Role of Apoptosis in Childhood Traumatic Brain Injuries: Blocking Cell Death to Improve Outcomes
Traumatic
brain injuries (TBIs) resulting from falls, accidents or abuse are a leading
cause of death and disability in infants and children. These traumas frequently
result in life-long cognitive, developmental and social deficits due to
permanent neural damage, which is poorly understood and correlates with injury
severity as well as age- the youngest children are frequently at highest risk
for permanent disabilities. Beyond supportive care, little treatment is
available to reduce the healthy tissue damage evident in children with a
TBI. We have recently found that
apoptosis (programmed cell death) is dynamically regulated during postnatal
development in the brain and may influence the cellular damage induced by TBIs
in young children. Specifically, we found that infants and children have a
hyperactive apoptosis pathway due to heightened expression of the key
pro-apoptotic protein BAX, predisposing their neurons and glia to undergoing
cell death in response to a wide variety of sources of damage or stress including
anti-cancer therapies. This is in contrast to adults, in which the apoptosis
pathway is suppressed in post-mitotic neural cells due to insufficient
expression of pro-apoptotic proteins, thus protecting them from stress-induced
apoptosis. Based on these findings, we hypothesize that TBI-induced brain
dysfunction in children may be in part driven by apoptotic cell death induced
in neurons or glia within the traumatic penumbra surrounding the primary
injury. To test this hypothesis, we will use well-established mouse TBI models
across the age spectrum (neonate, adolescent, juvenile and adult) to
definitively elucidate the role of apoptosis in trauma-induced tissue damage
and dysfunction as well as their resulting behavioral outcomes. Furthermore, using
genetic mouse models, we will directly test the extent to which blocking
apoptosis can reduce TBI-induced cell death and tissue dysfunction. These
studies will establish whether inhibition of apoptosis, which is now closer to
being possible due to the recent development of apoptosis-blocking agents, can
potentially improve outcomes for infants and children with traumatic brain
injuries.