Traumatic Brain Injury is Topic of Annual Hesburgh Lecture
Dr. Mayland Chang, research professor from the Department of Chemistry and Biochemistry at Notre Dame University, recently discussed concussions and traumatic brain injury (TBI) at Sacred Heart University in a lecture entitled “Win Just One for the Gipper: Advanced Treatment of Traumatic Brain Injury.” Her presentation was this year’s annual Hesburgh Lecture.
She started out by discussing the primary ways to receive a concussion – an injury that is prominent in sports and produces a cascade of neurological events, resulting in reduced blood flow to the brain, neuronal cell injury and sometimes death. Other common ways to get a concussion include automobile accidents, falls and assault. Currently, there is no treatment to rescue brain cells after each concussion.
She likened the effects of a concussion to a scrambled egg. “No science in the world can turn a scrambled egg into what it was before. TBI is the same,” she said. She said 1,365,000 people go to the emergency room each year with a TBI, which amounts to more than three TBIs per minute. One-third of all deaths from injury involve a TBI. The symptoms of a TBI include headache, nausea, vomiting, sensitivity to light, vision, fatigue, irritability, insomnia and cognitive deficits.
She told the nearly full house at the University’s Schine Auditorium that TBIs often involve a secondary wave of damage that can occur hours to days after the initial trauma. The second wave, caused by edema in the brain, can result in coma, seizures and/or death. In fact, she said, most people don’t die of TBI right away. Forty percent of TBI patients deteriorate after they are hospitalized. That secondary wave provides a window of opportunity – albeit a challenging one, she said.
At the moment, there is no treatment or drugs for TBI. Treatment is palliative and involves making the patient comfortable, maintaining blood flow to the brain and performing surgery on any mass lesions or objects, Chang said. But, she added, researchers at Notre Dame are hoping to change that through their work on a first-of-its-kind treatment for TBI.
Chang, who is also director of the Notre Dame Project Development Team, is one of the researchers searching for a solution. She said there is an opportunity to medicate patients in between the initial injury and the secondary injury. A major challenge is that the blood brain barrier that protects the brain from viruses and infection also keeps medicine from crossing into the brain. Another challenge is that TBI is highly complex and can cause various outcomes.
“Despite the challenges, it is critical that we work toward a solution. Forty-three percent of those who are hospitalized with a TBI are still dealing with the injury a year later,” she said. “At Notre Dame, we describe this research as ‘The Fighting Irish fighting to protect our players.’ ”
Chang said the researchers have tried a number of different treatments – several of which have already been withdrawn. “Recently, we found that activation of a certain enzyme breaks down the blood brain barrier. Our hope is that this could lead to possible treatments to prevent the secondary injury,” she said. “We want a drug that can cross to the brain quickly for immediate intervention, and we don’t want to wait until the brain barrier is damaged.”
She said the group has had some success testing compounds in mice. They have seen a 20 percent decrease in brain damage and long-term effects of significant reduction to the lesion area. The mice have also shown improved motor skills and coordination.
The drug, which is currently called ND-478, comes in a water-soluble version. Since the patients may be unconscious, an injectable or water-soluble drug may be needed. Future study will include studies with humans and clinical trials.
The Hesburgh Lecture is named for Father Theodore M. Hesburgh, who was president of the University of Notre Dame for 35 years. It is sponsored by the University of Notre Dame’s Alumni Association in areas where the association is active. The event was co-sponsored by University College at Sacred Heart University.