Autoantibody screening for the prediction of outcome and neurodegeneration post-TBI

Dr Edward Needham, University of Cambridge

Traumatic brain injury (TBI) is a globally important disease, representing a leading cause of death and disability in young adults. It creates substantial personal, societal and economic burden. Despite significant advances in technology, there are few reliable early prognostic markers to help predict long-term outcomes. In addition to the damage directly caused by the acute injury, TBI triggers a state of progressive brain damage in around one third of patients. The cause of this ongoing damage is not understood, but persistent abnormal inflammation in the brain has been implicated. Whilst the intention of inflammation is to allow healing, in certain circumstances the immune system can attack healthy tissue causing damage (“autoimmunity”).

Small studies have demonstrated autoantibodies, a marker of autoimmunity, in around two thirds of patients following traumatic brain injury, and have suggested an association with subsequent worse outcome. The technology conventionally used to detect these antibodies is not practical for routine clinical use.

We will use a novel autoantibody detection technology to assess for autoimmunity to the brain following traumatic brain injury, and relate this to patients’ outcome, additionally focussing on the relationship between autoantibodies and ongoing brain damage. We will collect blood and (where possible) cerebrospinal fluid from patients following TBI, and look for autoantibodies to the brain. We will then correlate these changes with the most reliable prognostic tool currently available to see whether the presence of autoantibodies adds additional prognostic accuracy. In addition, we will assess the relationship with magnetic resonance imaging scan markers of ongoing brain damage and clinical outcome rating scales.

In the short-term, we hope that the use of this technology will provide additional information to aid early prognostication. In addition, clarifying the role of autoimmunity following traumatic brain injury would allow the targeting of treatments to optimise the effects of the immune system in this disease, with the hope of improving outcomes.