13Traumatic brain injuries are a leading cause of morbidity and mortality worldwide. With 14 almost 50% of traumatic brain injuries being related to axonal damage, understanding the 15 nature of cellular level impairment is crucial. Experimental observations have so far led to the 16 formulation of conflicting theories regarding the cellular primary injury mechanism. 17 Disruption of the axolemma, or alternatively cytoskeletal damage has been suggested mainly 18 as injury trigger. However, mechanoporation thresholds of generic membranes seem not to 19 overlap with the axonal injury deformation range and microtubules appear too stiff and too 20 weakly connected to undergo mechanical breaking. Here, we aim to shed a light on the 21 mechanism of primary axonal injury, bridging finite element and molecular dynamics 22 simulations. Despite the necessary level of approximation, our models can accurately 23 describe the mechanical behavior of the unmyelinated axon and its membrane. More 24 importantly, they give access to quantities that would be inaccessible with an experimental 25 approach. We show that in a typical injury scenario, the axonal cortex sustains deformations 26 large enough to entail pore formation in the adjoining lipid bilayer. The observed axonal 27 deformation of 10-12% agree well with the thresholds proposed in the literature for axonal 28 injury and, above all, allow us to provide quantitative evidences that do not exclude pore 29 formation in the membrane as a result of trauma. Our findings bring to an increased 30 knowledge of axonal injury mechanism that will have positive implications for the prevention 31 and treatment of brain injuries.
33 34Traumatic brain injury (TBI) is defined as "an alteration in brain function, or other evidence 2 of brain pathology, caused by an external force". 1 In 2013 approximately 2.8 million TBI-3 related emergency department visits, hospitalization, and deaths occurred in the United 4 States. 2 In a recent study reporting the epidemiology of TBI in Europe, Peeters and coworkers 5 analyzed data from 28 studies on 16 European countries and reported an average mortality 6 rate of ≈ 11 per 100,000 population over an incidence rate of 262 per 100,000 population per 7year. 3 Diffuse axonal injury (DAI), a multifocal damage to white matter axons, is the most 8 common consequence of TBIs of all severities including mild TBIs or concussions. 4 Invisible 9 to conventional brain imaging, DAI can only be histologically diagnosed and its hallmark is 10 the presence of axonal swellings or retraction balls observable under microscopic 11 examination. 5 12 13Considerable research effort has been put into the understanding of the primary effects of 14 trauma onto the neurons. To define an axonal injury trigger, nervous tissues and neuronal 15 cultures have been subjected to dynamic loads leading to several hypotheses regarding the 16 cell injury mechanism. Mechanoporation (i.e. the generation of membrane pores due to 17 mechanical deformation) of the axolemma has been his...