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Bohnert S, Reinert C, Trella S, Cattaneo A, Preiß U, Bohnert M, Zwirner J, Büttner A, Schmitz W, Ondruschka B. Neuroforensomics: metabolites as valuable biomarkers in cerebrospinal fluid of lethal traumatic brain injuries. Sci Rep 2024; 14:13651. [PMID: 38871842 DOI: 10.1038/s41598-024-64312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 06/07/2024] [Indexed: 06/15/2024] Open
Abstract
Traumatic brain injury (TBI) is a ubiquitous, common sequela of accidents with an annual prevalence of several million cases worldwide. In forensic pathology, structural proteins of the cellular compartments of the CNS in serum and cerebrospinal fluid (CSF) have been predominantly used so far as markers of an acute trauma reaction for the biochemical assessment of neuropathological changes after TBI. The analysis of endogenous metabolites offers an innovative approach that has not yet been considered widely in the assessment of causes and circumstances of death, for example after TBI. The present study, therefore, addresses the question whether the detection of metabolites by liquid-chromatography-mass spectrometry (LC/MS) analysis in post mortem CSF is suitable to identify TBI and to distinguish it from acute cardiovascular control fatalities (CVF). Metabolite analysis of 60 CSF samples collected during autopsies was performed using high resolution (HR)-LC/MS. Subsequent statistical and graphical evaluation as well as the calculation of a TBI/CVF quotient yielded promising results: numerous metabolites were identified that showed significant concentration differences in the post mortem CSF for lethal acute TBI (survival times up to 90 min) compared to CVF. For the first time, this forensic study provides an evaluation of a new generation of biomarkers for diagnosing TBI in the differentiation to other causes of death, here CVF, as surrogate markers for the post mortem assessment of complex neuropathological processes in the CNS ("neuroforensomics").
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Affiliation(s)
- Simone Bohnert
- Institute of Forensic Medicine, University of Würzburg, Würzburg, Germany
| | - Christoph Reinert
- Institute of Forensic Medicine, University of Würzburg, Würzburg, Germany
| | - Stefanie Trella
- Institute of Forensic Medicine, University of Würzburg, Würzburg, Germany
| | - Andrea Cattaneo
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
| | - Ulrich Preiß
- Institute of Forensic Medicine, University of Würzburg, Würzburg, Germany
| | - Michael Bohnert
- Institute of Forensic Medicine, University of Würzburg, Würzburg, Germany
| | - Johann Zwirner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - Andreas Büttner
- Institute of Forensic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Werner Schmitz
- Institute of Biochemistry and Molecular Biology, Biozentrum, University of Würzburg, Würzburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Weng Y, Zhang Y, Li Y, Lin X, Guo Z, Hu H, Shao W, Yu G, Zheng F, Cai P, Li H, Wu S. Single-cell RNA-sequencing of cellular heterogeneity and pathogenic mechanisms in paraquat-induced Parkinson's disease with depression. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 273:116169. [PMID: 38447518 DOI: 10.1016/j.ecoenv.2024.116169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
Parkinson's disease (PD) is among the most prevalent neurodegenerative diseases, and approximately one third of patients with PD are estimated to have depression. Paraquat (PQ) exposure is an important environmental risk factor for PD. In this study, we established a mouse model of PQ-induced PD with depression to comprehensively investigate cellular heterogeneity and the mechanisms underlying the progression of depression in the context of PD. We utilized single-cell RNA-seq (scRNA-seq) to acquire the transcriptomic atlas of individual cells from model mice and characterize the gene expression profiles in each differentially expressed cell type. We identified a specific glutamatergic neuron cluster responsible for the development of heterogeneous depression-associated changes and established a comprehensive gene expression atlas. Furthermore, functional enrichment and cell trajectory analyses revealed that the mechanisms underlying the progression of PD with depression were associated with specific glutamatergic neurons. Together, our findings provide a valuable resource for deciphering the cellular heterogeneity of PD with depression. The suggested connection between intrinsic transcriptional states of neurons and the progression of depression can provide insight into potential biomarkers and specific targets for anti-depression treatment in patients with PD. SYNOPSIS: Our results obtained using model mice confirm the core effects of PQ exposure on glutamatergic neurons and their potential role in the development of PD with depression.
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Affiliation(s)
- Yali Weng
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yu Zhang
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yinhan Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Xinpei Lin
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Zhenkun Guo
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Hong Hu
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Wenya Shao
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Guangxia Yu
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Fuli Zheng
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Ping Cai
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Huangyuan Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China.
| | - Siying Wu
- The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China.
