Frontiers in TBI 2019: highlights from the Editor of Neuro Central

Sharon Salt the editor of Neuro Central, shares some of the key highlights and takeaway message from the Frontiers in Traumatic Brain Injury 2019 conference.

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This year we had the pleasure of attending the Frontiers in Traumatic Brain Injury (Frontiers in TBI) conference, which took place on 16 September 2019 (University College London, UK). The one-day conference showcased the exciting developments in the world of TBI research, including machine learning, criminality, big data, digital technology and much more. 

In this report originally published on Neuro Central, we’ll share with you some of our key highlights and takeaway messages from the conference.

Neuropathological aspects of TBI

One of the themes that stood out to us the most was the session on neuropathological aspects of TBI, which included talks on neurodegeneration, imaging in tau and preclinical models of tau propagation.

The mismatched mishmash of neurodegeneration in TBI

Starting off the session with a tongue-twisting title, we heard from William Stewart (University of Glasgow, UK) on the mismatched mishmash of neurodegeneration in TBI. In chronic traumatic encephalopathy (CTE), it is well known that pathognomonic lesions of the disease consist of p-tau aggregates within neurons and astrocytes. Additionally, cell processes around small vessels are distributed in patchy and irregular patters. What remains uncertain, however, is what seeing tau actually means in this instance.

In his presentation, Stewart presented data on how tau phenotypes in CTE recapitulate those of aging in astrocytes and Alzheimer’s disease. In individuals exposed to sport, CTE presents itself in many ways but the main challenges lie with how dementia-causing problems are observed across the board and there is a broad mixture of pathologies that are presented in individuals (e.g., tau pathology, neurofibrillary tangles, Lewy bodies, etc.). Due to this complex pathology being observed, Stewart concluded that CTE may be a co-morbidity and at present, it could be too early for us to define the disease.

Imaging in tau

Next up we heard from Nikos Gorgoraptis (Imperial College London, UK) on TBI-associated tauopathies, who spoke more specifically about his study utilizing PET imaging with the radioligand for tau protein, flortaucipir. Within this study, the researchers compared 21 TBI patients with 11 healthy controls and produced 3D images of flortaucipir binding in the brains of each participant in order to examine brain volume.

Their results revealed that there was an increase in flortaucipir signal in long-term TBI survivors compared with healthy controls. In addition to this, cerebrospinal fluid biomarkers of neurodegeneration and white matter damage correlated with the flortaucipir signal.

Gorgoraptis noted that these results suggested that flortaucipir PET imaging may be useful for diagnosis and prognostication of neuronal damage following a TBI. He also concluded that the data may have implications for treatment targeting tau following TBI – perhaps using tau PET as an outcome measure of treatment effect.

Preclinical models of tau propagation in TBI

To conclude this session, Eliza Zanier (Mario Negri Institute for Pharmacological Research, Milan, Italy) spoke about the possible induction of a transmissible tau pathology by TBI. In her talk, she mentioned how her team wanted to test the hypothesis that tau exhibits a prion-like behavior. In order to test this, Zanier and her team transplanted tissue from TBI mice into naïve mice and discovered that this induced widespread tau pathology, synaptic loss and persistent memory deficits in mice. According to Zanier, these findings suggest that TBI-generated tau may exhibit a prion-like behavior.

Following on from these observations, Zanier presented data that was conducted on Caenorhabditis elegans models. She noted that brain-injured tissue from TBI mice was toxic in C. elegans. However, TBI-associated toxicity was prevented by a T46 antibody.

When concluding her findings, Zanier noted how C. elegans may be a tractable model to assess TBI-associated tau toxicity and that targeting tau propagation may be a future treatment strategy for the field.

Criminality and TBI

Moving on to our next highlight on criminality and TBI, we heard from Huw Williams (University of Exeter, UK) who presented data from both men and women in prison. This made for an intriguing presentation, as previous talks in the day included a lack of data on women, especially when considering sport-related TBIs.

In his talk, Williams mentioned a study that examined Swedish population registries from 1973–2009 where researchers investigated the association of epilepsy and TBI with subsequent violent crime. He noted that individuals with TBI were more likely to commit a violent crime after their diagnosis and that this risk was attenuated when cases were compared with unaffected siblings.

Williams’ talk also covered data that surveyed adults in a male prison facility. When asked whether the participants had experienced a TBI, 60.4% responded ‘yes’ to having a TBI and 39.6% responded with ‘no’. From this, it was estimated that 65% may have had a TBI, 10 of which were severe, 5.6% moderate and 49.4% mild.

