The Role of Allopregnanolone Levels in Traumatic Brain Injury in Children and Adults and the Correlation of Its Levels with Computerized Tomography Images of the BrainFunding This study was supported by Süleyman Demirel University Scientific Research Projects Coordination Unit (Project no: 4647-TU1–16).
Aim Allopregnanolone (AP) is a steroid of progesterone origin and it can readily pass through the blood–brain barrier. The aim of this study was to determine the AP levels occurring after head trauma in children and adults and to compare these results to the findings observed in the computed tomography (CT) of the respective individuals.
Materials and Methods This study was conducted in the period from April 2018 to December 2018 on 92 patients admitted with isolated head trauma and on 80 healthy individuals in similar gender and age groups. The age, gender, and Glasgow Coma Scores of the patients; the cause of the head trauma; and the findings from CT imaging were recorded.
Results The levels of AP were significantly lower in the head trauma patients both in the adult and pediatric groups compared with the healthy control groups of respective ages (p < 0.001). Furthermore, the levels of AP were significantly lower in both the pediatric and adult patients with identified pathologies in the CT images compared with their counterpart control groups (p < 0.001). In predicting an existing pathology in the CT, an AP level of > 138.5 was found to be 85.7% sensitive and 85.3% specific in the pediatric patients, and an AP level of >118.3 was 75% sensitive and 83.5% specific in the adult patients.
Conclusion The levels of AP in head trauma patients were reduced in both the pediatric and adult patients and these low levels increase the likelihood of detecting pathology in CT images.
07 February 2020 (online)
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- 1 Martins ET, Linhares MN, Sousa DS. et al. Mortality in severe traumatic brain injury: a multivariated analysis of 748 Brazilian patients from Florianópolis city. J Trauma 2009; 67 (01) 85-90
- 2 Maas AIR, Menon DK, Adelson PD. et al. In TBIR Participants and Investigators. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol 2017; 16 (12) 987-1048
- 3 Polat Ö, Uçkun ÖM, Tuncer C, Belen AD. Is IL-8 level an indicator of clinical and radiological status of traumatic brain injury?. Ulus Travma Acil Cerrahi Derg 2019; 25 (02) 193-197
- 4 Marincowitz C, Lecky FE, Townend W, Borakati A, Fabbri A, Sheldon TA. The risk of deterioration in GCS13-15 patients with traumatic brain injury identified by computed tomography imaging: a systematic review and meta-analysis. J Neurotrauma 2018; 35 (05) 703-718
- 5 Huda W. Radiation risks: what is to be done?. Am J Roentgenol 2015; 204 (01) 124-127
- 6 Karout M, Miesch M, Geoffroy P. et al. Novel analogs of allopregnanolone show improved efficiency and specificity in neuroprotection and stimulation of proliferation. J Neurochem 2016; 139 (05) 782-794
- 7 Mutch CA, Talbott JF, Gean A. Imaging evaluation of acute traumatic brain injury. Neurosurg Clin N Am 2016; 27 (04) 409-439
- 8 Rosen CB, Luy DD, Deane MR, Scalea TM, Stein DM. Routine repeat head CT may not be necessary for patients with mild TBI. Trauma Surg Acute Care Open 2018; 3 (01) e000129
- 9 So WH, Chan HF, Li MK. Investigation of risk factors of geriatric patients with significant brain injury from ground-level fall: a retrospective cohort study in a local Accident and Emergency Department setting. Hong Kong J Emerg Med 2018; 25: 305-312
- 10 Zetterberg H, Blennow K. Fluid markers of traumatic brain injury. Mol Cell Neurosci 2015; 66 (Pt B) 99-102
- 11 Vallée M. Neurosteroids and potential therapeutics: focus on pregnenolone. J Steroid Biochem Mol Biol 2016; 160: 78-87
- 12 McEvoy K, Payne JL, Osborne LM. Neuroactive steroids and perinatal depression: a review of recent literature. Curr Psychiatry Rep 2018; 20 (09) 78
- 13 Dichtel LE, Lawson EA, Schorr M. et al. Neuroactive steroids and affective symptoms in women across the weight spectrum. Neuropsychopharmacology 2018; 43 (06) 1436-1444
- 14 Guennoun R, Labombarda F, Gonzalez Deniselle MC, Liere P, De Nicola AF, Schumacher M. Progesterone and allopregnanolone in the central nervous system: response to injury and implication for neuroprotection. J Steroid Biochem Mol Biol 2015; 146: 48-61
- 15 Yoshizawa K, Okumura A, Nakashima K, Sato T, Higashi T. Role of allopregnanolone biosynthesis in acute stress-induced anxiety-like behaviors in mice. Synapse 2017; 71 (08) 21978
- 16 Meyer M, Garay LI, Kruse MS. et al. Protective effects of the neurosteroid allopregnanolone in a mouse model of spontaneous motoneuron degeneration. J Steroid Biochem Mol Biol 2017; 174: 201-216
- 17 Reddy DS, Kim HY, Rogawski MA. Neurosteroid withdrawal model of perimenstrual catamenial epilepsy. Epilepsia 2001; 42 (03) 328-336
- 18 Schüle C, Nothdurfter C, Rupprecht R. The role of allopregnanolone in depression and anxiety. Prog Neurobiol 2014; 113: 79-87
- 19 Griffin LD, Gong W, Verot L, Mellon SH. Niemann-Pick type C disease involves disrupted neurosteroidogenesis and responds to allopregnanolone. Nat Med 2004; 10 (07) 704-711
- 20 Torres JM, Ortega E. Alcohol intoxication increases allopregnanolone levels in female adolescent humans. Neuropsychopharmacology 2003; 28 (06) 1207-1209
- 21 Marx CE, Naylor JC, Kilts JD. et al Neurosteroids and traumatic brain injury: translating biomarkers to therapeutics; overview and pilot investigations in Iraq and Afghanistan era veterans. In: Laskowitz D, Grant G. eds. Translational Research in Traumatic Brain Injury Boca Raton (FL). CRC Press; 2016: 166-183
- 22 Rasmusson AM, Pinna G, Paliwal P. et al. Decreased cerebrospinal fluid allopregnanolone levels in women with posttraumatic stress disorder. Biol Psychiatry 2006; 60 (07) 704-713
- 23 Müller K, Townend W, Biasca N. et al. S100B serum level predicts computed tomography findings after minor head injury. J Trauma 2007; 62 (06) 1452-1456
- 24 Thelin EP, Nelson DW, Bellander BM. A review of the clinical utility of serum S100B protein levels in the assessment of traumatic brain injury. Acta Neurochir (Wien) 2017; 159 (02) 209-225