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CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(03): 399-408
DOI: 10.1055/s-0043-1761926
Original Article

Pathological Spectrum and β-APP Immunoreactivity as a Diagnostic Tool of Diffuse Axonal Injury following Traumatic Brain Injury: A Novel Classification

Meenakshi Sharma
1   Division of Forensic Pathology and Molecular DNA Laboratory, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
,
Arulselvi Subramaniam 
2   Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
,
Kangana Sengar
2   Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
,
Vaishali Suri
3   Neuropathology Laboratory, Center for Neurosciences, All India Institute of Medical Sciences, New Delhi, India
,
Deepak Agrawal
4   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Nabarun Chakraborty
1   Division of Forensic Pathology and Molecular DNA Laboratory, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
,
Ravindra Mohan Pandey
5   Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
,
Rajesh Malhotra
6   Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
,
Sanjeev Lalwani
1   Division of Forensic Pathology and Molecular DNA Laboratory, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations Funding This work was supported by All India Institute of Medical Sciences, New Delhi, India, intramural research grant: code: A-507.
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Abstract

Aim Different deposition patterns and grading systems used to define and identify DAI remain discordant and to date these are a challenge in clinical practice. Our main objective was to study the post-mortem axonal changes and develop a grading system to identify DAI on the basis of histopathological and immunoreactive β-amyloid precursor protein (β-APP) observations in severe TBI cases.

Methods Prospective study with 35 decedents with sTBI (GCS score ≤ 8) was conducted and samples were collected from three different sites–corpus callosum, thalamus and brain stem. Serial sections from each site were stained with hematoxylin and eosin (H&E), and immunohistochemistry (IHC) of β-APP.

Results We developed a grading system based on histopathological characteristics to assess the overall damage of axonal injury. We found maximum histopathological changes in cases with prolonged stay. Corpus callosum showed maximum changes in both gradings. Curiously, we also detected axonal swellings with H&E staining. Usually neglected, the thalamus also showed significant histopathological and immunoreactive changes for sTBI.

Conclusion Our study based on histopathological and β-APP scoring system to define and identify DAI thus facilitates accurate diagnosis of DAI post mortem, which has forensic implications, and may further contribute toward survival and improvement of quality of life of sTBI patients.

Keywords

traumatic brain injury - diffuse axonal injury - β-app - H&E stain - forensic pathology

Author's Contributions

M.S., A.S., K.S., V.S. helped in conceptualization, design, literature review, data acquisition, manuscript layout, analysis, writing and editing, and gaining ethical approval. N.C. helped in analysis, writing, manuscript layout and editing. D.A. and R.M.P. helped in data acquisition and statistical analysis. R.M. helped in review. S.L. helped in concept, screening of intellectual content, and review. The manuscript has been reviewed and approved by all authors.


Data Availability Statement

The datasets used and/or analyzed during the current study can be made available by the corresponding author on request.


Ethical Approval

The study was approved by the Institute Ethics Committee (IEC), AIIMS, New Delhi (Ref. No.: IEC-69/2017).


Supplementary Material



Publication History

Article published online:
24 February 2023

© 2023. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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