Gaps in mTBI Research
TBI due to exposure to explosive blasts (mostly related to IEDs) is
responsible for over 70% of the combat casualties associated with Operation
Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New
Dawn (OND) [3,4]. While most of these TBIs are classified as mild, they can
have disabling long-term consequences. Mild TBI (mTBI) is widely recognized
as the signature injury of modern warfare, and yet little is known about
its acute effects on the brain or its long-term consequences, particularly
in individuals who have suffered multiple mTBIs. With the current practice
of repeated redeployment, the opportunities for Service Members to
experience multiple TBIs increase dramatically.
While much work has been done to study TBI in animal model systems, the
specific details of the neuropathological changes and the impact of trauma
from exposure to IED blast waves on the human brain remains unknown.
Moreover, the repair responses of the brain to these injuries and their
long-term consequences are similarly unclear.
The primary reason for this major gap in knowledge has been the lack of
available brain specimens for morphologic and molecular study derived from
deceased active or returned combatants who suffered mTBI. Access to brain
specimens that will be collected and made available to researchers through
the Core is needed to develop and advance methods for the diagnosis,
treatment, and prevention of mTBI and its long-term effects
Neuropathology Core, Boston VA
The Neuropathology Core, VA Boston, will recruit as many VA brain donors as
possible, casting a wide net aimed at acute and chronic neurotrauma, single
and multiple TBI, mild to severe TBI, and TBI from many possible sources
including blast injury, concussion, motor vehicle accidents, sports-related
injuries, and falls; however, we will emphasize military-related blast and
concussive injury in OEF/OIF/OND Veterans in our recruitment.
The Core will build on the experience and procedures of the Boston
University Alzheimer's Disease Center (BUADC) Brain Bank and the CTE Center
Brain Bank (VA-BU-SLI CTE Brain Bank), which collectively house over 1200
brain specimens, including over 350 brain and spinal cord specimens from
civilians and Veterans with TBI. Additionally, the Core will build on the
brain banking experience developed at VA Boston for the VA ALS brain bank,
the VA Gulf War brain bank and most recently, the VA PTSD brain bank. The
harvesting, neuropathological characterization, storage and distribution of
brain and other central nervous system (CNS) tissue will be precisely
standardized using state-of-the-art techniques. A uniform dataset of
neuropathological findings will be determined on each case and entered into
a privacy-protected database. The collection of brain, spinal cord, and eye
tissue from a broad range of traumatic injuries and the uniform dataset
will facilitate statistical analysis through wide-ranging TBI parameters
for correlation with military history, medical records, and clinical signs
1. Obtain brain specimens on all cases referred to the brain bank among
those enrolled in CENC studies who die and for whom consent for brain
donation is provided.
2. Accession the brain specimen derived from any Veteran who had been
deployed in OIF, OEF, or OND, who dies and the next-of-kin requests brain
donation for research studies of TBI.
3. Dissect and preserve the brain and CNS tissues using standard protocol
to maximize their use for TBI research.
4. Perform detailed neuropathological evaluations of all accessioned brain
specimens and issue a complete diagnostic neuropathology report.
5. Document the extent and distribution of relevant pathology present
within each brain specimen.
6. Make tissue specimens available to qualified researchers engaged in
7. Maintain permanently all pertinent specimen-related data and
neuropathological results in a manner accessible to all investigators
within the Consortium, as well as more broadly to other qualified
Ann McKee, MD, Investigator, Neuropathology Core Leader; firstname.lastname@example.org