Will Biomarkers be the Next Step?

The current imaging techniques available to the doctors and clinicians do not allow for a diagnosis of concussion or related degenerative issues of the brain.  There has been information about promising breakthroughs, Dr. Bennet Omalu’s interview, however there may be a way to compare and even diagnose if dialed in correctly.

The only issue is that this type of information gathering is invasive, but it does indeed show promise as various companies have been working on a process to gather information.  Thanks to the website Sports Medicine Research: In the Lab & In the Field I was able to read a paper concerning such biomarkers in boxers;

No difference were found between boxers and controls within their medical and social history. Only 1 boxer had current concussion signs and symptoms listed on the questionnaire. Both, boxers and control groups had no symptoms of concussion on their neurological exam, MRI, or neuropsychological examination. Boxers had significantly elevated concentrations of GFAP and NFL at both acute and long-term tests compared to controls. T-tau and S-100b were also significantly elevated in boxers compared to control but only during the acute test period.

Repetitive head trauma in boxing may be associated with increased risk of chronic traumatic brain injury. Analysis of biomarkers can assist in understanding the pathology associated, at a molecular level, with concussions. Furthermore, some biomarkers may be sensitive enough to detect subclinical brain responses to repetitive head impacts and could possibly be used to predict the risk of the patient having a prolong recovery or long-term effects. In this role, biomarkers may be able to prevent-long term effects if they can be eventually used to improve return to play guidelines.

You can read how the study was framed and run in the link above, however I feel this may be the important part.  The two prominent biomarkers above are glial fibrillary acidic protein (GFAP) and neurofilament light  (NFL) also know as NEFL.  Understanding biochemistry of the brain is like, well, trying to understand biochemistry of the brain – it is difficult – however I do know that GFAP is known to be part of the functioning of the blood brain barrier and some cell communication.

It doesn’t matter if there is a biomarker that is called “crap”, if “crap” only shows up in those that have had repetitive brain trauma and “crap” does not show up in a control group, there is a “crappy” problem.  The reason to why this is happening seems rather significant and cut-and-dry if all else is equal.

This type of information is important as we go forward, if there are objective measures that will allow for us as clinicians to better gauge return to play and safety of the injured individual it warrants further studies.  As for immediate biomarkers, say on a sideline test using a finger prick, that seems a long way off.  Nothing to this date has clinically shown it can do this.  However having a diagnostic tool after the fact is definitely a start in the right direction.


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