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3
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Kumar A, Kara S, van der Werf B, Fulcher M. Can the Buffalo Concussion Treadmill Test Be Used as a Prognostic Indicator for Patients With Sport-Related Mild Traumatic Brain Injury? Clin J Sport Med 2024; 34:91-96. [PMID: 37389465 DOI: 10.1097/jsm.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/22/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To establish whether time to exercise cessation using the Buffalo Concussion Treadmill Test (BCTT) protocol can be used as a prognostic indicator of recovery after sport-related mild traumatic brain injury (SR-mTBI). DESIGN Retrospective analysis of prospectively collected data. SETTING Specialist Concussion Clinic. PARTICIPANTS Three hundred and twenty one patients presenting between 2017 and 2019 who underwent BCTT for SR-mTBI. INTERVENTIONS Participants who remained symptomatic at a 2-week follow-up appointment after SR-mTBI underwent BCTT to develop a progressive subsymptom threshold exercise program with fortnightly follow-up until clinical recovery. MAIN OUTCOME MEASURES Clinical recovery was the primary outcome measure. RESULTS A total of 321 participants were eligible to participate in this study (mean age 22.94% and 46% female). The BCTT test duration was divided into 4-minute intervals and those who completed full 20 minutes. There was higher probability of clinical recovery in those who finished the entire 20-minute BCTT protocol compared with those who managed 17-<20 minutes (Hazard Ratio, HR 0.57), 13 to 16 minutes (HR 0.53), 9 to 12 minutes (HR 0.6), 5 to 8 minutes (HR 0.4), and 1 to 4 minutes (HR 0.7), respectively. Those seen earlier after injury ( P = 0.009), male patients ( P = 0.116), younger patients ( P = 0.0003), and those with physiological or cervical dominant ( P = 0.416) symptom clusters were more likely to achieve clinical recovery. Fifty percent of those who completed the full BCTT protocol achieved clinical recovery at day 19 post-injury. CONCLUSIONS The group completing full 20 minutes of BCTT achieved clinical recovery more quickly than those who did not complete full BCTT.
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Affiliation(s)
- Amitesh Kumar
- Axis Sports Medicine Specialists, Auckland, New Zealand
| | - Stephen Kara
- Axis Sports Medicine Specialists, Auckland, New Zealand
| | - Bert van der Werf
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; and
| | - Mark Fulcher
- Axis Sports Medicine Specialists, Auckland, New Zealand
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Taskina D, Zhu C, Schwab N, Hazrati LN. Brain pathology and symptoms linked to concussion history: beyond chronic traumatic encephalopathy. Brain Commun 2024; 6:fcad314. [PMID: 38560515 PMCID: PMC10977958 DOI: 10.1093/braincomms/fcad314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/13/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Repeated head trauma acquired through sports injuries has been associated with the development of long-term disabling symptoms that negatively impact the quality of life. In this retrospective case series, 52 male former professional athletes involved in contact sports and with a history of multiple concussions were evaluated for chronic clinical symptoms and post-mortem neuropathological diagnoses. The clinical symptoms of 19 cases were examined in greater detail for symptom type, severity and duration. Information on neurological, psychiatric and physical symptoms, substance use profiles and concussion histories was obtained from the athletes' next of kin and assessed in relation to post-mortem neuropathological diagnoses. Cases were categorized into three different neuropathological groups: no major neuropathological findings, the presence of only chronic traumatic encephalopathy (CTE) and the diagnosis(es) of other neurodegenerative diseases. Age at death and the presence of DNA damage in the post-mortem brains were analysed for correlation with the clinical symptoms. In this case series, 14/52 (26.9%) cases (mean age 48.2 ± 11.4) had neuropathological evidence of low-stage/low-burden CTE. A total of 11/52 (21.2%) cases (mean age 38.7 ± 12.7) presented a similar profile and severity of behavioural symptoms to those with CTE, despite the lack of significant post-mortem neuropathological findings. A total of 27/52 (51.9%) cases (mean age 75.5 ± 8.7) presented with complex post-mortem neurodegenerative diagnoses, including Alzheimer's disease and other mixed pathologies, and clinical symptoms associated with language, memory and sensory dysfunction. The presence of DNA damage in the brain was found in all neuropathological groups, predominantly in the ependymal lining of ventricles, and phosphorylated histone H2AX staining was correlated with higher age at death (r = 0.59) and symptoms of language dysfunction (r = 0.56). Findings from our case series suggest that post-concussive symptoms are not driven by CTE. Our findings show that proteinopathies alone may not account for the complexity of the clinical manifestations and suggest the possibility of other drivers, such as DNA damage, as potentially useful markers of brain trauma. Broadening the search for biological markers that reflect the effects of brain injury, even when proteinopathy is not observed, and taking a symptom-driven approach are therefore advised.
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Affiliation(s)
- Daria Taskina
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Cherrie Zhu
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Nicole Schwab
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Lili-Naz Hazrati
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
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Hageman G, Hageman I, Nihom J. Chronic Traumatic Encephalopathy in Soccer Players: Review of 14 Cases. Clin J Sport Med 2024; 34:69-80. [PMID: 37403989 DOI: 10.1097/jsm.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/22/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Exposure to repetitive sports-related concussions or (sub)concussive head trauma may lead to chronic traumatic encephalopathy (CTE). Which impact (heading or concussion) poses the greatest risk of CTE development in soccer players? DESIGN Narrative review. SETTING Teaching hospital and University of Applied sciences. PATIENTS A literature search (PubMed) was conducted for neuropathologic studies in the period 2005-December 2022, investigating soccer players with dementia and a CTE diagnosis, limited to English language publications. 210 papers were selected for final inclusion, of which 7 papers described 14 soccer players. ASSESSMENT Magnetic resonance imaging studies in soccer players show that lifetime estimates of heading numbers are inversely correlated with cortical thickness, grey matter volume, and density of the anterior temporal cortex. Using diffusion tensor imaging-magnetic resonance imaging, higher frequency of headings-particularly with rotational accelerations-are associated with impaired white matter integrity. Serum neurofilament light protein is elevated after heading. MAIN OUTCOME MEASURES Chronic traumatic encephalopathy pathology, history of concussion, heading frequency. RESULTS In 10 of 14 soccer players, CTE was the primary diagnosis. In 4 cases, other dementia types formed the primary diagnosis and CTE pathology was a concomitant finding. Remarkably, 6 of the 14 cases had no history of concussion, suggesting that frequent heading may be a risk for CTE in patients without symptomatic concussion. Rule changes in heading duels, management of concussion during the game, and limiting the number of high force headers during training are discussed. CONCLUSIONS Data suggest that heading frequency and concussions are associated with higher risk of developing CTE in (retired) soccer players. However based on this review of only 14 players, questions persist as to whether or not heading is a risk factor for CTE or long-term cognitive decline.
