UNC Health Talk

UNC leads first-of-its-kind, $21-million study of posttraumatic brain disorders

More than 2.5 million Americans have deployed to Iraq and Afghanistan since September 11, 2001. Among these veterans, chronic problems with brain health are common, including posttraumatic stress, minor traumatic brain injury symptoms, chronic pain, and depression. These same problems are common among civilian survivors of traumatic events such as motor vehicle collision and sexual assault. For the first time, researchers from across the country will join together to comprehensively evaluate the biological basis of these disorders from the immediate aftermath of trauma, thanks to a $21-million National Institutes of Health grant. The goal is to create more effective interventions for trauma survivors.

The newly launched AURORA study, led by Samuel McLean, MD, MPH, associate professor in the departments of anesthesiology and emergency medicine at the UNC School of Medicine, has three overarching goals: to characterize posttraumatic disorders at a fundamental biological level, to determine how these disorders develop, and to develop tools that will help clinicians identify individuals at high risk in the early aftermath of trauma.

More than 2.5 million Americans have deployed to Iraq and Afghanistan since September 11, 2001.

To accomplish this, McLean will bring together researchers and physicians from 19 institutions to enroll trauma survivors in the immediate aftermath of a traumatic event.

“Two hundred years ago, a soldier’s wounds from battle always got infected, because we didn’t understand the biology of infection,” said McLean, who is also research vice chair in the department of anesthesiology. “Once we learned that bacteria cause infection, we could develop ways to disinfect wounds and keep them clean, and wound infection went from very common to very rare. Today, with these posttraumatic disorders, we are right where we were two hundred years ago; they are common, we don’t understand how they develop, and we can’t prevent them. The goal of the AURORA study is to develop new insights into biology that will allow us to prevent these morbid outcomes that are so common in military veterans and civilian trauma survivors.”

Study participants will be enrolled in the immediate aftermath of trauma, and will receive a relatively comprehensive “molecules-to-symptoms” evaluation over the ensuing year, including genomic, neuroimaging, neurocognitive, behavioral, and symptom assessments.

“Assessing biologic processes directly, during the critical period of time after trauma when these disorders develop, is the best way to achieve the breakthroughs we need in order to prevent and better treat these posttraumatic disorders,” McLean said.

Among these veterans, chronic problems with brain health are common, including post-traumatic stress, minor traumatic brain injury symptoms, chronic pain, and depression.

The researchers will also periodically assess patients using flash surveys that study participants can access through their smart phones, and will collect bioinformatic information through wearable devices. The goal is to accumulate data that will give researchers the most comprehensive picture possible. “We’re not studying a particular disease,” McLean said. “We’re really trying to understand the individual and all that they are going through, and then work backwards from that to determine causes.”

The study is unprecedented in both comprehensiveness of the data and in its scope. Its initial recruitment goal is 5,000 trauma survivors. These individuals will be enrolled in the study in the emergency department, in the immediate aftermath of trauma.

“This will be the largest and most comprehensive longitudinal study of trauma survivors, beginning the early aftermath of trauma, that’s ever been done,” McLean said.

McLean and colleagues are currently pursuing additional foundation and philanthropic support to further increase the ability of the study to help trauma survivors and achieve new discoveries.

“Twenty-one million dollars sounds like a heck of a lot of money, and it is, but given the very high costs of the latest science – comprehensive molecular, neuroimaging, and bioinformatic methods – we actually need to leverage these public dollars with private support so that we can take full advantage of this once-in-a-generation opportunity to advance care for veterans and civilian survivors of traumas such as sexual assault.”

“Posttraumatic stress, depression, MTBI – these problems are epidemic in the veteran community and in civilian trauma survivors,” McLean said. “For individuals suffering from these conditions, we are going to do everything that we can to try to help.”

The AURORA study is funded by the National Institute of Mental Health, and will be based at the University of North Carolina at Chapel Hill.

Other UNC researchers on the project include Kenneth Bollen, PhD, Immerwahr Distinguished Professor in the departments of psychology, neuroscience and sociology, who will lead critical data analyses evaluating the pathogenesis of posttraumatic syndromes; and Sarah Linnstaedt, assistant professor of anesthesiology, who will help lead critical analyses evaluating the role of miRNA in disease pathogenesis.