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Longitudinal characterization of headache after TBI and potential immunological target

Postoll, Melissa (2018) Longitudinal characterization of headache after TBI and potential immunological target. Master Essay, University of Pittsburgh.

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Abstract

Headaches are a common adverse outcome after a traumatic brain injury (TBI) that can persist through the first year post-injury. Inflammation has been implicated in the pathophysiology of migraines and persists chronically after a TBI. Through the process of trans-signaling, the binding of interleukin(IL)-6 to its soluble receptor can lead to widespread inflammation. This process is restricted by the presence of soluble g-protein130 (sgp130). Previous studies have not examined the relationships between the IL-6 family soluble receptors and headaches in TBI patients. The aim of this study was to identify headache phenotypes and how these phenotypes are associated with other TBI outcomes. We also hypothesized that the relative levels of IL-6 family soluble receptors underlies post-traumatic headache pathophysiology.
We used monthly questionnaires to categorize headaches and to create temporal headache trajectory profiles in a prospective cohort of adults with TBI (n=79). We examined the relationship between trajectory profiles and quarterly ratios of sgp130 levels to levels of the sIL-6R (sgp130:sIL6-R), and other secondary outcomes including stress hormone, quality of life, anxiety, depression, fatigue, and disability.
There were three distinct headache profiles: low, resolve, and chronic trajectory groups. We compared ratios in the symptomatic trajectory groups, and determined a cut-point for an individual to be considered at risk. Those in the resolve trajectory group had higher sgp130:sIL-6R ratios compared to those in the chronic trajectory group across all time points (p<0.05 for all comparisons). In the adjusted model, a one standard deviation increase in quarter 1 sgp130:sIL-6R protects against chronic headaches by 75.9% (p=0.006). Those in the chronic trajectory group experienced elevated levels of stress hormone, lower quality of life, and higher anxiety, depression, fatigue and disability.
Those in the chronic trajectory group had less inhibition of the widespread inflammation caused by IL-6 binding to sIL-6R and worse co-occurring impairments. Future studies should test the effect of a sgp130:sIL-6R targeted immunotherapy to mitigate the detrimental and long-lasting effects of PTH after TBI.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Postoll, Melissamep141@pitt.edumep141
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairRosso, Andreaalr143@pitt.edualr143UNSPECIFIED
Committee MemberWagner, Amywagnerak@upmc.eduUNSPECIFIEDUNSPECIFIED
Committee MemberSonger, Thomastjs@pitt.edutjsUNSPECIFIED
Date: 10 December 2018
Date Type: Submission
Number of Pages: 48
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 28 Sep 2019 19:45
Last Modified: 28 Sep 2019 19:45
URI: http://d-scholarship.pitt.edu/id/eprint/35769

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