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Affiliation(s)
- Gerard Hageman
- Department of Neurology, Medisch Spectrum Twente, Hospital Enschede, Enschede, the Netherlands; and
| | - Ivar Hageman
- Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Jik Nihom
- Department of Neurology, Medisch Spectrum Twente, Hospital Enschede, Enschede, the Netherlands; and
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Donnelly RR, Ugbolue UC, Gao Y, Gu Y, Dutheil F, Baker JS. A Systematic Review and Meta-Analysis Investigating Head Trauma in Boxing. Clin J Sport Med 2023; 33:658-674. [PMID: 37862081 PMCID: PMC10597432 DOI: 10.1097/jsm.0000000000001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/22/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Although physical trauma has been reported in boxing since its inception, boxing still appeals to athletes and spectators. This systematic review and meta-analysis assess both acute and chronic neurological and neuropsychological effects that boxing has on the brain. Further assessments in terms of comparisons of the concussion ratio in boxing to other combat sports, as well as the efficiency of wearing headguards, are also performed. DATA SOURCES This systematic review and meta-analysis used the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The outcomes incorporated included physical chronic abnormalities of the brain, neuropsychiatric, and neurological disorders sustained in amateur or professional boxing, in addition to the safety benefits of boxing headguards. Odds ratios, descriptive statistics, and inferential statistics are also reported. MAIN RESULTS From the 84 articles reviewed, the 35 included articles suggested that boxers have a significantly elevated risk of sustaining a concussion compared with other combat sports (risk ratio [RR]: 0.253 vs RR: 0.065, P < 0.001). From the 631 amateur and professional boxers analyzed, 147 (23.30%) had cavum septum pellucidum, whereas 125 of 411 amateur and professional boxers (30.41%) presented with some form of brain atrophy. Dementia or amnesia was observed in 46 of 71 boxers (61.79%), 36 of 70 (51.43%) had various forms and severities of cognitive disorders, and 57 of 109 (52.29%) displayed abnormal computed tomography or electroencephalogram scan results. Utilization of headguards significantly increased the risk for stoppages in amateur bouts, compared with boxers not wearing a headguard (OR: 1.75 vs 0.53, P < 0.050). CONCLUSIONS Boxing is a hazardous sport that has the potential to have fatal and negative life-changing results. Because of the limited reliable data regarding the efficiency of boxing headguards, future research should focus on the overall significance that headguards may have for reducing head trauma.
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Affiliation(s)
- Robert R. Donnelly
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Ukadike Chris Ugbolue
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Yang Gao
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong; and
| | - Yaodong Gu
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong; and
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Merino J, Whelan BM, Finch E. Examining the occurrence and outcomes of concussion and mTBI in mixed martial arts athletes: a systematic review. PHYSICIAN SPORTSMED 2023; 51:394-404. [PMID: 35377825 DOI: 10.1080/00913847.2022.2061836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Mixed martial arts (MMA) is a sport growing in popularity around the world. However, many individuals participate in the sport with little understanding of the potential short- and long-term consequences of injuries sustained while participating. Specifically, individuals are placed at a high risk of minor traumatic brain injury (mTBI) and concussive episodes as a result of head injuries incurred during training and competition. AIMS The current review aimed to examine the literature surrounding the occurrence and outcomes of mTBI in MMA athletes to gain a better understanding of these consequences. METHODS Twenty-five studies were identified within the current review, of which 14 examined occurrence of mTBI within the sport setting, and elevenidentified outcomes of injury. RESULTS Overall, studies found that MMA athletes experienced mTBI and concussion to a greater extent than athletes in other sports. Deficits in memory, reaction time and processing speed were identified following occurrence of mTBI; however, several gaps in outcome measurement were identified within the current literature, including a lack of focus on speech and language outcomes. CONCLUSION Future research should examine a wider variety of outcomes to provide a clearer understanding of the consequences of participating in the sport.
