The Journal of Neurotrauma - 9

EXPERT PANEL DISCUSSION
But, I think overall, it is going to come down to an
objective measure. You need biomarkers that are more
objective than symptomatology, and clinician adoption of a measure is going to come down to ease of use
and cost.
Dr. Manley: I think that our recent article that came
out in Lancet Neurology4 suggests that these bloodbased biomarkers are going to be an aid in diagnosis.
And I think that maybe we should just call this condition ''brain injury.'' You know, I think we get hung
up on what is a concussion or what is a severe TBI. We
know that some patients with concussion or mild TBI
go on to have lifelong symptoms, so there is nothing
mild or transient about that injury for that individual.
And the last comment that I would make here, Dr.
Marion, and I want to be fully transparent here, is that
we work with Abbott Laboratories. We have studies
that we have done with Abbott. They have done assays for us. I have taken no money from them personally, nor do I have any stock in the company. And
with TRACK-TBI, we have had many people coming
to us wanting us to test their blood-based biomarker
assays.
I think what swayed us to work with Abbott is that
they were doing this on a point-of-care device called the
i-STAT that many of us already had a lot of experience
with clinically. So to us, this seemed to be something
that was closer to the patient's bedside because it was
just a cartridge that was being used on a handheld device that we already were using in our clinical arena that
we knew to be durable and could be used in an emergency department, or out in the field. I think it is appropriate for me to at least publicly disclose why we
had come to work with this company. It was not so
much that they offered us grant money or things like
that, but that they were using a device we were familiar
with that we had used clinically in the past for other
tests. So I just wanted to get that out there.
Dr. Gill: For my final comments, I think moving forward biomarkers are really promising, especially these
large consortiums where we can compare results. A lot
of the work we are doing is with Abbott, as well as with
Quanterix. A large focus of my lab is making sure that
everything is comparable, so it is all apples to apples,
and to be able to compare across these. I think that all of
us on this call were involved in multiple consortiums,
and so having these collaborations will move the science forward most quickly. I think it is really promising.
You know, I have really been focusing in the TBI area
for seven years, and to see it move so quickly is very
encouraging. It is a great area.

diagnosis of concussion. We are not quite there yet,
but in the meantime, I am looking forward to having
an objective tool to help me and my emergency
medicine colleagues identify patients who can be
safely managed without a head CT scan and its attendant radiation exposure. The high negative predictive value of this test has potential to really impact
emergency care of concussion. Even though only a
fraction of those with a positive test will have an
injury on head CT scan, I think there's a hidden
benefit to that. I'm hopeful that these positive tests
will raise awareness that brain injury can occur even
when the head CT scan is absolutely normal, and lend
legitimacy to an injury that has historically been all
but ignored.
And hopefully, we will not be missing 50% of these
that come through emergency departments, we will be
missing 0%. This raises awareness for everybody so
that we can recognize this and also reduce radiation
and unnecessary CT scans.
Dr. McCrea: Thanks for this opportunity to join,
Dr. Marion. As Dr. Gill stated, we have made enormous and truly accelerated progress in the TBI biomarker space over the last several years. For me, the
natural next step in that translational pathway from
research tools to clinical application is a point-ofcare platform.
As Dr. Manley indicated, when we see partners like
Abbott come into this space, and we do not have to
reinvent the wheel, we can leverage something like the
Abbott i-STAT device and platform, that then further
accelerates progress.
Most of all, the promise that biomarkers show in the
ability to optimize these onto a point-of-care platform
is critical to achieving some form of a precision
medicine model in neurotrauma. This is the reason all
of us got into this work in the first place: to have an
immediate impact in the critical care setting, in Military medicine, and in sports medicine. In a very short
period of time, we could take this from the laboratory
to a point-of-care platform for clinical use. That is just
incredibly exciting for all of us.
Dr. Marion: I agree. I am excited about the possibilities in the relatively short term. I think in the
next two to three years things are going to change
rapidly in terms of how comfortably we manage
these patients, and in the quality of care we are
capable of delivering.
Thank you all very much for joining in this
discussion.

Disclosure Statement
Dr. Bazarian: The ultimate goal of what we are
discussing is to develop these markers as an aid to
ª 2020 by MARY ANN LIEBERT, INC.

All participants confirm they have no competing
financial interests to disclose.
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The Journal of Neurotrauma

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