Cited by 1,045Traumatic Brain Injury and Neurovascular DisturbancesNeuroinflammation and Neurodegeneration MechanismsTraumatic Brain Injury Research

Inflammation and white matter degeneration persist for years after a single traumatic brain injury

Open access
Johnson, Victoria E., Stewart, Janice E., Begbie, Finn D., Trojanowski, John Q., Smith, Douglas H., Stewart, William·2013·Brain

Abstract

A single traumatic brain injury is associated with an increased risk of dementia and, in a proportion of patients surviving a year or more from injury, the development of hallmark Alzheimer's disease-like pathologies. However, the pathological processes linking traumatic brain injury and neurodegenerative disease remain poorly understood. Growing evidence supports a role for neuroinflammation in the development of Alzheimer's disease. In contrast, little is known about the neuroinflammatory response to brain injury and, in particular, its temporal dynamics and any potential role in neurodegeneration. Cases of traumatic brain injury with survivals ranging from 10 h to 47 years post injury (n = 52) and age-matched, uninjured control subjects (n = 44) were selected from the Glasgow Traumatic Brain Injury archive. From these, sections of the corpus callosum and adjacent parasaggital cortex were examined for microglial density and morphology, and for indices of white matter pathology and integrity. With survival of ≥3 months from injury, cases with traumatic brain injury frequently displayed extensive, densely packed, reactive microglia (CR3/43- and/or CD68-immunoreactive), a pathology not seen in control subjects or acutely injured cases. Of particular note, these reactive microglia were present in 28% of cases with survival of >1 year and up to 18 years post-trauma. In cases displaying this inflammatory pathology, evidence of ongoing white matter degradation could also be observed. Moreover, there was a 25% reduction in the corpus callosum thickness with survival >1 year post-injury. These data present striking evidence of persistent inflammation and ongoing white matter degeneration for many years after just a single traumatic brain injury in humans. Future studies to determine whether inflammation occurs in response to or, conversely, promotes white matter degeneration will be important. These findings may provide parallels for studying neurodegenerative disease, with traumatic brain injury patients serving as a model for longitudinal investigations, in particular with a view to identifying potential therapeutic interventions.

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  • Human studies report increased mRNA expression of microglial markers OX-6 and CD68 at 1 year post-injury.

    “These findings are consistent with human studies that report increased mRNA expression of microglial markers OX-6 and CD68 at 1 year post-injury (11)”

    From The Inflammatory Continuum of Traumatic Brain Injury and Alzheimer’s Disease (2018) · cites this paper as [11]

    The Activated microglia and Long-term survival sections report immunohistochemical staining for CR3/43 and CD68 in human TBI cases, including persistent CD68-reactive microglia. They do not report increased mRNA expression of OX-6 or CD68 at one year post-injury; the long-term findings concern protein staining and morphology, including cases 2–8 years after injury. Page numbers are not available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Several lines of evidence point to a relationship between single-incident TBI and AD.

    “Several lines of evidence point to a relationship between single-incident TBI and AD (10, 11).”
  • TBI is a biphasic injury: after the mechanical primary injury, a secondary dystrophic state produces long-term dysfunction including elevated neuroinflammation due to blood-brain barrier disruption, increased oxidative stress, and persistent changes in the microglial population.

    “TBI is a biphasic injury: after the mechanical primary injury, a secondary dystrophic state produces long-term dysfunction in the brain that includes elevated neuroinflammation as a result of blood-brain barrier disruption, increased oxidative stress, and persistent changes in the microglial population [100–106].”

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Authors
Johnson, V. E., Stewart, J. E., Begbie, F. D., Trojanowski, J. Q., Smith, D. H., & Stewart, W.
Affiliations
  • University of Pennsylvania (US)
  • Southern General Hospital (GB)
  • University of Glasgow (GB)
Venue
Brain
Published
2013-01
Volume
136
Issue
1
Pages
28-42
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
OpenAlex
W2035408187
Cited by
1,045
References
71
Citations by year
2026: 53 · 2025: 62 · 2024: 88 · 2023: 87 · 2022: 72 · 2021: 112 · 2020: 96 · 2019: 84 · 2018: 74 · 2017: 84 · 2016: 83 · 2015: 69 · 2014: 48 · 2013: 32 · 2012: 1
FWCI
49.07
Type
journal article
Language
en
Open access
Locations
  • Brain (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
Funders
  • University of Glasgow
  • National Institutes of Health
  • National Institute on Aging (AG038911, R03AG038911)
  • National Institute of Neurological Disorders and Stroke (NS-038104, R01NS038104)
Topics
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
traumatic brain injury, neuroinflammation, white matter degeneration, reactive microglia, corpus callosum, long-term survival, Alzheimer's disease, dementia risk, CD68, white matter integrity, neurodegeneration
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Axons, Brain, Brain Injuries, Child, Female, Humans, Inflammation, Male, Middle Aged, Nerve Degeneration, Nerve Fibers, Myelinated, Neurons, Microglia, Diffuse Axonal Injury

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