Circulating brain injury biomarkers have been studied extensively in adults, yet we have no clinically available biomarkers to acutely identify brain specific injury common in neonates, such as intraventricular hemorrhage (IVH) and neonatal hypoxic-ischemic encephalopathy (HIE), to follow therapeutic efficacy or evaluate new therapies in neonates at risk. Hurdles to adoption of brain injury biomarkers in the NICU have been the lack of normative data in the growing infant, effect of prematurity, relatively large sample volumes needed and no large studies with external validation. The overall goal of this proposal is to develop a multimarker circulating brain injury biomarker panel for neonatal IVH and HIE using well studied adult biomarkers, to provide a benchmark of therapeutic efficacy for current standard treatments and future investigational treatments, and to provide early prognostic information. The central hypothesis of this proposal is that circulating brain specific protein levels measured serially over days 0-7 of life in premature neonates and neonates with HIE will provide early injury detection, predict infants at risk for death or moderate-severe neurologic disability, predict therapeutic efficacy for therapeutic hypothermia, and serve as a basis for triaging neonates to appropriate new investigational therapies to decrease morbidity and improve outcomes. To examine our hypothesis we will utilize a novel multiplex panel of 4 brain specific proteins (BDNF, S100B, NSE and GFAP) and 4 brain injury related proteins (IL-1, IL-6, IL-8, VEGF) studied extensively in adults as biomarkers of brain injury, in training (Johns Hopkins Medicine, Baltimore, JHM) and external test (All Children?s Hospital JHM, St. Petersburg, FL) cohorts in the following Specific Aims: 1) Determine if circulating levels of brain injury biomarkers are dependent on gestational age using an existing cohort of longitudinal blood samples from premature and full term infants (N=400, 23-40 weeks gestation) admitted to the NICU without clinical brain injury to determine the effect of gestational age on baseline levels. 2) Determine in HIE if circulating brain injury biomarker levels during and after therapeutic hypothermia predict adverse outcomes including A) MRI abnormalities at 7-10 days and B) death or neurologic disability at 24 months. 3) Determine in IVH if circulating brain injury biomarker levels during the first 7 days of life in VLBW premature neonates are A) diagnostic for IVH, B) predict PVWMI brain injury at 6 weeks and C) neurologic disability at 24 months. Both of these aims will use concurrent IVH and HIE enrollment at JHM (training set) and ACH JHM (test set) for external validation. By focusing on a panel of blood brain barrier dependent and independent biomarker proteins studied exhaustively in adults, in a innovative and highly sensitive multiplex Pharma grade format, using large training and test cohorts we will confirm generalizability and efficacy in neonatal brain injury.

Public Health Relevance

In response to (PAR-13-296) ?Biomarkers: Bridging Pediatric and Adult Therapeutics? we will use a novel multiplex ELISA of the well studied adult brain injury biomarkers BDNF, S100B, NSE, GFAP, IL 1, 6, 8 and VEGF to determine gestational circulating expression in neonates from 23-40 weeks gestation (Aim 1), using a training and external test cohorts determine whether these adult biomarkers can predict imaging and 24 month neurodevelopmental outcomes in full term neonates with hypoxic ischemic encephalopathy or very low birthweight premature infants with intraventricular hemorrhage. The results of this study will deliver new, diagnostic and prognostic measures of neonatal brain injury that could support future intervention trials.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
1R01HD086058-01A1
Application #
9176142
Study Section
Special Emphasis Panel (ZRG1-SBIB-V (82)S)
Program Officer
Giacoia, George
Project Start
2016-09-01
Project End
2021-08-31
Budget Start
2016-09-01
Budget End
2017-08-31
Support Year
1
Fiscal Year
2016
Total Cost
$656,559
Indirect Cost
$202,743
Name
Johns Hopkins University
Department
Pediatrics
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21205
Graham, Ernest M; Everett, Allen D; Delpech, Jean-Christophe et al. (2018) Blood biomarkers for evaluation of perinatal encephalopathy: state of the art. Curr Opin Pediatr 30:199-203
Shores, Darla R; Everett, Allen D (2018) Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 193:14-20.e31
Salas, Jacqueline; Reddy, Nihaal; Orru, Emanuele et al. (2018) The Role of Diffusion Tensor Imaging in Detecting Hippocampal Injury Following Neonatal Hypoxic-Ischemic Encephalopathy. J Neuroimaging :
Lee, Jennifer K; Poretti, Andrea; Perin, Jamie et al. (2017) Optimizing Cerebral Autoregulation May Decrease Neonatal Regional Hypoxic-Ischemic Brain Injury. Dev Neurosci 39:248-256
Jan, Saber; Northington, Frances J; Parkinson, Charlamaine M et al. (2017) EEG Monitoring Technique Influences the Management of Hypoxic-Ischemic Seizures in Neonates Undergoing Therapeutic Hypothermia. Dev Neurosci 39:82-88
Lemmon, Monica E; Wagner, Matthias W; Bosemani, Thangamadhan et al. (2017) Diffusion Tensor Imaging Detects Occult Cerebellar Injury in Severe Neonatal Hypoxic-Ischemic Encephalopathy. Dev Neurosci 39:207-214
Lei, Jun; Paules, Cristina; Nigrini, Elisabeth et al. (2017) Umbilical Cord Blood NOS1 as a Potential Biomarker of Neonatal Encephalopathy. Front Pediatr 5:112
Lee, J K; Perin, J; Parkinson, C et al. (2017) Relationships between cerebral autoregulation and markers of kidney and liver injury in neonatal encephalopathy and therapeutic hypothermia. J Perinatol 37:938-942
Diaz, Johana; Abiola, Suleiman; Kim, Nancy et al. (2017) Therapeutic Hypothermia Provides Variable Protection against Behavioral Deficits after Neonatal Hypoxia-Ischemia: A Potential Role for Brain-Derived Neurotrophic Factor. Dev Neurosci 39:257-272
Adami, Rebecca R; Grundy, Maureen E; Poretti, Andrea et al. (2016) Distinguishing Arterial Ischemic Stroke From Hypoxic-Ischemic Encephalopathy in the Neonate at Birth. Obstet Gynecol 128:704-12