauma.  In this study, outcome will be determined by the change in cognitive performance post injury compared to pre injury.

New Interdisciplinary Approach to Improve Diagnosis of TBI: Combining Physics with Medical Imaging

This study will validate the wild bootstrapping approach to DTI image analysis by quantitative correlation with helmet impact forces acquired from football players at the University of Rochester.

Changes in Brain White Matter after Multiple Sub-Concussive Head Blows

In order to prevent sub-concussive head blows from causing neurologic harm to contact sport athletes in the future, this study is designed to examine the impact forces associated with brain injury, white matter changes on diffusion tensor imaging (DTI), the individual-level determinants of recovery from brain injury, and the effect of rest on recovery from brain injury.

Learn more about Changes in Brain White Matter

A Novel Tool for Field Assessment of Mild Traumatic Brain Injury

The aim of this research project is to test the use of DETECT, a novel platform for immediate post-injury neuropsychological assessment, in concert with marketed biomechanical helmet sensor technology, to improve the screening and management of potential concussion injuries, and to provide a more robust definition of head impact exposure tolerances.

Recent Publications

Janigro D, Puvenna V, Engeler M, Banjara M, Bernnan C, Schreiber P, Dadas A, Bahrami A, Solanki J, Bandyaopadhyay A, Morris JK, Bernick C, Ghosh C, Bazarian JJ. Is phosphorylated tau unique to chronic traumatic encephalopathy? Phosphorylated tau in epileptic brain and chronic traumatic encephalopathy. Brain Research 2016;1630:225-40.A

Welch RD, Ayaz SI, Lewis LM, Unden J, Chen JY, Mika VH, Saville B, Tyndall JA, Nash M, Buki A, Barzo P, Hack D, Tortella FC, Schmid K, Hayes R, Vossough A, Sweriduk ST, Bazarian JJ. Ability of serum glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1, and S100B to differentiate normal and abnormal head CT findings in patients with suspected mild or moderate TBI. Journal of Neurotrauma. 2015 Ahead of Print, doi:10.1089/neu.2015.4149

Bernstein JPK, Mitchell LS, Bazarian JJ, Langfitt JT. The King-Devick Test: an indicator of longer-term cognitive effects post-concussion. Acta Neuropsychologica. 2015;13(3):

Undén L, Calcagnile O, Undén J, Reinstrup P, Bazarian J. Validation of the Scandinavian guidelines for initial management of minimal, mild and moderate traumatic brain injury in adults. BMC Medicine. 2015;13:292

Gill J, Merchant-Borna K, Lee H, Livingston WS, Olivera A, Cashion A, Wang D, Bazarian JJ. Sports-Related Concussions Result in Differential Expression of Inflammatory Nuclear Factor-KB Genes In Peripheral Blood during the acute and subacute periods. Journal of Head Trauma Rehabilitation 2015. Ahead of Print, doi: 10.1097/HTR.0000000000000191.

Wasserman EB, Abar B, Shah MN, Wasserman D and Bazarian JJ.

Concussions Are Associated With Decreased Batting Performance Among Major League Baseball Players. Published Online March 2015;43(5):1127-33 DOI: 10.1177/0363546515576130

 

Puvenna V, Brennan C, Shaw G, Yang C, Marchi N, Bazarian JJ, Merchant-Borna K, Janigro D.  Significance of ubiquitin carboxy-terminal hydrolase l1 elevations in athletes after sub-concussive head hits. PLoS One. 2014. 7;9(5):e96296.  PMC4012998.

 

Bazarian JJ, Zhu T, Zhong J, Janigro D, Rozen E, Roberts A, Javien H,  Merchant-Borna K, Abar B, Blackman EG. Persistent, long-term cerebral white matter changes after sports-related repetitive head impacts. PLOS ONE. 2014 Apr 16;9(4):e94734. PMC3989251

Puvenna V, Brennan C, Shaw G, Yang C, Marchi N, Bazarian JJ,  Merchant-Borna K, Janigro D. Significance of ubiquitin carboxy-terminal hydrolase l1 elevations in athletes after sub-concussive head hits. PLoS One. 2014 May 7;9(5):e96296.

