Imagine two people with traumatic brain injuries that resulted from horrific car crashes. They’re the same age and gender, with similar wounds. Yet one makes a full recovery, while the other struggles with headaches and dizziness years after the incident.

Jessica Gill, the Bloomberg Distinguished Professor of Trauma Recovery Biomarkers at The Johns Hopkins University, is learning why traumatic brain injuries (TBIs) are so different from one patient to the next. 

Her PRECEDE Lab (Promoting Resilience through Emerging Clinical and Evolving Determinants of Equity Biomarkers) is identifying biomarkers for patients with TBIs who are at particular risk for long-term effects, including post-traumatic stress disorder, depression and the cluster of symptoms known as post-concussive syndrome, which can include headaches, dizziness, cognitive impairment, irritability and anxiety.

The findings are beginning to be used to guide care protocols, help clinicians set expectations with patients, and develop treatments for these injuries.

“We don’t know why people have different experiences with brain injury,” says Gill, who has primary appointments in the Johns Hopkins University School of Nursing and the Department of Neurology. “That’s the fundamental question of our work. Our lab is focused on how we can measure these things in a more accurate and precise way, so we can provide early intervention.”

Currently, the standard of care for a patient arriving in an emergency room with a brain injury is a CT scan to confirm the injury and its location, combined with monitoring for symptoms such as slurred speech or dizziness.

Yet, as Gill explains, serious brain injuries can release the same amyloids and tau proteins that are found in people with Alzheimer’s disease. A blood test identifying those proteins could show if that patient requires medical or surgical intervention, or it could be used to inform patients that they might experience symptoms such as intense headaches in the next few hours. 

From that starting point, Gill’s lab is using highly sensitive assay technology to sift through some 5,000 proteins in search of other biomarkers that may be linked to severe brain injury — “seeing what’s the most sensitive and specific combination of proteins that predict outcome,” she says.

That information is being combined with neuroimaging and clinical data to develop individualized approaches to TBI diagnosis, treatment and expectations, she says. Post-concussive symptoms such as depression, headaches and cognitive issues are also important, she says, because some symptoms seem to predict others.

“We try to understand why they come together and what the biological underpinnings are — how we can get biomarkers as early as possible to say if a patient is at high risk of having, for example, post-traumatic migraines so we can give that patient medication so they never develop,” she says. “And even if you don’t want to give medications to everybody because there are side effects, we still want to get closer to understanding the nature of it.”

Gill became interested in the underlying mechanisms of TBI response through clinical experience with patients experiencing aging, mental health issues and traumatic brain injuries. For her doctorate at the Johns Hopkins University School of Nursing, she studied the biological underpinnings of symptoms associated with those conditions, focusing more specifically on brain injuries while doing postdoctoral work at the National Institutes of Health. 

The goal of her work, she says, is “to give people information about their recovery, because it looks different for everybody.”