Moreover, when looking at data involving young offenders in the UK, people with TBI were linked to having more convictions, and the greater number of TBIs experienced led to more violence in these individuals. One question that was raised from this was whether children who experienced a TBI were more likely to engage in criminal behavior. According to Williams, there was clear evidence of ongoing problems for children who had a TBI compared with their non-injured counterparts.

Williams also presented some staggering data on costs associated with head injuries: the long-term cost of a case of head injury is approximately £155,000 for a 15-year-old in the general population compared with £345,000 for a 15-year-old young offender.

Lastly, with regards to women in prison who were based in Scotland (UK), 62% were reported to have sustained their brain injury through domestic violence and 33% sustained their first injury prior to their first offence. Although there wasn’t much data reported with regards to women, it was great to see sex differences in the field starting to be touched upon.

Panel discussion: neurotechnology in healthcare

In our last highlight on neurotechnology in healthcare, we heard from a fantastic line up of panelists, including Payam Barnaghi (University of Surrey, UK), Sarah Chan (University of Edinburgh, UK) and Andrea Gadotti (Imperial College London, UK), on various aspects including artificial intelligence, bioethics and computational privacy.

Artificial intelligence and TBI

First up, we heard from Barnaghi on the applications of artificial intelligence in TBI from a diagnostic, prognostic and rehabilitation perspective. In terms of diagnosis, artificial intelligence may be useful for collating large amounts of data and using deep-learning algorithms to accurately identify head CT scan abnormalities. However, one of the challenges posed by using artificial intelligence in such a way includes the quality of the data obtained – it’s messy, both in terms of collection and storage.

Looking at prognosis, Barnaghi mentioned how machine learning may be utilized to accurately analyze serum parameters in order to develop a prognostic model to predict 6-month outcomes in children with severe TBI. With rehabilitation, artificial intelligence systems could monitor patients in their homes to detect agitation, irritability and etc. However, with these applications come their pitfalls – there is a lot of variability in data and getting models to work everywhere is a notable and open problem.

Bioethical considerations

Following on from Barnaghi’s opening discussion, Chan guided us through a really engaging perspective on the bioethics behind technology – that is, how we operate on technology and how technology operates on us. Reiterating what Barnaghi said on how technical data is messy, Chan noted that there is also an ethical messiness when it comes to data, too. For example, how do we constitute ourselves as data subjects? Can robots really relieve the emotional burdens of care? Would this diminish the value of human–human interaction? If technology were to operate on us, could this alter normal human responses (e.g., make them enhanced)?

A lot of questions were raised from a bioethical perspective and it was really engaging to hear the considerations that we, as a society, need to consider when thinking about the integration of technology into our lives. Chan concluded her session by noting that we need to think about our relationship with technology and how this will reshape society, but also, society’s role in driving and shaping these developments.

Computational privacy

With technology comes the much-debated issue of privacy. For example, Gadotti questioned whether or not anonymous really meant anonymous. When we think about privacy, the issues with security and safety also need to be addressed. If we take examples that have occurred in the past (e.g., when Yahoo was breached in 2013 and when British Airways was breached in 2018), it poses questions such as, can we really meet security requirements if these big companies can be compromised?

To answer this, Chan raised a thought-provoking point on how systems are never going to be ‘fool-proof’. She mentioned an interesting concept about how privacy and what privacy encompasses is a social construct. That is, our expectations on boundaries can be reconfigured. To provide examples, Chan mentioned the sequencing of our genomes and how our idea on privacy can change over the course of time – what people might have considered to be private data is now becoming a common construct.

To conclude, Chan stated that our responses to breach, not security, is what we really need to think about going forwards.

Overall, Frontiers in TBI 2019 was a fantastic event to attend again! Although we were only able to cover a selection of talks that occurred, the breadth of topics covered throughout the day catered for a wide range of audiences – from neurorehabilitation, psychological treatments, emerging aspects and much more.

It was also fantastic to hear various speakers present information that not only focused on men but also women, and to see ‘hot topics’ from other fields incorporated into discussions (e.g., neurotechnology and the challenges surrounding bioethical considerations). Thank you very much to the organizers, especially Lucia Li (Imperial College London), who is one of our Early Career Expert Panelists, for a brilliant and insightful day – we’re already looking forward to Frontiers in TBI 2020!

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Sharon Salt

Editor, Neuro Central

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