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Affiliation(s)
- Joanne Merino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Brooke-Mai Whelan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
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Ozkizilcik A, Sharma A, Feng L, Muresanu DF, Tian ZR, Lafuente JV, Buzoianu AD, Nozari A, Wiklund L, Sharma HS. Nanowired delivery of antibodies to tau and neuronal nitric oxide synthase together with cerebrolysin attenuates traumatic brain injury induced exacerbation of brain pathology in Parkinson's disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 171:83-121. [PMID: 37783564 DOI: 10.1016/bs.irn.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Concussive head injury (CHI) is one of the major risk factors for developing Parkinson's disease in later life of military personnel affecting lifetime functional and cognitive disturbances. Till date no suitable therapies are available to attenuate CHI or PD induced brain pathology. Thus, further exploration of novel therapeutic agents are highly warranted using nanomedicine in enhancing the quality of life of veterans or service members of US military. Since PD or CHI induces oxidative stress and perturbs neurotrophic factors regulation associated with phosphorylated tau (p-tau) deposition, a possibility exists that nanodelivery of agents that could enhance neurotrophic factors balance and attenuate oxidative stress could be neuroprotective in nature. In this review, nanowired delivery of cerebrolysin-a balanced composition of several neurotrophic factors and active peptide fragments together with monoclonal antibodies to neuronal nitric oxide synthase (nNOS) with p-tau antibodies was examined in PD following CHI in model experiments. Our results suggest that combined administration of nanowired antibodies to nNOS and p-tau together with cerebrolysin significantly attenuated CHI induced exacerbation of PD brain pathology. This combined treatment also has beneficial effects in CHI or PD alone, not reported earlier.
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Affiliation(s)
- Asya Ozkizilcik
- Dept. Biomedical Engineering, University of Arkansas, Fayetteville, AR, United Staes
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Zhongshan Road (West), Shijiazhuang, Hebei Province, P.R. China
| | - Dafin F Muresanu
- Dept. Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; ''RoNeuro'' Institute for Neurological Research and Diagnostic, Mircea Eliade Street, Cluj-Napoca, Romania
| | - Z Ryan Tian
- Dept. Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - José Vicente Lafuente
- LaNCE, Dept. Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ala Nozari
- Department of Anesthesiology, Boston University, Albany str, Boston MA, United States
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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Karimpoor M, Georgiadis M, Zhao MY, Goubran M, Moein Taghavi H, Mills BD, Tran D, Mouchawar N, Sami S, Wintermark M, Grant G, Camarillo DB, Moseley ME, Zaharchuk G, Zeineh MM. Longitudinal Alterations of Cerebral Blood Flow in High-Contact Sports. Ann Neurol 2023; 94:457-469. [PMID: 37306544 DOI: 10.1002/ana.26718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Repetitive head trauma is common in high-contact sports. Cerebral blood flow (CBF) can measure changes in brain perfusion that could indicate injury. Longitudinal studies with a control group are necessary to account for interindividual and developmental effects. We investigated whether exposure to head impacts causes longitudinal CBF changes. METHODS We prospectively studied 63 American football (high-contact cohort) and 34 volleyball (low-contact controls) male collegiate athletes, tracking CBF using 3D pseudocontinuous arterial spin labeling magnetic resonance imaging for up to 4 years. Regional relative CBF (rCBF, normalized to cerebellar CBF) was computed after co-registering to T1-weighted images. A linear mixed effects model assessed the relationship of rCBF to sport, time, and their interaction. Within football players, we modeled rCBF against position-based head impact risk and baseline Standardized Concussion Assessment Tool score. Additionally, we evaluated early (1-5 days) and delayed (3-6 months) post-concussion rCBF changes (in-study concussion). RESULTS Supratentorial gray matter rCBF declined in football compared with volleyball (sport-time interaction p = 0.012), with a strong effect in the parietal lobe (p = 0.002). Football players with higher position-based impact-risk had lower occipital rCBF over time (interaction p = 0.005), whereas players with lower baseline Standardized Concussion Assessment Tool score (worse performance) had relatively decreased rCBF in the cingulate-insula over time (interaction effect p = 0.007). Both cohorts showed a left-right rCBF asymmetry that decreased over time. Football players with an in-study concussion showed an early increase in occipital lobe rCBF (p = 0.0166). INTERPRETATION These results suggest head impacts may result in an early increase in rCBF, but cumulatively a long-term decrease in rCBF. ANN NEUROL 2023;94:457-469.
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Affiliation(s)
| | | | - Moss Y Zhao
- Department of Radiology, Stanford University, Stanford, CA
| | - Maged Goubran
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
- Physical Sciences Platform & Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | | | - Brian D Mills
- Department of Radiology, Stanford University, Stanford, CA
| | - Dean Tran
- Department of Radiology, Stanford University, Stanford, CA
| | | | - Sohrab Sami
- Department of Radiology, Stanford University, Stanford, CA
| | - Max Wintermark
- Department of Radiology, Stanford University, Stanford, CA
| | - Gerald Grant
- Department of Neurosurgery, Stanford University, Stanford, CA
| | | | | | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA
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Flavin WP, Hosseini H, Ruberti JW, Kavehpour HP, Giza CC, Prins ML. Traumatic brain injury and the pathways to cerebral tau accumulation. Front Neurol 2023; 14:1239653. [PMID: 37638180 PMCID: PMC10450935 DOI: 10.3389/fneur.2023.1239653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Tau is a protein that has received national mainstream recognition for its potential negative impact to the brain. This review succinctly provides information on the structure of tau and its normal physiological functions, including in hibernation and changes throughout the estrus cycle. There are many pathways involved in phosphorylating tau including diabetes, stroke, Alzheimer's disease (AD), brain injury, aging, and drug use. The common mechanisms for these processes are put into context with changes observed in mild and repetitive mild traumatic brain injury (TBI). The phosphorylation of tau is a part of the progression to pathology, but the ability for tau to aggregate and propagate is also addressed. Summarizing both the functional and dysfunctional roles of tau can help advance our understanding of this complex protein, improve our care for individuals with a history of TBI, and lead to development of therapeutic interventions to prevent or reverse tau-mediated neurodegeneration.
