Attorneys Frequently Asked Questions

Neural-Injury Assessment Test™ Complete Panel and Neural-Injury Assessment Test™ Biomarker Panel

Laboratory Quality & Validation

What quality standards does Brazos Neuroscience laboratory follow?

The Neural-Injury Assessment Test™ is performed in a Clinical Laboratory Improvement Amendments (CLIA)-certified and College of American Pathologists (CAP)-accredited laboratory, reflecting compliance with rigorous federal and industry standards for laboratory quality, analytical performance, and ongoing quality assurance. The biomarkers included in the test are supported by a growing body of scientific literature and research related to traumatic brain injury, neurotoxicity, neuroinflammation, and neurological health.

What does it mean that Brazos Neuroscience is a CLIA-certified and CAP-accredited laboratory?

The Neural-Injury Assessment Test™ is performed in a Clinical Laboratory Improvement Amendments (CLIA)-certified and College of American Pathologists (CAP)-accredited laboratory. The biomarkers included in the test are supported by a growing body of scientific literature and research related to traumatic brain injury, neurotoxicity, neuroinflammation, and neurological health.

As part of CLIA and CAP requirements, the laboratory validates its testing methods, maintains comprehensive quality control procedures, participates in proficiency testing when applicable, and undergoes routine inspections to help ensure testing continues to meet established performance standards.

These certifications help ensure that laboratory testing is performed in a controlled, highly regulated environment using validated analytical methods.

What is the difference between an FDA-approved test and a laboratory developed test (LDT)?

FDA approval and CLIA validation serve different regulatory purposes and should not be confused.

The FDA regulates commercially manufactured diagnostic devices and test kits. In contrast, Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) regulate how clinical laboratories develop, validate, perform, and maintain laboratory testing.

The Neural-Injury Assessment Test™ is a Laboratory Developed Test (LDT) performed exclusively within Brazos Neuroscience's CLIA-certified and CAP-accredited laboratory. Unlike commercially distributed FDA-cleared diagnostic kits, Laboratory Developed Tests are analytically validated by the laboratory to demonstrate that they produce accurate, reliable, and reproducible results for their intended clinical use.

As part of this validation process, laboratories evaluate analytical performance characteristics such as accuracy, precision, reproducibility, reportable range, specimen stability, linearity, quality control, and potential sources of analytical interference. CLIA and CAP also require ongoing quality assurance, routine inspections, and proficiency testing to help ensure continued laboratory performance.

Importantly, FDA approval and CLIA/CAP validation represent different regulatory pathways. With regard to Laboratory Developed Test (LDT) reporting, federal regulations require laboratories to include a statement indicating that the assay was developed by the laboratory, along with information describing the method and performance characteristics necessary for clinical use. Accordingly, reports for the Neural-Injury Assessment Test™ include the following required statement: 'This test was developed and its performance characteristics determined by Brazos Neuroscience. It has not been cleared or approved by the U.S. Food and Drug Administration.'

This statement reflects the distinct regulatory framework governing Laboratory Developed Tests and should not be interpreted as an indication that the test is less scientifically rigorous or less reliable than an FDA-cleared or FDA-approved test. Rather, it reflects the regulatory pathway under which the test was developed, analytically validated, and is performed within a CLIA-certified and CAP-accredited laboratory.

Like all laboratory testing, Neural-Injury Assessment Test™ results should be interpreted by a healthcare provider alongside a patient's medical history, symptoms, physical examination, imaging, and other relevant clinical information."

Is the Neural-Injury Assessment Test™ efficacious?

The Neural-Injury Assessment Test™ is designed to objectively measure proteins associated with neurologic injury-related biological processes, including astroglial injury, neuronal injury, axonal injury, neuroinflammation, and tissue recovery. Biomarkers such as GFAP, UCH-L1, S100B, and neurofilament proteins are analytically measurable and have been associated in the scientific literature with neurologic injury and recovery trajectories.

The test is designed to provide accurate, reliable, and clinically meaningful biological information to support clinical decision making. It is not intended to function as a standalone diagnostic tool but rather as one component of a broader clinical evaluation interpreted alongside a patient's medical history, symptoms, physical examination, imaging studies, and other relevant clinical information.

Understanding the Test

What is the Neural-Injury Assessment Test™ Complete Panel?

The Neural-Injury Assessment Test™ Complete Panel combines protein biomarker analysis and genetic testing to provide objective biological data related to brain injury, neurological function, cellular repair processes, and certain neurological risk factors.

What does the Neural-Injury Assessment Test™ Complete Panel measure?

