Study shows modified blood thinner reduces the impact of traumatic brain injury in miceSeptember 13, 2017
PHILADELPHIA-- A chemically modified version of the common blood thinner heparin may be the first promising method of preventing the harmful cascade of destruction to brain tissue that commonly follows traumatic brain injury (TBI), according to new research findings. Though there is currently no drug therapy to prevent the repercussions that can occur in the days and weeks after TBI, researchers at the Perelman School of Medicine at the University of Pennsylvania showed that mice treated with a modified version of heparin with very low coagulant activity (known as 2-O, 3-O desulfated heparin, ODSH or CX-01) had less brain swelling and inflammation, and less evidence of brain damage, compared to mice that received saline. Results of the study will be presented in Baltimore this week at the annual meeting of the American Association for the Surgery of Trauma.
Traumatic brain injury (TBI), which accounts for more than 2.5 million emergency room visits every year in the United States, often triggers inflammation and other harmful processes in the brain, causing further damage and cognitive deterioration long after the initial injury. Ordinary heparin has anti-inflammatory properties and has been shown to protect various organs after injury, but its blood-thinning effect makes it problematic for use in injured brains, where a bleed could be fatal. ODSH has only a small fraction of heparin's anticoagulant effect, and thus seemed a good bet as a safer alternative. Prior studies in animal models of heart attack, stroke, and pneumonia have found evidence that ODSH has a heparin-like anti-inflammatory effect, without the risk of hemorrhages.
"When I first presented a heparin-TBI study, experts in treating these injuries laughed, and said 'that'll be the day, when we give heparin to TBI patients'," said study senior author Jose M. Pascual, MD, PhD, an associate professor of surgery at Penn Medicine. "But, there's an exciting possibility here that the molecule ODSH retains heparin's benefits in reducing swelling and inflammation but without the anticoagulant activity that could cause bleeding."
In the study, Pascual and colleagues treated mice for 48 hours after experimental TBI with ODSH or, as a control, ordinary saline. Immediately following the two days of treatment, the animals that had received ODSH showed less evidence of white blood cell infiltration into the brain via cerebral vessels, less evidence of cerebral vessel leakage, less brain swelling, and less evidence of brain damage on a standard neurological test, compared to the control mice.
In a cognitive test called the Morris Water Maze, 17 days after their TBI, the ODSH-treated animals also performed markedly better than the controls, doing on average almost as well as mice who had not experienced a TBI.
"We saw no evidence of bleeding," Pascual said.
Pascual and colleagues at Penn Medicine are now hoping to set up a clinical trial of ODSH to test its effectiveness in people with TBI.
Heparin has been in clinical use since the 1930s as an anticoagulant. But it is a natural molecule--a carbohydrate secreted by white blood cells called mast cells and basophils--and has multiple biological effects, including a reduction of inflammation after injury. In a study published last year, Pascual and colleagues found evidence that ordinary heparin protects mice from the inflammation, swelling and cognitive deficits caused by experimental TBI.
The company that produces ODSH, Cantex Pharmaceuticals Inc, is currently testing ODSH in patients with blood cancers, specifically, acute myeloid leukemia and myelodysplastic syndrome.
"The company already has safety data on ODSH from those trials in cancer patients, so we're hoping that for TBI we can go straight to a phase II study of the drug's effectiveness and optimal dose," Pascual said.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community.
University of Pennsylvania School of Medicine
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Related Traumatic Brain Injury Reading:
The Traumatized Brain: A Family Guide to Understanding Mood, Memory, and Behavior after Brain Injury (A Johns Hopkins Press Health Book)
by Vani Rao (Author), Sandeep Vaishnavi (Author), Peter V. Rabins (Foreword)
A traumatic brain injury is a life-changing event, affecting an individual’s lifestyle, ability to work, relationships―even personality. Whatever caused it―car crash, work accident, sports injury, domestic violence, combat―a severe blow to the head results in acute and, often, lasting symptoms. People with brain injury benefit from understanding, patience, and assistance in recovering their bearings and functioning to their full abilities.
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Manual of Traumatic Brain Injury: Assessment and Management
by Felise Zollman MD FAAN FAAMA (Editor)
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Life With a Traumatic Brain Injury: Finding the Road Back to Normal
by Amy Zellmer (Author)
Winner of the Midwest Book Awards in the "Health" category receiving a silver medal in May 2016.In February 2014 Amy Zellmer slipped on a patch of ice and fell, forcibly landing on the back of her skull. The impact briefly knocked her out, and when she started to get up, she immediately knew something was very wrong.Amy had suffered a Traumatic Brain Injury (TBI) and was about to start a journey unlike anything she had ever experienced. Her life had changed in literally a blink of the eye.
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by Diane Roberts Stoler (Author), Barbara Albers Hill (Author)
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by Mark J. Ashley (Editor), David A. Hovda (Editor)
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A blow to the head or the dramatic acceleration and deceleration that occur in a serious car crash can cause a traumatic injury to the brain. At their most serious, these events are critical and life threatening, but even a mild incident can cause problems with memory, communication, and mental focus. What’s worse, this kind of cognitive function loss often causes other psychological symptoms like depression and low self-esteem. Fortunately, there are things anyone can do to recover from a mild traumatic brain injury, get back lost cognitive ability, and restore a healthy frame of... View Details
In the last decade neuroscience has matured at a remarkable pace, shedding a far more exacting light on mechanisms of neurophysiology, pathophysiology of injury, neuroendocrinology, neuro-immunology, neuroplasticity, neuropharmacology and neurodegenerative processes. Individuals with acquired brain injury are treated earlier and now achieve far better recovery than in the past.
The fourth edition of this text constitutes a continuation of 20 years of coverage of traumatic brain injury, and broadens the discussion of acquired brain injury. Within TBI, the paradigm shift from an... View Details
Research into the rehabilitation of individuals following Traumatic Brain Injury (TBI) in the past 15 years has resulted in greater understanding of the condition. The second edition of this book provides an updated guide for health professionals working with individuals recovering from TBI.
Its uniquely clinical focus provides both comprehensive background information, and practical strategies for dealing with common problems with thinking, memory, communication, behaviour and emotional adjustment in both adults and children. The book addresses a wide range of challenges,... View Details