Kiechle K, Bazarian JJ,  Merchant-Borna K, Stoecklein V,  Rozen E,  Blyth B, Huang JH, Dayawansa S,  Kanz K, Biberthaler P.    Subject-specific Increases in Serum S-100B Distinguish Sports-Related Concussion from Sports-Related Exertion. PLoS One. 2014 Jan 8;9. PMCID: PMC3885765.

Wunderle K, Hoeger K, Wasserman E, Bazarian JJ. Menstrual Phase as Predictor of Outcome after Mild Traumatic Brain Injury in Women. J Head Trauma Rehab Nov 2013. PMID: 24220566.

Marchi N, Bazarian JJ, Puvenna V, Janigro M, Ghosh C, Zhong J, Zhu T, Blackman E, Stewart D, Ellis J, Butler R, Janigro D. Consequences of repeated blood-brain barrier disruption in football players. PLOS One. 2013;8(3):e56805. PMCID: PMC3590196.

Bazarian JJ, Donnelly K, Peterson DR, Warner GC, Zhu T, Zhong T. The Relation between Post Traumatic Stress Disorder and Mild Traumatic Brain Injury Acquired During Operations Enduring Freedom and Iraqi Freedom: A DTI Study. Journal of Head Trauma Rehabilitation. 2013;28(1):1-12. PMID: 22647965.

Babcock L,  Byczkowski T, Wade SL, Ho M, MS, Bazarian JJInability of S100B to Predict Post-Concussion Syndrome in Children who Present to the Emergency Department with Mild Traumatic Brain Injury: A Brief Report Pediatric Emergency Care 2013;29(4):458-61. PMID: 23528506; PMCID: PMC3623559.

Babcock L, Byczkowski T, Wade S, Ho M, Mookerjee S, Bazarian JJPredicting Post-Concussion Syndrome After Mild Traumatic Brain Injury in Children who Present to the Emergency Department. JAMA Pediatrics. 2013;167(2):156-61.  PubMed PMID: 23247384.

Bazarian JJ, Blyth BJ, He H, Mookerjee S, Jones C, Keichle K, Moynihan R, Wojcik SM, Grant WD, Secreti LM, Triner W, Moscati R, Leinhart A, Ellis GL, Khan J. Classification Accuracy of Serum ApoA-I and S100B for the Diagnosis of Mild TBI and Prediction of Abnormal Initial Head CT Scan. J Neurotrauma 30:1747-1754. PMID: 23758329.

Slobounov S ,Bazarian JJ, Bigler E, Cantu R, Hallett M, Harbaugh R, Hovda D, Mayer AR, Nuwer MR, Kou Z, Lazzarino G, Papa L, Vagnozz R. Sport-Related Concussion: Ongoing Debate. Br J Sports Med.  2013; PMID: 23501836.

Bazarian JJ. Subject-Specific Changes in Brain White Matter on Diffusion Tensor Imaging After Sports-Related Concussion Magnetic Resonance Imaging. Magnetic Resonance Imaging. 2012;30:171-80.

Archive Publications

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Funding

Source Type Description
NIH/NICHD K24 Validation of Putative Serum of Axonal Damage After Mild TBI.
NFL Foundation Grant to examine changes in brain white matter after multiple sub-concussive head blows.
University of Rochester Provost's Multidisciplinary Award Foundation New Interdisciplinary Approach to Improve Diagnosis of TBI: Combining Physics with medical Imaging.
BrainScope Company, Inc. Industry Use of the BrainScope EEG for the identification and prognostication of ED patients with TBI.
BrainScope Company, Inc. Industry

Assessment of Head Injury in the ED: Clinical Validation of the BrainScope Ahead M-100 (B-AHEAD II Trial)

Banyan Biomarkers Industry

A prospective evaluation of biomarkers of mild, moderate and severe traumatic brain injury (ALERT)