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Analysis of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 in Postmortem Serum and Cerebrospinal Fluid in Traumatic Cerebral Deaths

Year 2022, Volume: 12 Issue: 1, 242 - 248, 30.03.2022
https://doi.org/10.33808/clinexphealthsci.943779

Abstract

Objective: There is a growing body of research aimed at identifying biological markers that could indicate traumatic cerebral deaths such as traumatic brain damage in the postmortem period. In the event of astrocytic and neuronal injury, glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) are released into cerebrospinal fluid and blood. In the postmortem identification of traumatic brain injury, the present research explores the ability of GFAP and UCH-L1.
Methods: Cerebrospinal fluid and blood samples were obtained from medicolegal autopsies, 17 cases with severe head trauma, 9 cases with the non-lethal head trauma group and 18 control cases. UCH-L1 and GFAP levels in postmortem cerebrospinal fluid and serum were determined
from an enzyme-linked immunosorbent assay (ELISA).
Results: GFAP level in cerebrospinal fluid and serum was 2.68±0.67 ng/ml and 0.79±0.92 ng/ml in the lethal head trauma group, 2.74±0.64 ng/ml and 1.05±0.68 ng/ml the non-lethal head trauma group and 2.49±0.55 ng/ml and 1.05±0.89 ng/ml in the control group, respectively.
UCH-L1 level in cerebrospinal fluid and serum was 3.02±0.68 ng/ml and 2.69±0.77 ng/ml in the lethal head trauma group, 3.34±0.70 ng/ml and 2.59±0.65 ng/ml the non-lethal head trauma group and 3.28±0.33 ng/ml and 2.74±0.34 ng/ml in the control group, respectively. Elevated cerebrospinal fluid and serum UCH-L1 and GFAP levels were observed in all cases, although absence of statistically significant difference between the trauma and control groups (p>0.05).
Conclusion: Further studies are needed to assess whether postmortem serum and CSF GFAP and UCH-L1 concentrations increase regardless of the cause of death.

Supporting Institution

Scientific Research Coordination Unit of Pamukkale University

Project Number

2018HZDP017

Thanks

This study was supported by Scientific Research Coordination Unit of Pamukkale University under the project number 2018HZDP017.

