Science + Technology

Could standard treatment for traumatic brain injury be wrong?

NIH grant to support research on alternative 'fuels' for injured brain

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Traumatic brain injury— not heart disease, stroke or cancer —is thenumber onecause of death and disabilityin people under 45. Each year, some 1.5 million Americans, including soldiers, athletes,the elderly andchildren,sustain head injuries, and nearly half of them will be hospitalized and treated in an emergency room or intensive care unit.
But what if they are treated incorrectly?
The Brain Injury Research Center (BIRC) in the UCLA Department of Neurosurgery has been awarded a $4.2 million grant from the National Institutes of Health to researchnew ways to heal the brain after a traumatic brain injury, or TBI. Specifically, researcherswill be looking at how to best feed the brain the nutrients it needs to optimize recovery.
The standardthinking for many years has been thatafter a TBI, the brain lies in a docile state or coma and thus requires very little energy. But research from the BIRC now shows that the brain's response to trauma requires enormous amounts of energy.
"Many patients with a traumatic brain injury exhibit hyperglycemia — high blood sugar — by the time they arrive in the ER," said David Hovda, professor of neurosurgery and director of the BIRC. "So the standard protocol was to give the patient insulin to tightly control the levels of glucose that would take them to normal. For many regions of the injured brain, this may be the wrong thing to do."
In fact, the brain needs fuel to initiate the healing process — and not just glucose, Hovda suspects. Because they have found that the way glucose is used by the brain changes after a TBI, researchers believe other naturally used compounds, including pyruvate, beta-hydroxybutyrate, lactate and ketones, should be consideredin treatment. Hovda and his colleaguesthink thateach of these fuels may serve a different purpose, depending on the severity of the injury and whether the injured individual is an adult or adolescent. The goal, therefore, is to identify the optimal brain fuels for different age groups that will improve recovery.
"Our work is challenging because we're questioning a standard protocol," said Dr. Christopher Giza,UCLAassociate professor of neurosurgery and a co-investigator on the NIH grant. "If the brain is actually asking for fuel (glucose), that means that after trauma, Mother Nature is shifting gears and changing the chemistry of the brain. These concepts and constructs are what we're going to be examining closely."
"The majority of head injuries are called mild traumatic brain injuries," Hovda said. "But what we've discovered is the path of physiological consequences measured in severe head injuries also occurs in mild traumatic head injuries as well. So this research might just change what's put in the IV bag at the onset of treatment."
Overthe past 20 years, there have been more than75 clinical trials for traumatic brain injury, but none have resulted in a standard treatment for TBI. The currentgrant will have both a research and a clinical component: The research will look at the use of alternative fuels and how these fuels enter the brain and contribute to the healing process, while the clinicalaspect will test alternative fuels and examine the possible threat to recovery after TBI when hyperglycemia is stopped.
Interest in continuing researchon head trauma recovery is widespread and is supported by, among others, Major League Baseball, the National Football League, the World Boxing Council and the U.S. Department of Defense.
"We wish there was a cure for TBI," Hovda said."But for now all that's available is rehabilitation therapy. Patients diagnosed with epilepsy or depression have medications that may help. But as of now there is no cocktail remedy for TBI. Our hope is to change that."
The UCLA Brain Injury Research Center maintains a comprehensive basic and clinical scientific program in the field of traumatic brain injury. Its scientists conduct research into imaging, neurophysiology, molecular biology, modeling, and behavioral neuroscience in order to apply this knowledge toward understanding the neurobiology of human TBI.
For more news, visit the UCLA Newsroom.
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