Subject-specific multiscale analysis of concussion: from macroscopic loads to molecular-level damage

Abstract Sports concussion is a form of mild traumatic brain injury (mTBI) caused by an impulsive force transmitted to the head. While concussion is recognized as a complex pathophysiological process affecting the brain at multiple scales, the causal link between external load and cellular, molecular level damage in mTBI remains elusive. The present study proposes a multiscale framework to analyze concussion and demonstrates its applicability with a real-life concussion case. The multiscale analysis starts from inputting mouth guard-recorded head kinematic into a detailed finite element (FE) head model tailored to the subject's head and white matter (WM) tract morphology. The resulting WM tract-oriented strains are then extracted and input to histology-informed micromechanical models of corpus callosum subregions with axonal detail to obtain axolemma strains at a subcellular level. By comparing axolemma strains against mechanoporation thresholds obtained via molecular dynamics (MD) simulations, axonal damage is inferred corresponding to a likelihood of concussion, in line with clinical observation. This novel multiscale framework bridges the organ-to-molecule length scales and accounts both inter- and intra-subject regional variability, providing a new way of non-invasively predicting axonal damage and real-life concussion analysis. The framework may contribute to a better understanding of the mechanistic causes behind concussion. Statement of Significance This study reports a multiscale computational framework for concussion, for the first time revealing a picture of how a global impact to the head measured on the field transfers to the cellular level of axons and finally down to the molecular level. Demonstrated with a real-life concussion case using a detailed and subject-specific head model, the results show molecular level damage corresponds to a likelihood of concussion, in line with clinical observation. An insight into the multiscale mechanical consequences is critical for a better understanding of the complex pathophysiological process affecting the brain at impact, which today are still poorly understood. Analyzing the concussive injury mechanisms the whole way from brains to molecules may also have significant clinical relevance. We show that in a typical injury scenario, the axolemma sustains large enough strains to entail pore formation in the adjoining lipid bilayer. Proration is found to occur in bilayer regions lacking ganglioside lipids, which provides important implications for the treatment of brain injury and other related neurodegenerative diseases.