References

  • [1] Knight B, Saukko P. Knight’s Forensic Pathology. London: E Arnold, 2004: 98-135.
  • [2] Werner C, Engelhard K. Pathophysiology of traumatic brain injury. Br J Anaesth. 2007 Jul;99(1):4-9.
  • [3] Olczak M, Niderla-Bielińska J, Kwiatkowska M, Samojłowicz D, Tarka S, Wierzba-Bobrowicz T. Tau protein (MAPT) as a possible biochemical marker of traumatic brain injury in postmortem examination. Forensic Sci Int. 2017;280:1-7.
  • [4] Diaz-Arrastia R, Wang KK, Papa L, Sorani MD, Yue JK, Puccio AM, McMahon PJ, Inoue T, Yuh EL, Lingsma HF, Maas AIR, Valadka AB, Okonkwo DO, Manley GT, TRACK-TBI Investigators. Acute biomarkers of traumatic brain injury: relationship between plasma levels of ubiquitin C-terminal hydrolase-L1 and glial fibrillary acidic protein. J Neurotrauma 2014;31(1):19-25.
  • [5] Jones A, Jarvis P. Review of the potential use of blood neurobiomarkers in the diagnosis of mild traumatic brain injury. Clin Exp Emerg Med. 2017;4(3):121-127.
  • [6] Zetterberg H, Blennow K. Fluid markers of traumatic brain injury. Mol Cell Neurosci 2015; 66: 99-102.
  • [7] Olczak M, Kwiatkowska M, Niderla-Bielińska J, Chutorański D, Tarka S, Wierzba-Bobrowicz T. Brain-originated peptides as possible biochemical markers of traumatic brain injury in cerebrospinal fluid post-mortem examination. Folia Neuropathol. 2018;56(2):97-103.
  • [8] Breitling B, Brunkhorst R, Verhoff M, Foerch C. Post-mortem serum concentrations of GFAP correlate with agony time but do not indicate a primary cerebral cause of death. PLoS One 2018;13(10):1-11.
  • [9] Missler U, Wiesmann M, Wittmann G, Magerkurth O, Hagenstrom H. Measurement of glial fibrillary acidic protein in human blood: analytical method and preliminary clinical results. Clin Chem 1999;45(1):138–141.
  • [10] Foerch C, Niessner M, Back T, Bauerle M, De Marchis GM, Ferbert A, Grehl H, Hamann GF, Jacobs A, Kastrup A, Klimpe S, Palm F, Thomalla G, Worthmann H, Sitzer M, BE FAST Study Group. Diagnostic accuracy of plasma glial fibrillary acidic protein for differentiating intracerebral hemorrhage and cerebral ischemia in patients with symptoms of acute stroke. Clin Chem. 2012;58(1):237-245.
  • [11] Helwig K, Seeger F, Hölschermann H, Lischke V, Gerriets T, Niessner M, Foerch C. Elevated Serum Glial Fibrillary Acidic Protein (GFAP) is Associated with Poor Functional Outcome After Cardiopulmonary Resuscitation. Neurocrit Care 2017;27(1):68-74.
  • [12] Herrmann M, Vos P, Wunderlich MT, de Bruijn CH, Lamers KJ. Release of glial tissue-specific proteins after acute stroke: A comparative analysis of serum concentrations of protein S-100B and glial fibrillary acidic protein. Stroke 2000;31(11):2670-2677.
  • [13] Doran JF, Jackson P, Kynoch PA, Thompson RJ. Isolation of PGP 9.5, a new human neurone-specific protein detected by highresolution two-dimensional electrophoresis. J Neurochem. 1983;40(6):1542-1547.
  • [14] Day IN, Thompson RJ. UCHL1 (PGP 9.5): neuronal biomarker and ubiquitin system protein. Prog Neurobiol. 2010;90(3):327- 362.
  • [15] Paul Bishop, Dan Rocca, Jeremy M. Henley. Ubiquitin C-terminal hydrolase L1 (UCH-L1): structure, distribution and roles in brain function and dysfunction. Biochem J. 2016; 473(16): 2453–2462.
  • [16] Papa L, Akinyi L, Liu MC, Pineda JA, Tepas JJ, Oli MW, Zheng W, Robinson G, Robicsek SA, Gabrielli A, Heaton SC, Hannay HJ, Demery JA, Brophy GM, Layon J, Robertson CS, Hayes RL, Wang KK. Ubiquitin C-terminal hydrolase is a novel biomarker in humans for severe traumatic brain injury. Crit Care Med. 2010;38(1):138-144.
  • [17] Iliff JJ, Chen MJ, Plog BA, Zeppenfeld DM, Soltero M, Yang L, Singh I, Deane R, Nedergaard M. Impairment of glymphatic pathway function promotes tau pathology after traumatic brain injury. J Neurosci. 2014; 34 (49): 16180-16193.
  • [18] Plog BA, Dashnaw ML, Hitomi E, Peng W, Liao Y, Lou N, Rashid Deane R, Nedergaard M. Biomarkers of traumatic injury are transported from brain to blood via the glymphatic system. J Neurosci. 2015;35(2):518-526.
