Andrew Fisher

Chronic Traumatic Encephalopathy in Blast-Exposed Military Veterans and a Blast Neurotrauma Mouse Model

Blast exposure is associated with chronic traumatic encephalopathy, impaired neuronal function, and persistent cognitive deficits in blast-exposed military veterans and experimental animals. Blast Brain: An Invisible Injury Revealed Traumatic brain injury (TBI) is the “signature” injury of the conflicts in Afghanistan and Iraq and is associated with psychiatric symptoms and long-term cognitive disability. Recent estimates indicate that TBI may affect 20% of the 2.3 million U.S. servicemen and women deployed since 2001. Chronic traumatic encephalopathy (CTE), a tau protein–linked neurodegenerative disorder reported in athletes with multiple concussions, shares clinical features with TBI in military personnel exposed to explosive blast. However, the connection between TBI and CTE has not been explored in depth. In a new study, Goldstein et al. investigate this connection in the first case series of postmortem brains from U.S. military veterans with blast exposure and/or concussive injury. They report evidence for CTE neuropathology in the military veteran brains that is similar to that observed in the brains of young amateur American football players and a professional wrestler. The investigators developed a mouse model of blast neurotrauma that mimics typical blast conditions associated with military blast injury and discovered that blast-exposed mice also demonstrate CTE neuropathology, including tau protein hyperphosphorylation, myelinated axonopathy, microvascular damage, chronic neuroinflammation, and neurodegeneration. Surprisingly, blast-exposed mice developed CTE neuropathology within 2 weeks after exposure to a single blast. In addition, the neuropathology was accompanied by functional deficits, including slowed axonal conduction, reduced activity-dependent long-term synaptic plasticity, and impaired spatial learning and memory that persisted for 1 month after exposure to a single blast. The investigators then showed that blast winds with velocities of more than 330 miles/hour—greater than the most intense wind gust ever recorded on earth—induced oscillating head acceleration of sufficient intensity to injure the brain. The researchers then demonstrated that blast-induced learning and memory deficits in the mice were reduced by immobilizing the head during blast exposure. These findings provide a direct connection between blast TBI and CTE and indicate a primary role for blast wind–induced head acceleration in blast-related neurotrauma and its aftermath. This study also validates a new blast neurotrauma mouse model that will be useful for developing new diagnostics, therapeutics, and rehabilitative strategies for treating blast-related TBI and CTE. Blast exposure is associated with traumatic brain injury (TBI), neuropsychiatric symptoms, and long-term cognitive disability. We examined a case series of postmortem brains from U.S. military veterans exposed to blast and/or concussive injury. We found evidence of chronic traumatic encephalopathy (CTE), a tau protein–linked neurodegenerative disease, that was similar to the CTE neuropathology observed in young amateur American football players and a professional wrestler with histories of concussive injuries. We developed a blast neurotrauma mouse model that recapitulated CTE-linked neuropathology in wild-type C57BL/6 mice 2 weeks after exposure to a single blast. Blast-exposed mice demonstrated phosphorylated tauopathy, myelinated axonopathy, microvasculopathy, chronic neuroinflammation, and neurodegeneration in the absence of macroscopic tissue damage or hemorrhage. Blast exposure induced persistent hippocampal-dependent learning and memory deficits that persisted for at least 1 month and correlated with impaired axonal conduction and defective activity-dependent long-term potentiation of synaptic transmission. Intracerebral pressure recordings demonstrated that shock waves traversed the mouse brain with minimal change and without thoracic contributions. Kinematic analysis revealed blast-induced head oscillation at accelerations sufficient to cause brain injury. Head immobilization during blast exposure prevented blast-induced learning and memory deficits. The contribution of blast wind to injurious head acceleration may be a primary injury mechanism leading to blast-related TBI and CTE. These results identify common pathogenic determinants leading to CTE in blast-exposed military veterans and head-injured athletes and additionally provide mechanistic evidence linking blast exposure to persistent impairments in neurophysiological function, learning, and memory.

An Official American Thoracic Society/European Respiratory Society Statement: Research questions in chronic obstructive pulmonary disease

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this Official American Thoracic Society (ATS)/European Respiratory Society (ERS) Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. METHODS Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarized, and then salient knowledge gaps were identified. RESULTS Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. CONCLUSIONS Great strides have been made in the diagnosis, assessment, and management of COPD as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS Research Statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centered outcomes.

Concussion, microvascular injury, and early tauopathy in young athletes after impact head injury and an impact concussion mouse model

The mechanisms underpinning concussion, traumatic brain injury (TBI) and chronic traumatic encephalopathy (CTE) are poorly understood. Using neuropathological analyses of brains from teenage athletes, a new mouse model of concussive impact injury, and computational simulations, Tagge et al. show that head injuries can induce TBI and early CTE pathologies independent of concussion.

