Not only is brain damage caused by mechanical injury, but initial impact triggers a destructive cascade of biological events sustained over hours or days that exacerbate the injury. The cascade involves the activation of two enzymes; calpain and caspase, which break down proteins in brain cells, resulting in progressive damage and death of brain tissue.

Banyan has discovered a number of protein fragments in the blood of brain injured patients and has developed, or is developing, sandwich Enzyme Linked Immunosorbent Assays (ELISA) to quantify these biomarkers. These and other biomarkers can be used for point-of-care diagnosis and to follow the progression of other diseases.

Traumatic Brain Injury: Q & A

1. What is traumatic brain injury (TBI) and why is it such a major civilian and military problem?
   Traumatic brain injury results from the mechanical impact to the skull - like a car accident or bullet wound. TBI is often called "the silent epidemic" because few people recognize that more than 1.4 million people annually suffer TBI in the U.S. resulting in more than 230,000 hospitalizations, 50,000 deaths and 80,000-90,0000 experience permanent disability from their injury. Currently, 5.3 million Americans live with TBI-related disabilities; compared with the more than 4 million disabled by Alzheimer's disease. More than 80% of TBIs are concussive injuries and 90% of the 300,000 sports-related TBIs are concussions and often go unreported.
   
   TBI is also one of the most frequent causes of morbidity and mortality on the modern battlefield. Nearly half of all combat deaths result from injuries to the head, and these injuries are among the most frequent causes of persistent disability for survivors. U.S. casualties in Iraq may be suffering a greater percentage of brain injuries than in previous wars. Recent assessments have indicated that about 2/3 of casualties have brain injuries, and concussion is a growing military medical problem.
   
   
2. What happens when a TBI occurs and how is it currently treated?
   Surprisingly, TBI often results more from secondary pathological biochemical responses than from the mechanical impact itself. Currently, there are no treatments for TBI. The best hope for patients suffering TBI is to receive careful medical management, an elusive goal in the absence of good markers for TBI or the obvious improvement or deterioration of the patient's condition. The American Association of Neurological Surgeons has established guidelines for management of TBI patients. Unfortunately, less than 50% of patients are managed according to these guidelines, resulting in poorer clinical outcomes.