# Brainstem Connectome Mapping to Guide Targeted Stimulant Therapy in Patients with Traumatic Coma

> **NIH NIH R21** · MASSACHUSETTS GENERAL HOSPITAL · 2020 · $218,280

## Abstract

Project Summary/Abstract
More than one million civilians experience a coma from severe traumatic brain injury (TBI) each year, and
thousands of military personnel have experienced a traumatic coma since the start of Operation Enduring
Freedom in 2001. Many civilians and veterans face prolonged disorders of consciousness or devastating
disability, but recovery of consciousness, communication, and functional independence are possible. This
recovery depends upon the preservation of axonal connections within the brainstem’s ascending arousal network
(AAN), a subcortical network whose activation of the cerebral cortex is essential for human consciousness. Yet
despite the AAN’s critical role in consciousness, there are currently no clinical tools available to identify comatose
patients who retain sufficient AAN connectivity to recover consciousness. This limitation leads to inaccurate
prognostication and increases the likelihood that life-sustaining therapy will be withdrawn prematurely in the
intensive care unit. Moreover, an AAN connectivity map is needed to develop targeted therapies that stimulate
AAN neurotransmission, reactivate the cortex and restore consciousness. In this R21 application, we propose
to develop an automated AAN segmentation algorithm that will enable AAN connectivity mapping in patients with
acute traumatic coma. The segmentation algorithm will be based upon integration of histological immunostaining
data and ex vivo 7 Tesla MRI data acquired at ultra-high resolution (100-200 µm) in ten postmortem human brain
specimens. The algorithm will be validated for in vivo use in an MRI dataset of 25 healthy human subjects and
will then be applied to an MRI dataset acquired in 25 patients with acute traumatic coma. Our goal is to create
a quantitative AAN connectivity biomarker for an upcoming clinical trial: STIMPACT (Stimulant Therapy Targeted
to Individualized Connectivity Maps to Promote ReACTivation of Consciousness). This work is expected to have
a significant positive impact because we will disseminate the automated segmentation algorithm to the academic
community to advance the study of human consciousness, and because our approach will usher in a new era of
targeted stimulant therapy aimed at promoting recovery of consciousness based upon personalized AAN
connectivity maps.

## Key facts

- **NIH application ID:** 10018117
- **Project number:** 5R21NS109627-02
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Brian L. Edlow
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $218,280
- **Award type:** 5
- **Project period:** 2019-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10018117

## Citation

> US National Institutes of Health, RePORTER application 10018117, Brainstem Connectome Mapping to Guide Targeted Stimulant Therapy in Patients with Traumatic Coma (5R21NS109627-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10018117. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*