Considerations for Experimental Animal Models of Concussion, Traumatic Brain Injury, and Chronic Traumatic Encephalopathy—These Matters Matter

Animal models of concussion, traumatic brain injury (TBI), and chronic traumatic encephalopathy (CTE) are widely available and routinely deployed in laboratories around the world. Effective animal modeling requires careful consideration of four basic principles. First, animal model use must be guided by clarity of definitions regarding the human disease or condition being modeled. Concussion, TBI, and CTE represent distinct clinical entities that require clear differentiation: concussion is a neurological syndrome, TBI is a neurological event, and CTE is a neurological disease. While these conditions are all associated with head injury, the pathophysiology, clinical course, and medical management of each are distinct. Investigators who use animal models of these conditions must take into account these clinical distinctions to avoid misinterpretation of results and category mistakes. Second, model selection must be grounded by clarity of purpose with respect to experimental questions and frame of reference of the investigation. Distinguishing injury context (“inputs”) from injury consequences (“outputs”) may be helpful during animal model selection, experimental design and execution, and interpretation of results. Vigilance is required to rout out, or rigorously control for, model artifacts with potential to interfere with primary endpoints. The widespread use of anesthetics in many animal models illustrates the many ways that model artifacts can confound preclinical results. Third, concordance between key features of the animal model and the human disease or condition being modeled is required to confirm model biofidelity. Fourth, experimental results observed in animals must be confirmed in human subjects for model validation. Adherence to these principles serves as a bulwark against flawed interpretation of results, study replication failure, and confusion in the field. Implementing these principles will advance basic science discovery and accelerate clinical translation to benefit people affected by concussion, TBI, and CTE.

CONCUSSION, MICROVASCULAR INJURY, AND EARLY TAUOPATHY IN YOUNG ATHLETES AFTER IMPACT HEAD INJURY AND AN IMPACT CONCUSSION MOUSE MODEL

tauopathy in young athletes after impact head injury and an impact concussion mouse model 5 Chad A. Tagge,* Andrew M. Fisher,* Olga V. Minaeva,* Amanda GaudreauBalderrama, Juliet A. Moncaster, Xiao-Lei Zhang, Mark W. Wojnarowicz, Noel Casey, Haiyan Lu, Olga N. Kokiko-Cochran, Sudad Saman, Maria Ericsson, Kristen D. Onos, Ronel Veksler, Vladimir V. Senatorov, Jr, Asami Kondo, Xiao Z. Zhou, Omid Miry, Linnea R. Vose, Katisha R. Gopaul, Chirag Upreti, 10 Christopher J. Nowinski, Robert C. Cantu, Victor E. Alvarez, Audrey M. Hildebrandt, Erich S. Franz, Janusz Konrad, James A. Hamilton, Ning Hua, Yorghos Tripodis, Andrew T. Anderson, Gareth R. Howell, Daniela Kaufer, Garth F. Hall, Kun P. Lu, Richard M. Ransohoff,7,z Robin O. Cleveland, Neil W. Kowall, Thor D. Stein, Bruce T. Lamb, Bertrand R. Huber, 15 William C. Moss, Alon Friedman, Patric K. Stanton, Ann C. McKee, Lee E. Goldstein

Mechanistic pathobiology of acute concussion, traumatic brain injury, and chronic traumatic encephalopathy in mouse models of blast neurotrauma and impact concussion

(active form), while had no effect on the level of Tyrosine-307phosphorylated PP-2A. Unexpectedly, 5-HT1A agonist 8-OHDPAT did not decrease forskolin-induced tau hyperphophorylation. Conclusions:Escitalopram could protect forskolin-induced tau hyperphosphorylation at multiple AD-related sites, and the mechanism involves inactivation of GSK-3b. Our findings suggest that escitalopram could be a promising therapeutic target for AD-like tau hyperphosphorylation, this may support a potential effective role of antidepressants, at least of the SSRI class, in the prevention of dementia associated with depression in patients.

Metallomic imaging mass and optical spectrometry (MIMOS) of the murine and human eye and brain in Alzheimer's disease and normal aging

correlation using conventional and advanced mri imaging techniques in differentiating the subtypes of progressive supranuclear palsy (PSP) i.e psp-p and psp richardson subtypes. Methods: This was a prospective study comprising of 24 patients of PSP (psp P 1⁄4 11 and psp-rs1⁄4 13) and 26 matched healthy controls. routine mri imaging and planimetry were used to diffrentiate.VBM analysis for both gray matter with t1 weighted image and white matter using DTI was performed.advanced TBSS analysis was also perfrmed and Fractionalanisotropy, mean diffusivity (MD), axial diffusivity, andradial diffusivity (RD) changes were studied in theWM of these PSP patients to identify relative severity of WM changes as well as identify spatial distribution of the differences. Clinicoradiological correlation was done to determine the strength of correlation between WM abnormalities.minerlarisation was also evaluated used r2 relaxometry. Results: The frontoparietal cerebral WM, thalamus, midbrain tectum,superior cerebellar peduncle, and cerebellar WM showed significant abnomality. Compared to PSP-P, the patients of PSP-RS had more spatial abnormalities localized to the frontal WM. Conclusions: PSP-RS showed more severe white matter abnormality compared to the PSP-P subtype.