Although the term chronic traumatic encephalopathy (CTE) has only recently entered the research and common vernacular, the neuropsychiatric sequelae have been recognized for decades as dementia pugilistica (DP) in some individuals with careers in boxing. Yet, despite the intense new interest in `CTE', the number of reported cases has been surprisingly limited and there are no validated neuropathological diagnostic criteria to define it as a distinct disease entity. Notwithstanding this, there is a widely held, abeit unfounded, perception that repetitive TBI (rTBI) alone culminates in `CTE' and that `CTE' is primarily characterized by a unique tau pathology. However, multiple neuropathological features have been reported for DP/CTE beyond tau pathologies, including brain atrophy, amyloid-? plaques, TDP-43 pathologies and neuroinflammation. Furthermore, it is now recognized that almost all of these pathologies are observed in a proportion of cases years after just one moderate to severe single TBI (sTBI). As TBI-associated neurodegeneration has become a major health concern, there is a clear and pressing need to develop robust operational neuropathological criteria for diagnosis, which will, in turn, be critical to the success of all fuure mechanistic, diagnostic and interventional studies. Towards this end, we have assembled an international, multidisciplinary team of experts who provide unparalleled experience in both the study of long-term neurodegeneration after TBI, and the development of optimized assessment of common neuropathological diseases including Alzheimer's disease (AD). Through our team members, we have custodial access to the only comprehensive TBI brain archives in the US and UK that include both sTBI and rTBI cases as well as ~1500 longitudinally followed and extensively characterized autopsy confirmed cases of AD and related disorders for comparison. For our primary Aim 1, we will use a standardized approach successfully applied to AD, to generate baseline diagnostic neuropathological criteria using existing post-mortem material of sTBI and rTBI.
In Aim 2 we will pursue biochemical, and genetic studies to explore potential associations with neuropathological outcomes from chronic TBI.
In Aim 3 we will explore the temporal course of neuroinflammation to examine its potential role in progressive neurodegeneration following TBI. Finally, in Aim 4 will secure a networked archive of the extensive resources of data and biospecimens generated in Aims 1-3 for wider access across the research community.

Public Health Relevance

Although neurodegeneration in chronic survivors of single and repetitive traumatic brain injury (TBI) has become a major health concern, currently there are no validated clinical or neuropathological diagnostic criteria that define it as a distinct disease entity. In addition, the mechanisms of progressive TBI-associated neurodegeneration are unknown. Therefore, we propose to develop baseline operational neuropathological, criteria to diagnose this disorder and define its relationship with other well-known neurodegenerative diseases such as AD and related disorders. In addition we will examine the potential mechanistic basis of TBI induced neurodegeneration by examining the temporal course and potential contribution of inflammatory changes following TBI cases. The achievement of the aims of this application could transform current clinical and mechanistic understanding of the long term consequences of sTBI and rTBI as well reveal new avenues for developing diagnostics and therapeutics for TBI. Understanding of the long term consequences of sTBI and rTBI as well reveal new avenues for developing diagnostics and therapeutics for TBI.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Bellgowan, Patrick S F
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University of Pennsylvania
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