  • [19] Fraser DD, Close TE, Rose KL, Ward R, Mehl M, Farrell C, Lacroix J, Creery D, Kesselman M, Stanimirovic D, Hutchison JS, Canadian Critical Care Translational Biology Group. Severe traumatic brain injury in children elevates glial fibrillary acidic protein in cerebrospinal fluid and serum. Pediatr Crit Care Med. 2011;12(3):319-324.
  • [20] Mondello S, Papa L, Buki A, Bullock MR, Czeiter E, Tortella FC Wang KK, Hayes RL. Neuronal and glial markers are differently associated with computed tomography findings and outcome in patients with severe traumatic brain injury: a case control study. Crit Care. 2011;15(3):R156.
  • [21] Hausmann R, Riess R, Fieguth A, Betz P. Immunohistochemical investigations on the course of astroglial GFAP expression following human brain injury. Int J Legal Med. 2000;113(2):70– 75.
  • [22] Hozumi I, Aquino DA, Norton WT. GFAP mRNA levels following stab wound in rat brain. Brain Res. 1990;534(1-2):291–294
  • [23] Lescuyer P, Allard L, Zimmermann-Ivol CG, Burgess JA, Hughes-Frutiger S, Burkhard PR, Sanchez JC, Hochstrasser DF. Identification of post-mortem cerebrospinal fluid proteins as potential biomarkers of ischemia and neurodegeneration. Proteomics 2004;4(8):2234-2241.
  • [24] Teunissen CE, Petzold A, Bennett JL, Berven FS, Brundin L, Comabella M, Franciotta D, Frederiksen J L, Fleming J O, Furlan R, Hintzen R Q, Hughes S G, Johnson M H, Krasulova E, Kuhle J, Magnone M C, Rajda C, Rejdak K, Schmidt H K, Pesch V van, Waubant E, Wolf C, Giovannoni G, Hemmer B, Tumani H, Deisenhammer F. A consensus protocol for the standardization of cerebrospinal fluid collection and biobanking. Neurology 2009;73(22):1914-1922.
  • [25] Gul SS, Huesgen KW, Wang KK, Mark K, Tyndall JA. Prognostic utility of neuroinjury biomarkers in post out-of-hospital cardiac arrest (OHCA) patient management. Med Hypotheses 2017;105:34-47.
  • [26] Chalak LF, Sánchez PJ, Adams-Huet B, Laptook AR, Heyne RJ, Rosenfeld CR. Biomarkers for severity of neonatal hypoxicischemic encephalopathy and outcomes in newborns receiving hypothermia therapy. J Pediatr. 2014;164(3):468-474.
  • [27] Liu MC, Akinyi L, Scharf D, Mo J, Larner SF, Muller U, Oli MW, Zheng W, Kobeissy F, Papa L, Lu XC, Dave JR, Tortella FC, Hayes RL, Wang KKW. Ubiquitin C-terminal hydrolase-L1 as a biomarker for ischemic and traumatic brain injury in rats. Eur J Neurosci. 2010;31(4):722–732.
  • [28] Papa L, Brophy GM, Welch RD, Lewis LM, Braga CF, Tan CN, Ameli NJ, Lopez MA, Haeussler CA, Giordano DIM, Silvestri S, Giordano P, Weber KD, Hill-Pryor C, Hack DC. Time course and diagnostic accuracy of glial and neuronal blood biomarkers GFAP and UCH-L1 in a large cohort of trauma patients with and without mild traumatic brain injury. JAMA Neurology 2016;73(5):551–560.
  • [29] Mondello S, Linnet A, Buki A, Robicsek S, Gabrielli A, Tepas J, Papa L, Brophy GM, Tortella F, Hayes RL, Wang KK. Clinical utility of serum levels of ubiquitin C-terminal hydrolase as a biomarker for severe traumatic brain injury. Neurosurgery 2012;70(3):666-675.
  • [30] Fink EL, Berger RP, Clark RS, Watson RS, Angus DC, Panigrahy A, Richichi R, Callaway CW, Bell MJ, Mondello S, Hayes RL, Kochanek PM. Exploratory study of serum ubiquitin carboxylterminal esterase L1 and glial fibrillary acidic protein for outcome prognostication after pediatric cardiac arrest. Resuscitation 2016;101:65-70.
  • [31] Siman R, Roberts VL, McNeil E, Dang A, Bavaria JE, Ramchandren S, McGarvey M. Biomarker evidence for mild central nervous system injury after surgically-induced circulation arrest. Brain Res. 2008;1213: 1-11
  • [32] Piette MH, Pieters SE, De Letter EA. Evaluation of the agonal stress: can immunohistochemical detection of ubiquitin in the locus coeruleus be useful? Int J Legal Med. 2011;125(3):333- 340.
Year 2022, Volume: 12 Issue: 1, 242 - 248, 30.03.2022
https://doi.org/10.33808/clinexphealthsci.943779

