• Alicia K Au, Rajesh K Aneja, Hülya Bayır, Michael J Bell, Keri Janesko-Feldman, Patrick M Kochanek, and Clark Robert S B RSB Department of Critical Care Medicine, Safar Center for Resuscitation Research and the Children's Hospital of Pittsburgh of UPMC, University of Pittsb.
• Department of Critical Care Medicine, Safar Center for Resuscitation Research and the Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, 4401 Penn Avenue, Faculty Pavilion, Suite 2000, Pittsburgh, PA, 15224, USA. auak@upmc.edu.
• Neurocrit Care. 2017 Jun 1; 26 (3): 348-355.

BackgroundAutophagy is a process that recycles damaged proteins and organelles. Beclin 1 is involved in the nucleation phase, while p62 is consumed during the elongation phase. We hypothesized that these autophagy biomarkers are increased in cerebrospinal fluid (CSF) after traumatic brain injury (TBI) in children and associated with unfavorable outcome.MethodsThirty children with severe TBI had CSF collected on days 1, 3, and 7. Patients without TBI or meningoencephalitis served as controls. Beclin 1 and p62 were measured by ELISA. Outcome was assigned 6 months after injury (Glasgow Outcome Scale score; GOS).ResultsMean and peak CSF beclin 1 and p62 levels were increased compared to controls (P < 0.05). Peak p62 levels were higher in patients with unfavorable versus favorable outcome (0.79 ± 1.03 vs. 0.17 ± 0.54 ng/ml, respectively; mean ± SD, P = 0.002) and were independently associated with outcome when controlling for age and initial Glasgow Coma Scale score (P = 0.019; AUC 0.88, 95% CI 0.76, 1.00).ConclusionsBeclin 1 and p62 are increased in CSF after TBI, suggesting increased autophagy with impairment of, and/or exceeding the capacity for, autophagic flux. The association of increased p62 with unfavorable outcome suggests that autophagy in excess of the capacity to clear degradation products may be deleterious after TBI.

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