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Affiliation(s)
- William P. Flavin
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
- Steve Tisch BrainSPORT Program, Department of Pediatrics and Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
| | - Helia Hosseini
- Department of Bioengineering, UCLA, Los Angeles, CA, United States
| | - Jeffrey W. Ruberti
- Department of Bioengineering, Northeastern University, Boston, MA, United States
| | - H. Pirouz Kavehpour
- Department of Bioengineering, UCLA, Los Angeles, CA, United States
- Department of Mechanical and Aerospace Engineering, UCLA, Los Angeles, CA, United States
| | - Christopher C. Giza
- Steve Tisch BrainSPORT Program, Department of Pediatrics and Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
- Department of Bioengineering, UCLA, Los Angeles, CA, United States
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
| | - Mayumi L. Prins
- Steve Tisch BrainSPORT Program, Department of Pediatrics and Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
- Department of Bioengineering, UCLA, Los Angeles, CA, United States
- Department of Neurosurgery, Brain Injury Research Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
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11
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Zhao T, Wei N, Li T, Chen K, Cui W, Wang Z, Wang F, Lin Y, Zhu J. Transplantation of glutamatergic neuronal precursor cells in the paraventricular thalamus and claustrum facilitates awakening with recovery of consciousness. CNS Neurosci Ther 2023; 29:1785-1804. [PMID: 36880283 PMCID: PMC10324366 DOI: 10.1111/cns.14137] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/09/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Stem cells offer a promising therapeutic strategy for patients with disorders of consciousness (DOC) after severe traumatic brain injury (TBI), but the optimal transplantation sites and cells are not clear. Although the paraventricular thalamus (PVT) and claustrum (CLA) are associated with consciousness and are candidate transplantation targets, few studies have been designed to investigate this possibility. METHODS Controlled cortical injury (CCI) was performed to establish a mouse model of DOC. CCI-DOC paradigm was established to investigate the role of excitatory neurons of PVT and CLA in disorders of consciousness. The role of excitatory neuron transplantation in promoting arousal and recovery of consciousness was determined by optogenetics, chemogenetics, electrophysiology, Western blot, RT-PCR, double immunofluorescence labeling, and neurobehavioral experiments. RESULTS After CCI-DOC, neuronal apoptosis was found to be concentrated in the PVT and CLA. Prolonged awaking latency and cognitive decline were also seen after destruction of the PVT and CLA, suggesting that the PVT and CLA may be key nuclei in DOC. Awaking latency and cognitive performance could be altered by inhibiting or activating excitatory neurons, implying that excitatory neurons may play an important role in DOC. Furthermore, we found that the PVT and CLA function differently, with the PVT mainly involved in arousal maintenance while the CLA plays a role mainly in the generation of conscious content. Finally, we found that by transplanting excitatory neuron precursor cells in the PVT and CLA, respectively, we could facilitate awakening with recovery of consciousness, which was mainly manifested by shortened awaking latency, reduced duration of loss of consciousness (LOC), enhanced cognitive ability, enhanced memory, and improved limb sensation. CONCLUSION In this study, we found that the deterioration in the level and content of consciousness after TBI was associated with a large reduction in glutamatergic neurons within the PVT and CLA. Transplantation of glutamatergic neuronal precursor cells could play a beneficial role in promoting arousal and recovery of consciousness. Thus, these findings have the potential to provide a favorable basis for promoting awakening and recovery in patients with DOC.
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Affiliation(s)
- Tong Zhao
- Department of Neurosurgery, The First Affiliated Hospital, Neurosurgery Research InstituteFujian Medical UniversityFuzhouFujianChina
- Department of Neurosurgery, State Key laboratory of Medical Neurobiology, Shanghai Key Laboratory of Brain Function and Regeneration, Shanghai Medical College, Fudan University Huashan Hospital, Institute of Brain ScienceFudan UniversityShanghaiChina
| | - Naili Wei
- Department of NeurosurgeryThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Tianwen Li
- Department of Neurosurgery, State Key laboratory of Medical Neurobiology, Shanghai Key Laboratory of Brain Function and Regeneration, Shanghai Medical College, Fudan University Huashan Hospital, Institute of Brain ScienceFudan UniversityShanghaiChina
| | - Kezhu Chen
- Department of Neurosurgery, State Key laboratory of Medical Neurobiology, Shanghai Key Laboratory of Brain Function and Regeneration, Shanghai Medical College, Fudan University Huashan Hospital, Institute of Brain ScienceFudan UniversityShanghaiChina
| | - Wenqiang Cui
- Department of NeurologyAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanShandongChina
| | - Zhifu Wang
- Department of Neurosurgery, State Key laboratory of Medical Neurobiology, Shanghai Key Laboratory of Brain Function and Regeneration, Shanghai Medical College, Fudan University Huashan Hospital, Institute of Brain ScienceFudan UniversityShanghaiChina
| | - Fan Wang
- Department of NeurologyPeking University Third HospitalBeijingChina
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital, Neurosurgery Research InstituteFujian Medical UniversityFuzhouFujianChina
| | - Jianhong Zhu
- Department of Neurosurgery, State Key laboratory of Medical Neurobiology, Shanghai Key Laboratory of Brain Function and Regeneration, Shanghai Medical College, Fudan University Huashan Hospital, Institute of Brain ScienceFudan UniversityShanghaiChina
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12
