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Background Danger associated molecular patterns (DAMPs) are nuclear or cytoplasmic proteins that are released from the injured tissues and activate the innate immune system. Mitochondrial DNA (mtDNA) is a novel DAMP that is released into the extracellular milieu subsequent to cell death and injury. We hypothesized that cell death within the central nervous system in children with traumatic brain injury (TBI) would lead to release of mtDNA into the cerebrospinal fluid (CSF) and has the potential to predict the outcome after trauma. Results The median age for patients with TBI was 6.3 y and 62% were male. The common mechanisms of injury included motor vehicle collision (35.8%) followed by falls (21.5%) and inflicted TBI (19%); 6 children (14.2%) died during their ICU course. The mean CSF mtDNA concentration was 1.10E +05 ± 2.07E+05 and 1.63E+03 ± 1.80E+03 copies/µL in the pediatric TBI and control population respectively.

Furthermore, the mean CSF mtDNA concentration in pediatric patients who later died or had severe disability was significantly higher than that of the survivors (1.63E+ 05 ± 2.77E+05 vs. 5.05E+04 ± 6.21E+04 copies/µL) ( p. Introduction Severe traumatic brain injury (TBI) accounts for 25% of all TBI and exacts a considerable societal and economic toll (, ). According to the Centers for Disease Control and Prevention, TBI accounts for an estimated 7400 deaths in children 0–19 years of age annually ().

The pro-inflammatory cytokine response after TBI has been fairly well characterized (–) and recently the role of damage-associated molecular patterns (DAMPs, also known as alarmins) has also been recognized. The pattern recognition receptors (PRRs) present on the microglia and astrocytes can sense cellular damage and stress in the absence of infection due to the presence of DAMPs. DAMPs are rapidly released into the extracellular milieu following injury and modulate the innate immune system. Some examples of DAMPs include nuclear and cytoplasmic proteins e.g., high mobility group box 1 (HMGB1), heat shock proteins, the S100 family of calcium-binding proteins, histones, and interleukin 1 (IL-1) family members (, ).

List of ingredients recipe. Computed tomography of the head; Medical diagnostics: Computer tomography of human brain, from base of the skull to top. Taken with intravenous contrast medium.

HMGB1 is a prototypical danger associated molecular patterns (DAMP) molecule that activates the innate immune system in response to tissue injury due to trauma, ischemia/reperfusion or infection (). HMGB1 exerts pro-inflammatory properties through its effects on Toll-like receptor (TLR) -2, -4 and the receptor for advanced glycation end products (RAGE) (, –), and it has been identified as a late mediator of LPS-induced mortality in mice (, ).

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