More than 40 million people show up in emergency rooms and health care clinics in the United States each year with a variety of serious injuries. Of these, approximately 2.5 million are traumatic brain injuries (TBI), according to the Centers for Disease Control and Prevention. Fortunately, the majority of TBI patients survive their injuries, although symptom burden remains high and disabilities may persist for years or decades after initial injury. Unlike the majority of other injuries, brain injuries can potentially affect all aspects of an individual’s life, including cognition, personality, and the ability to return to normal roles.
Now at the UT Austin School of Nursing, research is underway to improve traumatic brain injury treatment and recovery by developing precision care based on an individual’s genetic makeup and circulating levels of proteins found in the blood after TBI.
“For a long time, we didn’t think neurological injuries would have a genetic component that could affect treatment response or the recovery trajectory,” said Nico Osier, PhD, RN and assistant professor at the School of Nursing and Dell Medical School. “Using objective genetic and protein markers, I’m attempting to explain differences in symptoms and outcomes and build evidence to support precision care initiatives to inform care and education to TBI patients. The ultimate goal is to improve recovery and reduce long-term disability after brain trauma.”
Precision health care is an exciting emerging field that experts believe will predict with more accuracy how well a disorder will react to a treatment so that clinicians can tailor care to the individual characteristics of each patient.
“We need to quit trying to treat brain injury as if it were a single homogenous condition where everyone looks the same,” Osier said. “Genes are likely a big factor in determining the right care. Identifying biomarkers or gene variants predictive of good or bad recovery can help with TBI prognosis and selection of the correct types and intensities of therapies needed to improve outcomes.
“The sooner we can identify the molecular difference between those TBI patients who tend to do better and those who are at high risk of developing post-traumatic stress disorder and other severe psychological symptoms, the sooner we’ll be able to route them into targeted risk reduction programs or specific treatment for a potentially better outcome.”
The exact brain changes that lead to neurological problems after brain injury are not completely understood. Osier acknowledges that researchers still have a lot to learn about how brain development may be altered after an injury and how the developing brain recovers from an injury. She hopes this pediatric brain injury study will advance that knowledge.
“Pediatric TBI is even less studied than adult, even though a lot of children suffer traumatic brain injuries,” Osier said. “Understanding the pathophysiological mechanisms specific to both children and adults may maximize our ability to treat TBI. In some cases, it could even be the difference between life and death.”
In two currently funded studies, Osier examines blood and saliva samples from TBI patients to determine which genetic and protein markers can be used to reliably predict good or bad recovery outcomes. From this knowledge, she believes that health care providers could prioritize the management of care.
“At this time, there are no FDA-approved therapies for TBI. This research could lead to therapies that are the difference between experiencing many years of suffering and pain or returning to pre-injury functioning,” she said. “Better recovery outcomes will also positively affect family members, who generally are responsible for caring for TBI patients.”
Osier’s latest study Exploring Blood and Saliva Biomarkers Predictive of Symptoms Over 6 Months Following Pediatric TBI: A Feasibility Study builds on her past work with adults but focuses on children. She and her lab team are currently recruiting children who present with closed head wounds at a local children’s hospital emergency department.
“The challenge is to find children without prior brain injuries who have been diagnosed with an injury within a 24-hour window,” Osier said. “The hospital has given us site approval to screen admissions to the emergency department, which means we have eyes on the charts around the clock. As an assistant professor I wear many hats (researcher, teacher, administrator), so I cannot watch the charts all day every day. Thankfully, I have a team of devoted undergraduates who help me so our recruitment is going well.
“So far, we’ve enrolled 33 kids. Most studies have a 50 percent or lower rate of parents agreeing to enroll their children. Ours is currently at 65 percent.”
Once the team determines that a child has been admitted with a brain injury, they go to the hospital to approach the parents, obtain consent/assent from interested families, and request a blood draw order from the doctor to be completed by a nurse.
“We provide everything necessary for blood to be drawn so that the hospital assumes no extra costs on our behalf,” Osier said. “And we’re careful to ask the nurses to do the draw at their convenience. Afterwards, we process the blood ourselves so as not to burden the hospital laboratory.”
The rapid response required to successfully enroll participants has caused the lab team to grow from around 10 to 60 students. One of them is Stephany Kim, a recent UCLA graduate with a degree in physiology and Russian. She described how the various students from all backgrounds and all disciplines manage to work seamlessly in approaching the clinical staff and parents during a stressful time.
“Team members need to be able to communicate effectively with both parents and the clinical staff in order to get background information and a blood draw,” she said. “The student nurses on the team have been very helpful in demonstrating how to approach a hypothetical patient and get consent.”
Osier credits the lab’s success to this sort of coaching and to their adopted philosophy of kaizen, a Japanese term for continual growth improvement that depends on all members of the team.
“The lab team is encouraged to make suggestions they think will improve how we do things,” she said. “They know they have ‘buy in’ with the lab and that makes them want to make our processes even better.”