A Better Way to Diagnose Concussions

Daniel Lim, MD, PhD and Geoffrey Manley, MD, PhD
2016 - 2019 Weill Innovation Award

“If we can find an accurate blood ‘signature,’ we can more confidently diagnose and treat concussion.  It may even be possible to develop a small, portable device that allows for immediate diagnosis.” Daniel Lim, MD, PhD

UCSF neurosurgeon Daniel Lim, MD, PhD, has joined forces with Geoffrey Manley, MD, PhD, Chief of Neurosurgery at Zuckerberg San Francisco General Hospital, to develop a highly specific and sensitive diagnostic test for concussion, also known as mild traumatic brain injury (mTBI).

While the physician-scientists have trod similar paths – both attended Weill Cornell Medical College and eventually took up faculty positions in the UCSF Department of Neurosurgery – this project represents their first opportunity to bring their distinct but complementary research portfolios to the same table.

By integrating Dr. Manley’s large, ongoing, clinical TBI research program with Dr. Lim’s expertise with brain-specific long noncoding RNAs (lncRNA), the two men are working to determine which lncRNAs can be detected in the blood of patients with concussion to form the basis of a better diagnostic test.

Why this work is so crucial: “Every year, 2.5 million patients with a TBI visit an emergency department in the US, with most falling into the mild TBI, or concussion, category. Children and adults who sustain repeated concussions are at risk for more serious conditions and permanent cognitive damage.” Daniel Lim

Where the diagnostic test comes in: “We can reduce the risk of permanent cognitive damage by accurately diagnosing concussion and allowing injured patients to recover before returning to activities that present additional risk, like contact sports or military service. Daniel Lim

Right now, we have no good way of doing this. Our diagnostic toolkit is mostly made up of questions – which soldiers, athletes, and others don’t always answer honestly – and a CT scan, which can’t be administered in the field and cannot accurately diagnose mild traumatic brain injury. Daniel Lim

If we can find an accurate blood ‘signature’ for concussion, we can more confidently diagnose and make clinical recommendations.  It may even be possible to develop a small, portable device that allows for immediate diagnosis.” Daniel Lim

What made this collaboration possible: “This project was percolating in the back of my mind, and the announcement of an award from the UCSF Weill Institute provided the perfect opportunity to put a pen to paper. This is the kind of research that is too early-stage and too exploratory to earn funding from the NIH. But it is absolutely crucial.  In my opinion, most truly bold ideas are funded through philanthropy.” Daniel Lim

Why UCSF: “There is essentially no barrier between junior faculty members and senior faculty members here, which really facilitates collaboration. As a second-year assistant professor, I had an opportunity to collaborate with the chair of bioengineering at UCSF for a full three years.  She came to my little windowless office and sat on a wooden stool for our meetings. There was no sense of hierarchy.” Daniel Lim

Before he was a scientist: “As a kid, anytime something was broken, I wanted to fix it, and my dad really encouraged that instinct. When my bicycle wheel was busted, he bought me the rims, hub, and spokes all separately and wanted me to put it together. As a teenager, I never took my car to the shop. I think all of this underlies my desire to diagnose and fix the things that are broken in our patients.” Daniel Lim