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Serum amyloid A is increased in children with abusive head trauma: a gel-based proteomic analysis
Weimin Gao1, Chuanwen Lu1, Patrick M Kochanek2
1Department of Environmental Toxicology, The Institute of Environmental and Human Health, Texas Tech University, Lubbock, Texas.
Insights
Serum amyloid A (SAA) may help identify abusive head trauma (AHT) in infants. Increased SAA levels in serum can indicate AHT, even with mild symptoms and no trauma history.
Area of Science:
- Biochemistry
- Pediatric Traumatology
- Biomarker Discovery
Background:
- Abusive head trauma (AHT) is a leading cause of pediatric TBI mortality.
- Mild AHT cases present with nonspecific symptoms and lack of trauma history, complicating diagnosis.
- Early identification of mild AHT is crucial for timely intervention.
Purpose of the Study:
- To identify potential serum biomarkers for diagnosing mild abusive head trauma (AHT) in children.
- To evaluate serum amyloid A (SAA) as a diagnostic marker for mild AHT.
- To assess the correlation between SAA levels and AHT severity.
Main Methods:
- Serum proteomic profiling using 2D-DIGE and mass spectrometry in mild AHT cases and controls.
- Confirmation of protein changes via Western blot analysis.
- Quantification of serum amyloid A (SAA) by ELISA in mild, moderate, and severe AHT cases.
Main Results:
- Two protein spots significantly differed between mild AHT cases and controls, identified as SAA.
- SAA concentrations were elevated in children with mild AHT compared to controls.
- No significant correlation was found between SAA levels and AHT injury severity.
Conclusions:
- Serum amyloid A (SAA) shows potential as a biomarker for identifying mild abusive head trauma (AHT) in children.
- SAA may aid in recognizing cases requiring head CT, especially when trauma history is absent.
- Further research is warranted to validate SAA as a routine diagnostic tool for pediatric AHT.
Background:
Abusive head trauma (AHT) is the leading cause of death from traumatic brain injury in infants and young children. Identification of mild AHT (Glasgow Coma Scale score: 13-15) is difficult because children can present with nonspecific symptoms and with no history of trauma.
Methods:
Two-dimensional difference gel electrophoresis combined with mass spectrometry was used to compare the serum protein profile of children with mild AHT and age-matched controls. Protein changes were confirmed by western blots. Western blots were performed using serum from children with mild, moderate, and severe AHT to assess the effect of injury severity on protein intensity. The protein identified--serum amyloid A (SAA)--was then measured by enzyme-linked immunosorbent assay.
Results:
Using serum from 18 mild AHT cases and 20 controls, there were ~1,000 protein spots; 2 were significantly different between groups. Both spots were identified as SAA. There was no relationship between protein levels and injury severity. SAA concentrations measured by enzyme-linked immunosorbent assay were increased in cases vs. controls.
Conclusion:
SAA may be a potential biomarker to identify children with mild AHT who present for medical care without a history of trauma and who might otherwise not be recognized as needing a head computed tomography.
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