Cohen Veterans Bioscience is driving the development a Brain Trauma Blueprint to guide a next generation of diagnostics and therapeutics across Traumatic Brain Injury and Post-Traumatic Stress Disorder. In 2019, we hosted our second State of the Science Summit (SOSS) with over 100 thought leaders to foster consensus around potential paths to treatment for TBI. The goal was to define TBI beyond the typical classifications of mild, moderate or severe, in order to more clearly describe underlying disease mechanisms. The Summit focused on the chronic sequelae of TBI and aimed to identify current knowledge gaps in the etiology and mechanisms of persistent TBI symptoms.
The resulting recommendations create actionable research priorities to be prioritized across the research ecosystem and will be rolled out in the next few months.
The Brain Trauma Blueprint is an initiative aimed at accelerating an era of personalized medicine for survivors of brain trauma through a series of invitation-only State of the Science Summits (SoSS). With few FDA-approved treatments for long term neuropsychiatric sequelae of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), the development of targeted therapeutics will require clearer understanding of their biological underpinnings. By fostering collaboration across the broader stakeholder community, we will enable translational research gaps to be bridged and achieve solutions sooner for those suffering from trauma-related brain disorders.
Each SoSS serves as a 2-day retreat in which a review of the landscape is drafted before the meeting, presentations and working sessions discussing the state of the field and major gaps occurs on the first day, and the second day includes time to define, refine, and prioritize research gaps.
The trauma-related brain disorder research community has repeatedly lamented the lack of mechanistically targeted therapeutics for TBI. For therapies to navigate the path to patients requires advancing knowledge on molecular mechanisms of injury, more refined methods of diagnosis, subtyping patients to better select potential treatments for their disease mechanism, and successfully advancing through clinical trials. A blueprint of past and current research activities can help guide development efforts and accelerate the progression towards a new generation of precision diagnostics and targeted therapeutics.
Great strides have been made in managing patients after acute TBI injuries, particularly those classified as severe. Despite initial hospitalization and inpatient rehabilitation services, about 50% of people with TBI will experience further decline in their daily lives or die within 5 years of their injury. Some of the health consequences of TBI can be prevented or reduced1.
Given the progress in acute care and rehabilitation, the field is increasingly looking to address the chronic sequelae of these injuries with a focus on prevention and diagnosis of sports concussions and blast injuries and the ability to translate findings in animal models2. By making gaps in our understanding of the presence, presentation, trajectories, and underlying mechanisms of these long-term effects known, we can help move therapeutics forward. Currently, TBI is classified as mild, moderate, or severe; and is managed based on a level of consciousness, irrespective of the heterogenic pathophysiology leading to that severity score. The ability of these classifications to predict subsequent patient burden, including neurodegenerative trajectory, is not well understood. Patients presenting to clinics months after their TBI are prescribed treatment plans based on their current symptom burden and family reports. Unfortunately, these are often complicated by subjective measurement techniques, fluctuating presentations, and comorbid disorders. To ultimately reduce patient burden, elucidation of underlying biological processes across TBI injury types would advance precision diagnosis, TBI patient biotyping, and better advance clinical trials allowing discovery of targeted therapeutics.
1TBI Model Systems (TBIMS) National Database
The theme of the second State of the Science Summit is Paths to Treatment for Traumatic Brain Injury(s) with a focus on the taxonomy and nosology of the chronic sequelae, challenges and opportunities in clinical practice and development, and etiology and mechanism of persistent symptoms3. As measurement tools advance, research has been able to focus on different types of injury, beyond the mild, moderate, and severe classifications. To augment and support the many efforts across fields and organizations over the past decade, we aim to map a consensus blueprint to drive translational science for TBI.
3Excluding penetrating injury; stroke; acute surgical emergencies
This is an invitation-only event however we are interested in connecting with new stakeholders and thought leaders in the field of diagnosis or treatment of trauma-related brain disorders, such as TBI, PTSD, and related comorbidities, including those interested in:
Proceedings and outcomes from this effort will be published later this year.
Stephen Ahlers, PhD
Director, Operational and Undersea Medicine Directorate at Naval Medical Research Center
David Cifu, MD
Chairman and Professor at VCU Department of PM&R, National Director for PM&R in Department of Veterans Affairs
Fiona Crawford, PhD
President & CEO, Roskamp Institute
Jam Ghajar, MD, PhD, FACS
President, Brain Trauma Foundation, Clinical Professor of Neurosurgery at Stanford University School of Medicine
Jessica Gill, PhD, RN, FAAN
Deputy Scientific Director of the Division of Intramural Research at the National Institute of Nursing Research
Grant Iverson, PhD
Director, Sports Concussion Program, MassGeneral Hospital for Children; Director, Neuropsychology Outcome Assessment Laboratory, Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Network; Associate Director, Traumatic Brain Injury Program, Home Base, A Red Sox Foundation and Massachusetts General Hospital Program
Michael McCrea, PhD, ABPP
Professor, Neurosurgery and Neurology; Director, Brain Injury Research Program, Medical College of Wisconsin
James Stone, MD, PhD
Vice Chairman of Clinical Research, Associate Professor of Radiology and Medical Imaging, University of Virginia
Elisabeth Wilde, PhD
Associate Professor, Director of Research for Physical Medicine and Rehabilitation, Baylor College of Medicine
Kristine Yaffe, MD
Professor of Psychiatry, Neurology and Epidemiology, Roy and Marie Scola Endowed Chair, Vice Chair of Research in Psychiatry, UCSF