The Complete Panel measures:

Four Protein Biomarkers

GFAP (Glial Fibrillary Acidic Protein)

UCH-L1 (Ubiquitin Carboxyl-Terminal Hydrolase L1)

S100B (S100 Calcium-Binding Protein B)

NF-H (Neurofilament Heavy Chain)

Two Genetic Markers

APOE (Apolipoprotein E )

MTHFR (Methylenetetrahydrofolate Reductase)

These biomarkers and genetic markers provide information related to neuronal injury, glial injury, astrocyte injury, blood-brain barrier disruption, cellular response and recovery processes, and certain neurological risk factors.

What is the Neural-Injury Assessment Test™ Biomarker Panel?

The Neural-Injury Assessment Test™ Complete Panel combines a four-protein biomarker analysis to provide objective biological data related to brain injury, neurological function, cellular repair processes, and longitudinal monitoring.

What does the Neural-Injury Assessment Test™ Biomarker Panel measure?

The Neural-Injury Assessment Test™ measures four protein biomarkers:

• GFAP (Glial Fibrillary Acidic Protein)

• UCH-L1 (Ubiquitin Carboxyl-Terminal Hydrolase L1)

• S100B (S100 Calcium-Binding Protein B)

• NF-H (Neurofilament Heavy Chain)

Together, these protein biomarkers provide objective biological data related to neuronal injury, glial injury, astrocyte injury, cellular response and repair processes, neuroaxonal injury, and the longitudinal monitoring of brain injury.

What brain injuries can these tests provide insights into?

The Neural-Injury Assessment Test™ is a frontline test that can be used alongside when for clients when evaluating your clients with:

• Concussions and traumatic brain injuries (TBI)

• Motor vehicle accidents

• Falls and premises liability incidents

• Sports-related head injuries

• Military blast exposures

• Occupational and workplace injuries

• Repetitive head impacts

• Heavy metal exposure

• Carbon monoxide poisoning

• Environmental neurotoxic exposures

• Neuroinflammation and neuroimmune activation

• Conditions associated with inflammation affecting the brain and nervous system

Results should always be interpreted in conjunction with your medical history, symptoms, and other clinical findings.

Can the Neural-Injury Assessment Test™ be used beyond 30 days after an injury?

Scientific literature demonstrates that blood-based neurologic biomarkers may remain clinically relevant beyond the acute injury window and into the subacute and chronic phases of recovery. While some biomarkers peak during the acute phase, others may remain elevated or demonstrate meaningful biological patterns for weeks, months, or longer depending on injury severity, underlying biological processes, and individual recovery trajectories.

During the subacute and chronic phases, biomarker testing may provide objective biological context regarding ongoing injury-associated processes, including neuroinflammation, axonal injury, and tissue recovery. When interpreted alongside clinical history, symptoms, physical examination, imaging studies, and other diagnostic information, these biomarkers may support longitudinal clinical monitoring over time.

Blood Collection Process

How is the test performed?

The test is performed through a simple blood draw conducted by a trained phlebotomist, and typically takes only a few minutes to complete.

How will my client’s blood sample be collected?

The blood sample may be collected through one of the following options:

• In-office collection at their provider's clinic

• Mobile phlebotomy, where a trained professional comes to your client

• An outpatient collection center

Available collection options may vary based on the provider and location.

View Blood Draw Collection Methods

How much blood is collected?

Only two small tubes of blood are required. The blood draw is similar to many routine laboratory tests.

Will someone contact my client to schedule their blood draw?

Yes. If mobile or outpatient collection is needed, a Brazos Patient Scheduling Coordinator will contact your client within 24 business hours after their provider orders their test.

Test Results

How long does it take for my client to receive their test results?

Results are typically available within 7–10 business days after the laboratory receives their sample.

How will my client receive my test results?

Your client’s results will be securely delivered to both your client and their healthcare provider. Their healthcare provider will review the findings with them and discuss how it may fit into their overall clinical evaluation and care plan.

Scientific & Clinical Information

How accurate is the test?

The Neural-Injury Assessment Test™ demonstrates:

99% sensitivity

93% specificity

How long after a brain injury can the Neural-Injury Assessment Test™ be performed?

The Neural-Injury Assessment Test™ may provide clinically relevant information following both recent and past injuries. Some patients are tested shortly after an event, while others may be evaluated months or years later.

Because every individual and every injury is different, there is no single timeframe that applies to all patients. Your provider ordered this test because they believe it will help provide valuable insights when considered alongside your clinical history, symptoms, and other diagnostic findings.

Protein Biomarkers (GFAP, UCH-L1, NF-H, S100B)

Are the blood-protein biomarkers analyzed in this test qualitative or quantitative?

Brazos Neuroscience's protein biomarker analysis is designed to provide quantitative measurements of specific proteins in the blood associated with neurological-related injuries or neurological conditions. These quantitative measurements can assist healthcare providers in evaluating neural injuries, monitoring changes over time, and correlating findings within a comprehensive clinical assessment framework.