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Rydzik Ł, Pałka T, Sobiło-Rydzik E, Tota Ł, Ambroży D, Ambroży T, Ruzbarsky P, Czarny W, Kopańska M. An Attempt to Develop a Model of Brain Waves Using Quantitative Electroencephalography with Closed Eyes in K1 Kickboxing Athletes-Initial Concept. SENSORS (BASEL, SWITZERLAND) 2023; 23:4136. [PMID: 37112480 PMCID: PMC10145354 DOI: 10.3390/s23084136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Brain injuries are a common problem in combat sports, especially in disciplines such as kickboxing. Kickboxing is a combat sport that has several variations of competition, with the most contact-oriented fights being carried out under the format of K-1 rules. While these sports require a high level of skill and physical endurance, frequent micro-traumas to the brain can have serious consequences for the health and well-being of athletes. According to studies, combat sports are one of the riskiest sports in terms of brain injuries. Among the sports disciplines with the highest number of brain injuries, boxing, mixed martial arts (MMA), and kickboxing are mentioned. METHODS The study was conducted on a group of 18 K-1 kickboxing athletes who demonstrate a high level of sports performance. The subjects were between the ages 18 and 28. QEEG (quantitative electroencephalogram) is a numeric spectral analysis of the EEG record, where the data is digitally coded and statistically analysed using the Fourier transform algorithm. Each examination of one person lasts about 10 min with closed eyes. The wave amplitude and power for specific frequencies (Delta, Theta, Alpha, Sensorimotor Rhythm (SMR), Beta 1, and Beta2) were analysed using 9 leads. RESULTS High values were shown in the Alpha frequency for central leads, SMR in the Frontal 4 (F4 lead), Beta 1 in leads F4 and Parietal 3 (P3), and Beta2 in all leads. CONCLUSIONS The high activity of brainwaves such as SMR, Beta and Alpha can have a negative effect on the athletic performance of kickboxing athletes by affecting focus, stress, anxiety, and concentration. Therefore, it is important for athletes to monitor their brainwave activity and use appropriate training strategies to achieve optimal results.
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Affiliation(s)
- Łukasz Rydzik
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland
| | - Tomasz Pałka
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, University of Physical Education, 31-571 Kraków, Poland
| | | | - Łukasz Tota
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, University of Physical Education, 31-571 Kraków, Poland
| | - Dorota Ambroży
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland
| | - Tadeusz Ambroży
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland
| | - Pavel Ruzbarsky
- Department of Sports Kinanthropology, Faculty of Sports, Universtiy of Presov, 08001 Prešov, Slovakia
| | - Wojciech Czarny
- Department of Sports Kinanthropology, Faculty of Sports, Universtiy of Presov, 08001 Prešov, Slovakia
- College of Medical Sciences, Institute of Physical Culture Studies, University of Rzeszow, 35-959 Rzeszów, Poland
| | - Marta Kopańska
- Department of Pathophysiology, Institute of Medical Sciences, Medical College of Rzeszów University, 35-959 Rzeszów, Poland
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13
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Mavroudis I, Petridis F, Balmus IM, Ciobica A, Gorgan DL, Luca AC. Review on the Role of Salivary Biomarkers in the Diagnosis of Mild Traumatic Brain Injury and Post-Concussion Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13081367. [PMID: 37189468 DOI: 10.3390/diagnostics13081367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: While mild traumatic brain injuries (TBIs) are a major public health issue, post-concussion syndrome (PCS) remains a controversial entity. In both cases, the clinical diagnosis is mainly based on the symptoms and brain imaging evaluation. The current molecular biomarkers were described from blood and cerebrospinal fluid (CSF), yet both fluid collection methods are invasive. Saliva could be preferred in molecular diagnosis due to its non-invasive and non-expensive methods of acquisition, transport, and samples processing. (2) Objectives: In the present study, we aimed to review the latest developments in salivary biomarkers and their potential role in diagnosing mild TBIs, and PCS. (3) Results: In TBIs and PCS, a few novel studies focusing on salivary biomarkers have emphasized their importance in diagnosis. The previous studies mainly focused on micro RNAs, and only a few on extracellular vesicles, neurofilament light chain, and S100B. (4) Conclusions: The combination between salivary biomarkers, clinical history and examination, self-reported symptoms, and cognitive/balance testing can provide a non-invasive alternative diagnostic methodology, as compared to the currently approved plasma and cerebrospinal fluid biomarkers.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ioana-Miruna Balmus
- Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, Alexandru Ioan Cuza University of Iasi, Alexandru Lapusneanu Street, No. 26, 700057 Iasi, Romania
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, B dul Carol I, No. 11, 700506 Iasi, Romania
| | - Dragos Lucian Gorgan
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, B dul Carol I, No. 11, 700506 Iasi, Romania
| | - Alina Costina Luca
- Department of Mother and Child, Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
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14
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Ye C, Behnke JA, Hardin KR, Zheng JQ. Drosophila melanogaster as a model to study age and sex differences in brain injury and neurodegeneration after mild head trauma. Front Neurosci 2023; 17:1150694. [PMID: 37077318 PMCID: PMC10106652 DOI: 10.3389/fnins.2023.1150694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
Repetitive physical insults to the head, including those that elicit mild traumatic brain injury (mTBI), are a known risk factor for a variety of neurodegenerative conditions including Alzheimer's disease (AD), Parkinson's disease (PD), and chronic traumatic encephalopathy (CTE). Although most individuals who sustain mTBI typically achieve a seemingly full recovery within a few weeks, a subset experience delayed-onset symptoms later in life. As most mTBI research has focused on the acute phase of injury, there is an incomplete understanding of mechanisms related to the late-life emergence of neurodegeneration after early exposure to mild head trauma. The recent adoption of Drosophila-based brain injury models provides several unique advantages over existing preclinical animal models, including a tractable framework amenable to high-throughput assays and short relative lifespan conducive to lifelong mechanistic investigation. The use of flies also provides an opportunity to investigate important risk factors associated with neurodegenerative conditions, specifically age and sex. In this review, we survey current literature that examines age and sex as contributing factors to head trauma-mediated neurodegeneration in humans and preclinical models, including mammalian and Drosophila models. We discuss similarities and disparities between human and fly in aging, sex differences, and pathophysiology. Finally, we highlight Drosophila as an effective tool for investigating mechanisms underlying head trauma-induced neurodegeneration and for identifying therapeutic targets for treatment and recovery.
