Significance

​​Traumatic brain injury (TBI) is a major health concern affecting millions of individuals worldwide. Within the United States (U.S.), the Centers for Disease Control and Prevention report that there were more than 200,000 TBI-related hospitalization in 2020, and more than 69,000 TBI-related deaths in 2021. Moreover, estimates suggest that there are more than 5.3 million individuals living with TBI-related disabilities. Consequently, TBI has been described as a “silent epidemic” for multiple reasons. First, epidemiological reports likely reflect an underestimation of incidence, particularly for milder forms of brain injury. Second, without an accurate incidence rate, it is impossible to identify the true public health and economic consequence of brain injury, including caregiver burden. Third, survivors of mild to moderate brain injury often display delayed and task-specific impairments making chronic, time-dependent reporting essential in documenting long-term effects of TBI. Finally, many post-injury problems are not visible, including cognitive and emotional impairment. Together, these points emphasize the many challenges that we face in attempting to improve recovery following TBI.

Inflammation

Inflammation following TBI is a complex and dynamic response of both the central and peripheral nervous systems, which is influenced by age, sex, injury location and severity, secondary injury cascades, and genetics. Inflammation occurs after all brain injuries and is considered to be an integral mediator of post-injury outcome. Excessive or chronic neuroinflammation is linked to progressive pathophysiology and behavioral impairment. Accumulating data show that immune stimuli before or after TBI significantly influences brain pathology and behavioral outcome. Therefore, TBI should not be viewed as an isolated life event. Pre- and post-injury immune stimuli may be equally critical in mediating long-term recovery. 

Ongoing Projects

We use combination models to study the effects of TBI. Why? Quite simply, life is complicated! TBI does not occur in isolation, and we believe it is critical to consider the effects of immune stimuli before and after injury. This can occur in the form of endogenous and exogenous factors, which may or may not be modifiable. See the figure below for some examples, adapted from Houle & Kokiko-Cochran, 2022 and created with BioRender. Ongoing projects examine how genetic risk for neurogenerative disease, stress, or infection influence outcome following TBI. We are grateful to the public and private agencies that have supported our work. 

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