What do blood-protein biomarkers measure?

Protein biomarkers measure the presence of specific proteins linked to the structural and cell maintenance components of brain cells that are released into the bloodstream following various stressors and injuries (e.g., neuroinjury, neuroinflammation, neurotoxicity, neurodegeneration, and neurotrauma).

Elevated levels of these proteins may suggest brain cell changes, cellular damage, or inflammatory responses. By analyzing protein biomarkers associated with brain injury, healthcare providers use these results of this test in conjunction with clinical evaluations to inform overall assessments of brain function, monitor biomarkers over time, and support personalized recovery strategies.

How long could blood-protein biomarker levels be elevated after a brain injury?

Biomarkers associated with brain injuries may change over time. Published studies have reported biomarker elevations persisting for varying lengths of time; however, no definitive timeline has been established across all biomarkers, patient populations, and testing platforms.

Healthcare providers should consider the timing of biomarker levels and trends over time when interpreting results within the appropriate clinical context. Additionally, this test does not establish injury severity or timing of a brain injury event.

Do elevated blood-protein levels suggest further evaluation?

While this test does not independently recommend or rule out additional assessments, healthcare providers may consider further evaluation if symptoms persist, worsen, or do not align with expected clinical progress, as determined within a clinical framework.

Additional assessments may include:

• Comprehensive Neurological Examination

• Vestibular/Oculomotor Testing

• CT or MRI Scans, including Diffusion Tensor Imaging (DTI)

• Assessments for Exercise Intolerance (Autonomic Dysfunction)

• Neuropsychological Assessment

• EEG/qEEG Scans

Can the protein biomarkers be monitored over time?

Yes. Protein biomarkers can be measured periodically to help providers evaluate biological changes over time and monitor recovery or progression. Many providers choose to repeat testing every 3 months to monitor changes over time.

Genetic Markers (APOE, MTHFR)

How do genetic variants provide additional clinical context?

Genetic variants are common alterations in the DNA sequence that may influence individual traits and health.

APOE and MTHFR genetic variants are associated with brain health, offering insights into factors that could affect cognitive function, neurological conditions, and mental well-being.

Having a genetic variant alone does not mean an individual will develop or experience symptoms related to a specific condition. Genetic variants should never be assessed in isolation from other contributing factors, such as nutrition, environment, and overall health.

Healthcare providers may use genetic variant findings to better understand gene-environment interactions, assess potential risks, and identify lifestyle modifications to support patient care.

What is the APOE gene and how common is it to have an APOE ε4 allele?

The APOE gene encodes apolipoprotein E, a protein involved in lipid metabolism and the transport of cholesterol and other fats in the bloodstream.

APOE plays an important role in facilitating the repair and maintenance of neuronal membranes, promoting synaptic function, and supporting the overall health of brain cells.

Normal APOE function is important for communication between brain cells and may influence cognitive ability and memory.

The ε4 allele may be associated with impaired synaptic function and neuroinflammation, potentially contributing to cognitive changes over time.

The APOE ε4 allele is found in approximately 15–30% of people worldwide, depending on ethnicity and geographic region.

What health conditions are associated with the APOE ε4 allele?

Emerging scientific research indicates an association between the APOE ε4 allele and an increased risk of developing various mental health and neurological conditions, including but not limited to:

• Alzheimer's disease

• Lewy body dementia

• Cognitive impairment

• Increased neuroinflammation

• Anxiety

• Depression

What is the MTHFR gene and how common is it to have an MTHFR genetic variant?

The MTHFR gene encodes methylenetetrahydrofolate reductase, an enzyme that converts dietary folate (vitamin B9) into an active form called methylfolate.

The brain uses methylfolate for:

• DNA synthesis and repair

• Neurotransmitter production (e.g., serotonin, dopamine, norepinephrine)

• Methylation, a process that helps regulate genes and chromosomal structure

• Supporting myelin integrity to insulate nerve fibers

All of these functions are vital for optimal cognitive function.

Certain genetic variants of the MTHFR gene may reduce enzyme activity and impair folate metabolism. This may be associated with elevated homocysteine levels and reduced availability of methylfolate, potentially influencing cognition and mood.

MTHFR genetic variants are very common, with at least one copy of either the rs1801133 or rs1801131 variant found in approximately 60–70% of people worldwide, depending on ethnicity and geographic region.

What health conditions are associated with MTHFR genetic variants?

Emerging scientific research indicates an association between MTHFR genetic variants and an increased risk of developing various mental health and neurological conditions, including but not limited to:

• Alzheimer's disease

• Cognitive impairment

• Depression

Do the genetic markers need to be tested more than once?

No. Genetic markers only need to be tested once because your DNA does not change over time.

Neuroendocrine Assessment Test (Coming Soon)

Have Additional Questions?

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