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Affiliation(s)
- Changtian Ye
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
| | - Joseph A. Behnke
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
| | - Katherine R. Hardin
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
| | - James Q. Zheng
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Center for Neurodegenerative Diseases, Emory University School of Medicine, Atlanta, GA, United States
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15
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Mao Y, Zhao D, Li J, Fu W. Incidence Rates and Pathology Types of Boxing-Specific Injuries: A Systematic Review and Meta-analysis of Epidemiology Studies in the 21st Century. Orthop J Sports Med 2023; 11:23259671221127669. [PMID: 37025124 PMCID: PMC10071201 DOI: 10.1177/23259671221127669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/24/2022] [Indexed: 04/08/2023] Open
Abstract
Background To the best of our knowledge, an evidence-based investigation into 21st-century boxing-specific injury rates and types has yet to be performed. Purpose To provide an overview and quantitative synthesis of the incidence rates (IRs) and pathological categorizations of boxing-specific injuries in the 21st century. Study Design Systematic review; Level of evidence, 3. Methods Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched literature published from January 2000 to November 2021 in PubMed and the Cochrane Library systematically for qualifying epidemiology studies of organized boxing activities across the world. Two independent reviewers completed the literature review, data extraction, and quality assessment. The IRs of injuries per 1000 boxers (IRN), per 1000 competition exposures (IRE), and per 1000 minutes of competition (IRC) or training (IRT) were subsequently calculated. Single-arm meta-analyses were performed for the subgroups of different types of boxing. Sample size weighted means were calculated using a random-effects model in all studies with 95% CIs. Results Out of an initial 9584 articles, 14 studies were included, with most (11/14) having a moderate level of quality. The pooled IRN in overall injuries was 223.9 (95% CI, 157.5-290.4), the IRE was 233.3 (95% CI, 161.3-305.2), and the IRC was 13.0 (95% CI, 8.9-17.1). In professional boxing, the IRN (399.8), IRE (379.8), and IRC (23.9) were all significantly higher than in the amateur and female groups. The IRE (76.6 vs 250.6; P < .000) and IRC (9.2 vs 15.4; P < .000) in amateur boxing were significantly lower in studies between 2010 and 2019 than in earlier studies. For pathology categorization, the pooled frequencies were 12.3% (95% CI, 8.7%-15.9%) for concussion, 21.4% (95% CI, 14.1%-28.6%) for skin laceration, 30.2% (95% CI, 22.1%-38.2%) for soft tissue contusion, 15.3% (95% CI, 7.7%-22.9%) for sprain and muscle/ligament injury, and 11.4% (95% CI, 2.7%-20.1%) for fracture. Conclusion IRs of injury remain high in professional boxing, although they have decreased in the past 10 years in amateur boxing. Soft tissue contusion was the most common injury type. Better exposure measurements and epidemiologic indicators should be applied in future studies. Registration CRD42021289993 (PROSPERO).