Abstract

Project Number

2018HZDP017

References

  • [1] Knight B, Saukko P. Knight’s Forensic Pathology. London: E Arnold, 2004: 98-135.
  • [2] Werner C, Engelhard K. Pathophysiology of traumatic brain injury. Br J Anaesth. 2007 Jul;99(1):4-9.
  • [3] Olczak M, Niderla-Bielińska J, Kwiatkowska M, Samojłowicz D, Tarka S, Wierzba-Bobrowicz T. Tau protein (MAPT) as a possible biochemical marker of traumatic brain injury in postmortem examination. Forensic Sci Int. 2017;280:1-7.
  • [4] Diaz-Arrastia R, Wang KK, Papa L, Sorani MD, Yue JK, Puccio AM, McMahon PJ, Inoue T, Yuh EL, Lingsma HF, Maas AIR, Valadka AB, Okonkwo DO, Manley GT, TRACK-TBI Investigators. Acute biomarkers of traumatic brain injury: relationship between plasma levels of ubiquitin C-terminal hydrolase-L1 and glial fibrillary acidic protein. J Neurotrauma 2014;31(1):19-25.
  • [5] Jones A, Jarvis P. Review of the potential use of blood neurobiomarkers in the diagnosis of mild traumatic brain injury. Clin Exp Emerg Med. 2017;4(3):121-127.
  • [6] Zetterberg H, Blennow K. Fluid markers of traumatic brain injury. Mol Cell Neurosci 2015; 66: 99-102.
  • [7] Olczak M, Kwiatkowska M, Niderla-Bielińska J, Chutorański D, Tarka S, Wierzba-Bobrowicz T. Brain-originated peptides as possible biochemical markers of traumatic brain injury in cerebrospinal fluid post-mortem examination. Folia Neuropathol. 2018;56(2):97-103.
  • [8] Breitling B, Brunkhorst R, Verhoff M, Foerch C. Post-mortem serum concentrations of GFAP correlate with agony time but do not indicate a primary cerebral cause of death. PLoS One 2018;13(10):1-11.
  • [9] Missler U, Wiesmann M, Wittmann G, Magerkurth O, Hagenstrom H. Measurement of glial fibrillary acidic protein in human blood: analytical method and preliminary clinical results. Clin Chem 1999;45(1):138–141.
  • [10] Foerch C, Niessner M, Back T, Bauerle M, De Marchis GM, Ferbert A, Grehl H, Hamann GF, Jacobs A, Kastrup A, Klimpe S, Palm F, Thomalla G, Worthmann H, Sitzer M, BE FAST Study Group. Diagnostic accuracy of plasma glial fibrillary acidic protein for differentiating intracerebral hemorrhage and cerebral ischemia in patients with symptoms of acute stroke. Clin Chem. 2012;58(1):237-245.
  • [11] Helwig K, Seeger F, Hölschermann H, Lischke V, Gerriets T, Niessner M, Foerch C. Elevated Serum Glial Fibrillary Acidic Protein (GFAP) is Associated with Poor Functional Outcome After Cardiopulmonary Resuscitation. Neurocrit Care 2017;27(1):68-74.
  • [12] Herrmann M, Vos P, Wunderlich MT, de Bruijn CH, Lamers KJ. Release of glial tissue-specific proteins after acute stroke: A comparative analysis of serum concentrations of protein S-100B and glial fibrillary acidic protein. Stroke 2000;31(11):2670-2677.
  • [13] Doran JF, Jackson P, Kynoch PA, Thompson RJ. Isolation of PGP 9.5, a new human neurone-specific protein detected by highresolution two-dimensional electrophoresis. J Neurochem. 1983;40(6):1542-1547.
  • [14] Day IN, Thompson RJ. UCHL1 (PGP 9.5): neuronal biomarker and ubiquitin system protein. Prog Neurobiol. 2010;90(3):327- 362.
  • [15] Paul Bishop, Dan Rocca, Jeremy M. Henley. Ubiquitin C-terminal hydrolase L1 (UCH-L1): structure, distribution and roles in brain function and dysfunction. Biochem J. 2016; 473(16): 2453–2462.
  • [16] Papa L, Akinyi L, Liu MC, Pineda JA, Tepas JJ, Oli MW, Zheng W, Robinson G, Robicsek SA, Gabrielli A, Heaton SC, Hannay HJ, Demery JA, Brophy GM, Layon J, Robertson CS, Hayes RL, Wang KK. Ubiquitin C-terminal hydrolase is a novel biomarker in humans for severe traumatic brain injury. Crit Care Med. 2010;38(1):138-144.
  • [17] Iliff JJ, Chen MJ, Plog BA, Zeppenfeld DM, Soltero M, Yang L, Singh I, Deane R, Nedergaard M. Impairment of glymphatic pathway function promotes tau pathology after traumatic brain injury. J Neurosci. 2014; 34 (49): 16180-16193.
  • [18] Plog BA, Dashnaw ML, Hitomi E, Peng W, Liao Y, Lou N, Rashid Deane R, Nedergaard M. Biomarkers of traumatic injury are transported from brain to blood via the glymphatic system. J Neurosci. 2015;35(2):518-526.
