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2016 ; 124
(3
): 675-86
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Structural and biochemical abnormalities in the absence of acute deficits in mild
primary blast-induced head trauma
#MMPMID26295915
Walls MK
; Race N
; Zheng L
; Vega-Alvarez SM
; Acosta G
; Park J
; Shi R
J Neurosurg
2016[Mar]; 124
(3
): 675-86
PMID26295915
show ga
OBJECTIVE: Blast-induced neurotrauma (BINT), if not fatal, is nonetheless
potentially crippling. It can produce a wide array of acute symptoms in
moderate-to-severe exposures, but mild BINT (mBINT) is characterized by the
distinct absence of acute clinical abnormalities. The lack of observable
indications for mBINT is particularly alarming, as these injuries have been
linked to severe long-term psychiatric and degenerative neurological dysfunction.
Although the long-term sequelae of BINT are extensively documented, the
underlying mechanisms of injury remain poorly understood, impeding the
development of diagnostic and treatment strategies. The primary goal of this
research was to recapitulate primary mBINT in rodents in order to facilitate
well-controlled, long-term investigations of blast-induced pathological
neurological sequelae and identify potential mechanisms by which ongoing damage
may occur postinjury. METHODS: A validated, open-ended shock tube model was used
to deliver blast overpressure (150 kPa) to anesthetized rats with body shielding
and head fixation, simulating the protective effects of military-grade body armor
and isolating a shock wave injury from confounding systemic injury responses,
head acceleration, and other elements of explosive events. Evans Blue-labeled
albumin was used to visualize blood-brain barrier (BBB) compromise at 4 hours
postinjury. Iba1 staining was used to visualize activated microglia and
infiltrating macrophages in areas of peak BBB compromise. Acrolein, a potent
posttraumatic neurotoxin, was quantified in brain tissue by immunoblotting and in
urine through liquid chromatography with tandem mass spectrometry at 1, 2, 3, and
5 days postinjury. Locomotor behavior, motor performance, and short-term memory
were assessed with open field, rotarod, and novel object recognition (NOR)
paradigms at 24 and 48 hours after the blast. RESULTS: Average speed, maximum
speed, and distance traveled in an open-field exploration paradigm did not show
significant differences in performance between sham-injured and mBINT rats.
Likewise, rats with mBINT did not exhibit deficits in maximum revolutions per
minute or total run time in a rotarod paradigm. Short-term memory was also
unaffected by mBINT in an NOR paradigm. Despite lacking observable motor or
cognitive deficits in the acute term, blast-injured rats displayed brain acrolein
levels that were significantly elevated for at least 5 days, and acrolein's
glutathione-reduced metabolite, 3-HPMA, was present in urine for 2 days after
injury. Additionally, mBINT brain tissue demonstrated BBB damage 4 hours
postinjury and colocalized neuroinflammatory changes 24 hours postinjury.
CONCLUSIONS: This model highlights mBINT's potential for underlying detrimental
physical and biochemical alterations despite the lack of apparent acute symptoms
and, by recapitulating the human condition, represents an avenue for further
examining the pathophysiology of mBINT. The sustained upregulation of acrolein
for days after injury suggests that acrolein may be an upstream player
potentiating ongoing postinjury damage and neuroinflammation. Ultimately,
continued research with this model may lead to diagnostic and treatment
mechanisms capable of preventing or reducing the severity of long-term
neurological dysfunction following mBINT.