It Takes Two: The Power Of Concussion Biomarkers

One second you're up, and the next you fall down. Two biomarkers can help explain what's going on in your brain.

Diagnostics Testing|Sep.28, 2022

Hero and sidekick. Peanut butter and jelly. Thunder and lightning.

Glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1).

It’s a mouthful of a word pair, but it’s a unique one that opens the door to understanding concussion, sometimes called a mild traumatic brain injury or mTBI. From bumps to blows to jolts to the head, GFAP and UCH-L1 are a reliable pair of biomarkers released into the bloodstream after a brain injury. From a broad perspective, biomarkers are characteristics of the body that are measurable, like blood pressure or amounts of a protein in the blood, and they help assess our health.

Let's take a closer look at how this invisible couple impacts concussion assessment.

A Biomarkers Analogy

If you show up to the emergency room, hand on your heart and complaining of chest pain, you're likely getting a blood test. The test you receive will look at the levels for a protein called Troponin-I, which appears more in the blood after a heart attack. Healthcare professionals have had blood tests for the heart, liver and kidneys for some time, but not one for the brain. When looked at together, the GFAP and UCH-L1 biomarkers open the window to understanding concussions.

Exploring the use of biomarkers to better understand what is going on in the body began with the link between troponin and suspected heart attack. Although it took years for troponin to be officially adopted as the standard of care, it did occur in 2007 – and the same could happen for GFAP and UCH-L1 for traumatic brain injuries in the future.

"It's not just troponin and chest pain. If we didn't have the blood tests we do today for HIV/AIDS, we wouldn't have seen progress in fighting that infectious disease," says Beth McQuiston, medical director at Abbott. "Blood-based biomarkers, like GFAP and UCH-L1, could one day have the same impact when it comes to improving concussion diagnosis."

In other words, these brain-specific biomarkers have the potential to revolutionize the way we help people with concussions because they provide objective, actionable numbers. And objectivity is important – the Glasgow Coma Scale, which is a nearly 50-year-old scale that doctors use to assess injuries based on responsiveness, is subjective. A 2015 study found that scoring accuracy across more than 200 emergency providers was only 33%.

Abbott's currently FDA-cleared blood test for concussions, the i-STAT TBI Plasma test, uses the two biomarkers to rule out the need for a head CT scan, and we continue to pursue research to expand the indications of our tests.

The Power of a Pair

The word pair of GFAP and UCH-L1 connects to another word pair: diagnosis and prognosis. In a recent study, researchers discovered that GFAP and UCH-L1 levels in the blood are a way to not only help evaluate traumatic brain injuries but also to paint a clearer picture about a person’s course of recovery and the long-term effects of his or her concussion.

"Objective biomarker data could revolutionize the standard of care for traumatic brain injuries," explains McQuiston. "Patients and their family members deserve the opportunity to make fully informed decisions when it comes to concussion. Understanding GFAP and UCH-L1 levels, alongside their clinician, can empower them to make the right health decisions when they need it most."

The future of healthcare revolves around putting reliable, actionable answers in clinicians' and patients' hands. Using biomarkers in diagnostic tests opens the door to progressing healthcare – and we've seen it with troponin and heart attack.

Biomarkers and treatment: Now that's a word pair that can change the way we approach traumatic brain injury.