  • [19] Fraser DD, Close TE, Rose KL, Ward R, Mehl M, Farrell C, Lacroix J, Creery D, Kesselman M, Stanimirovic D, Hutchison JS, Canadian Critical Care Translational Biology Group. Severe traumatic brain injury in children elevates glial fibrillary acidic protein in cerebrospinal fluid and serum. Pediatr Crit Care Med. 2011;12(3):319-324.
  • [20] Mondello S, Papa L, Buki A, Bullock MR, Czeiter E, Tortella FC Wang KK, Hayes RL. Neuronal and glial markers are differently associated with computed tomography findings and outcome in patients with severe traumatic brain injury: a case control study. Crit Care. 2011;15(3):R156.
  • [21] Hausmann R, Riess R, Fieguth A, Betz P. Immunohistochemical investigations on the course of astroglial GFAP expression following human brain injury. Int J Legal Med. 2000;113(2):70– 75.
  • [22] Hozumi I, Aquino DA, Norton WT. GFAP mRNA levels following stab wound in rat brain. Brain Res. 1990;534(1-2):291–294
  • [23] Lescuyer P, Allard L, Zimmermann-Ivol CG, Burgess JA, Hughes-Frutiger S, Burkhard PR, Sanchez JC, Hochstrasser DF. Identification of post-mortem cerebrospinal fluid proteins as potential biomarkers of ischemia and neurodegeneration. Proteomics 2004;4(8):2234-2241.
  • [24] Teunissen CE, Petzold A, Bennett JL, Berven FS, Brundin L, Comabella M, Franciotta D, Frederiksen J L, Fleming J O, Furlan R, Hintzen R Q, Hughes S G, Johnson M H, Krasulova E, Kuhle J, Magnone M C, Rajda C, Rejdak K, Schmidt H K, Pesch V van, Waubant E, Wolf C, Giovannoni G, Hemmer B, Tumani H, Deisenhammer F. A consensus protocol for the standardization of cerebrospinal fluid collection and biobanking. Neurology 2009;73(22):1914-1922.
  • [25] Gul SS, Huesgen KW, Wang KK, Mark K, Tyndall JA. Prognostic utility of neuroinjury biomarkers in post out-of-hospital cardiac arrest (OHCA) patient management. Med Hypotheses 2017;105:34-47.
  • [26] Chalak LF, Sánchez PJ, Adams-Huet B, Laptook AR, Heyne RJ, Rosenfeld CR. Biomarkers for severity of neonatal hypoxicischemic encephalopathy and outcomes in newborns receiving hypothermia therapy. J Pediatr. 2014;164(3):468-474.
  • [27] Liu MC, Akinyi L, Scharf D, Mo J, Larner SF, Muller U, Oli MW, Zheng W, Kobeissy F, Papa L, Lu XC, Dave JR, Tortella FC, Hayes RL, Wang KKW. Ubiquitin C-terminal hydrolase-L1 as a biomarker for ischemic and traumatic brain injury in rats. Eur J Neurosci. 2010;31(4):722–732.
  • [28] Papa L, Brophy GM, Welch RD, Lewis LM, Braga CF, Tan CN, Ameli NJ, Lopez MA, Haeussler CA, Giordano DIM, Silvestri S, Giordano P, Weber KD, Hill-Pryor C, Hack DC. Time course and diagnostic accuracy of glial and neuronal blood biomarkers GFAP and UCH-L1 in a large cohort of trauma patients with and without mild traumatic brain injury. JAMA Neurology 2016;73(5):551–560.
  • [29] Mondello S, Linnet A, Buki A, Robicsek S, Gabrielli A, Tepas J, Papa L, Brophy GM, Tortella F, Hayes RL, Wang KK. Clinical utility of serum levels of ubiquitin C-terminal hydrolase as a biomarker for severe traumatic brain injury. Neurosurgery 2012;70(3):666-675.
  • [30] Fink EL, Berger RP, Clark RS, Watson RS, Angus DC, Panigrahy A, Richichi R, Callaway CW, Bell MJ, Mondello S, Hayes RL, Kochanek PM. Exploratory study of serum ubiquitin carboxylterminal esterase L1 and glial fibrillary acidic protein for outcome prognostication after pediatric cardiac arrest. Resuscitation 2016;101:65-70.
  • [31] Siman R, Roberts VL, McNeil E, Dang A, Bavaria JE, Ramchandren S, McGarvey M. Biomarker evidence for mild central nervous system injury after surgically-induced circulation arrest. Brain Res. 2008;1213: 1-11
  • [32] Piette MH, Pieters SE, De Letter EA. Evaluation of the agonal stress: can immunohistochemical detection of ubiquitin in the locus coeruleus be useful? Int J Legal Med. 2011;125(3):333- 340.
There are 32 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Ayşe Kurtuluş Dereli 0000-0002-0592-585X

