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J Neurotrauma. 2016 Jan 15;33(2):215-25. doi: 10.1089/neu.2015.3949. Epub 2015 Sep 18.

Circulating Brain-Derived Neurotrophic Factor Has Diagnostic and Prognostic Value in Traumatic Brain Injury.

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1 Department of Emergency Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.
2 Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland.
3 Clinical Chemistry Laboratory, San Francisco General Hospital , San Francisco, California.
4 Department of Neurological Surgery, University of California San Francisco , San Francisco, California.
5 Department of Radiology, Johns Hopkins University School of Medicine , Baltimore, Maryland.
6 Department of Medicine, the Advanced Clinical Biosystems Research Institute , Cedars Sinai Medical Center, Los Angeles, California.
7 Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, Maryland.
8 The Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Investigators .
9 Department of Neurological Surgery, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
10 Seton Brain and Spine Institute , Austin, Texas.
11 Department of Rehabilitation Medicine, Mount Sinai School of Medicine , New York, New York.
12 Department of Neurosurgery, Antwerp University Hospital , Edegem, Belgium .
13 Department of Radiology and Biomedical Imaging University of California San Francisco , San Francisco, California.
14 Department of Public Health Center for Medical Decision Making Erasmas Medical Center , Rotterdam, the Netherlands .
15 Department of Psychology, University of Texas , Austin, Texas.


Brain-derived neurotrophic factor (BDNF) is important for neuronal survival and regeneration. We investigated the diagnostic and prognostic values of serum BDNF in traumatic brain injury (TBI). We examined serum BDNF in two independent cohorts of TBI cases presenting to the emergency departments (EDs) of the Johns Hopkins Hospital (JHH; n = 76) and San Francisco General Hospital (SFGH, n = 80), and a control group of JHH ED patients without TBI (n = 150). Findings were subsequently validated in the prospective, multi-center Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Pilot study (n = 159). We investigated the association between BDNF, glial fibrillary acidic protein (GFAP), and ubiquitin C-terminal hydrolase-L1 (UCH-L1) and recovery from TBI at 6 months in the TRACK-TBI Pilot cohort. Incomplete recovery was defined as having either post-concussive syndrome or a Glasgow Outcome Scale Extended score <8 at 6 months. Median day-of-injury BDNF concentrations (ng/mL) were lower among TBI cases (JHH TBI, 17.5 and SFGH TBI, 13.8) than in JHH controls (60.3; p = 0.0001). Among TRACK-TBI Pilot subjects, median BDNF concentrations (ng/mL) were higher in mild (8.3) than in moderate (4.3) or severe TBI (4.0; p = 0.004. In the TRACK-TBI cohort, the 75 (71.4%) subjects with very low BDNF values (i.e., <the 1st percentile for non-TBI controls, <14.2 ng/mL) had higher odds of incomplete recovery than those who did not have very low values (odds ratio, 4.0; 95% confidence interval [CI]: 1.5-11.0). The area under the receiver operator curve for discriminating complete and incomplete recovery was 0.65 (95% CI: 0.52-0.78) for BDNF, 0.61 (95% CI: 0.49-0.73) for GFAP, and 0.55 (95% CI: 0.43-0.66) for UCH-L1. The addition of GFAP/UCH-L1 to BDNF did not improve outcome prediction significantly. Day-of-injury serum BDNF is associated with TBI diagnosis and also provides 6-month prognostic information regarding recovery from TBI. Thus, day-of-injury BDNF values may aid in TBI risk stratification.


biomarkers; brain-derived neurotrophic factor; glial fibrillary acidic protein; traumatic brain injury; ubiquitin C-terminal hydrolase-L1

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