Mücahit Seçme 0000-0002-2084-760X

Kemalettin Acar 0000-0002-0200-4764

Project Number 2018HZDP017
Publication Date March 30, 2022
Submission Date May 31, 2021
Published in Issue Year 2022 Volume: 12 Issue: 1

Cite

APA Kurtuluş Dereli, A., Seçme, M., & Acar, K. (2022). Analysis of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 in Postmortem Serum and Cerebrospinal Fluid in Traumatic Cerebral Deaths. Clinical and Experimental Health Sciences, 12(1), 242-248. https://doi.org/10.33808/clinexphealthsci.943779
AMA Kurtuluş Dereli A, Seçme M, Acar K. Analysis of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 in Postmortem Serum and Cerebrospinal Fluid in Traumatic Cerebral Deaths. Clinical and Experimental Health Sciences. March 2022;12(1):242-248. doi:10.33808/clinexphealthsci.943779
Chicago Kurtuluş Dereli, Ayşe, Mücahit Seçme, and Kemalettin Acar. “Analysis of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 in Postmortem Serum and Cerebrospinal Fluid in Traumatic Cerebral Deaths”. Clinical and Experimental Health Sciences 12, no. 1 (March 2022): 242-48. https://doi.org/10.33808/clinexphealthsci.943779.
EndNote Kurtuluş Dereli A, Seçme M, Acar K (March 1, 2022) Analysis of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 in Postmortem Serum and Cerebrospinal Fluid in Traumatic Cerebral Deaths. Clinical and Experimental Health Sciences 12 1 242–248.
IEEE A. Kurtuluş Dereli, M. Seçme, and K. Acar, “Analysis of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 in Postmortem Serum and Cerebrospinal Fluid in Traumatic Cerebral Deaths”, Clinical and Experimental Health Sciences, vol. 12, no. 1, pp. 242–248, 2022, doi: 10.33808/clinexphealthsci.943779.
ISNAD Kurtuluş Dereli, Ayşe et al. “Analysis of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 in Postmortem Serum and Cerebrospinal Fluid in Traumatic Cerebral Deaths”. Clinical and Experimental Health Sciences 12/1 (March 2022), 242-248. https://doi.org/10.33808/clinexphealthsci.943779.
JAMA Kurtuluş Dereli A, Seçme M, Acar K. Analysis of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 in Postmortem Serum and Cerebrospinal Fluid in Traumatic Cerebral Deaths. Clinical and Experimental Health Sciences. 2022;12:242–248.
MLA Kurtuluş Dereli, Ayşe et al. “Analysis of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 in Postmortem Serum and Cerebrospinal Fluid in Traumatic Cerebral Deaths”. Clinical and Experimental Health Sciences, vol. 12, no. 1, 2022, pp. 242-8, doi:10.33808/clinexphealthsci.943779.
Vancouver Kurtuluş Dereli A, Seçme M, Acar K. Analysis of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 in Postmortem Serum and Cerebrospinal Fluid in Traumatic Cerebral Deaths. Clinical and Experimental Health Sciences. 2022;12(1):242-8.

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