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Affiliation(s)
- Yunhe Mao
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
| | - Dongmei Zhao
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Department of Orthopedics, Orthopedic Research Institute, West China
Hospital, Sichuan University, Chengdu, China
- Weili Fu, MD, Department of Orthopedics, Orthopedic Research
Institute, West China Hospital, Sichuan University, No. 37, Guoxue Alley,
Chengdu 610041, China ()
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16
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Traumatic Brain Injury Induces Microglial and Caspase3 Activation in the Retina. Int J Mol Sci 2023; 24:ijms24054451. [PMID: 36901880 PMCID: PMC10003323 DOI: 10.3390/ijms24054451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023] Open
Abstract
Traumatic brain injury (TBI) is among the main causes of sudden death after head trauma. These injuries can result in severe degeneration and neuronal cell death in the CNS, including the retina, which is a crucial part of the brain responsible for perceiving and transmitting visual information. The long-term effects of mild-repetitive TBI (rmTBI) are far less studied thus far, even though damage induced by repetitive injuries occurring in the brain is more common, especially amongst athletes. rmTBI can also have a detrimental effect on the retina and the pathophysiology of these injuries is likely to differ from severe TBI (sTBI) retinal injury. Here, we show how rmTBI and sTBI can differentially affect the retina. Our results indicate an increase in the number of activated microglial cells and Caspase3-positive cells in the retina in both traumatic models, suggesting a rise in the level of inflammation and cell death after TBI. The pattern of microglial activation appears distributed and widespread but differs amongst the various retinal layers. sTBI induced microglial activation in both the superficial and deep retinal layers. In contrast to sTBI, no significant change occurred following the repetitive mild injury in the superficial layer, only the deep layer (spanning from the inner nuclear layer to the outer plexiform layer) shows microglial activation. This difference suggests that alternate response mechanisms play a role in the case of the different TBI incidents. The Caspase3 activation pattern showed a uniform increase in both the superficial and deep layers of the retina. This suggests a different action in the course of the disease in sTBI and rmTBI models and points to the need for new diagnostic procedures. Our present results suggest that the retina might serve as such a model of head injuries since the retinal tissue reacts to both forms of TBI and is the most accessible part of the human brain.
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Risk of Migraine after Traumatic Brain Injury and Effects of Injury Management Levels and Treatment Modalities: A Nationwide Population-Based Cohort Study in Taiwan. J Clin Med 2023; 12:jcm12041530. [PMID: 36836064 PMCID: PMC9959615 DOI: 10.3390/jcm12041530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/04/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
Traumatic brain injury (TBI) causes several long-term disabilities, particularly headaches. An association between TBI and subsequent migraine has been reported. However, few longitudinal studies have explained the link between migraine and TBI. Moreover, the modifying effects of treatment remain unknown. This retrospective cohort study used records from Taiwan's Longitudinal Health Insurance Database 2005 to evaluate the risk of migraine among patients with TBI and to determine the effects of different treatment modalities. Initially, 187,906 patients, aged ≥ 18 years, who were diagnosed as TBI in 2000, were identified. In total, 151,098 patients with TBI and 604,394 patients without TBI were matched at a 1:4 ratio according to baseline variables during the same observation period. At the end of follow-up, 541 (0.36%) and 1491 (0.23%) patients in the TBI and non-TBI groups, respectively, developed migraine. The TBI group exhibited a higher risk of migraine than the non-TBI group (adjusted HR: 1.484). Major trauma (Injury Severity Score, ISS ≥ 16) was associated with a higher migraine risk than minor trauma (ISS < 16) (adjusted HR: 1.670). However, migraine risk did not differ significantly after surgery or occupational/physical therapy. These findings highlight the importance of long-term follow-up after TBI onset and the need to investigate the underlying pathophysiological link between TBI and subsequent migraine.
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Sharma HS, Muresanu DF, Nozari A, Lafuente JV, Buzoianu AD, Tian ZR, Huang H, Feng L, Bryukhovetskiy I, Manzhulo I, Wiklund L, Sharma A. Neuroprotective Effects of Nanowired Delivery of Cerebrolysin with Mesenchymal Stem Cells and Monoclonal Antibodies to Neuronal Nitric Oxide Synthase in Brain Pathology Following Alzheimer's Disease Exacerbated by Concussive Head Injury. ADVANCES IN NEUROBIOLOGY 2023; 32:139-192. [PMID: 37480461 DOI: 10.1007/978-3-031-32997-5_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Concussive head injury (CHI) is one of the major risk factors in developing Alzheimer's disease (AD) in military personnel at later stages of life. Breakdown of the blood-brain barrier (BBB) in CHI leads to extravasation of plasma amyloid beta protein (ΑβP) into the brain fluid compartments precipitating AD brain pathology. Oxidative stress in CHI or AD is likely to enhance production of nitric oxide indicating a role of its synthesizing enzyme neuronal nitric oxide synthase (NOS) in brain pathology. Thus, exploration of the novel roles of nanomedicine in AD or CHI reducing NOS upregulation for neuroprotection are emerging. Recent research shows that stem cells and neurotrophic factors play key roles in CHI-induced aggravation of AD brain pathologies. Previous studies in our laboratory demonstrated that CHI exacerbates AD brain pathology in model experiments. Accordingly, it is quite likely that nanodelivery of NOS antibodies together with cerebrolysin and mesenchymal stem cells (MSCs) will induce superior neuroprotection in AD associated with CHI. In this review, co-administration of TiO2 nanowired cerebrolysin - a balanced composition of several neurotrophic factors and active peptide fragments, together with MSCs and monoclonal antibodies (mAb) to neuronal NOS is investigated for superior neuroprotection following exacerbation of brain pathology in AD exacerbated by CHI based on our own investigations. Our observations show that nanowired delivery of cerebrolysin, MSCs and neuronal NOS in combination induces superior neuroprotective in brain pathology in AD exacerbated by CHI, not reported earlier.
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Affiliation(s)
- Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania
- "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Ala Nozari
- Anesthesiology & Intensive Care, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, USA
| | - Hongyun Huang
- Beijing Hongtianji Neuroscience Academy, Beijing, China
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, China
| | - Igor Bryukhovetskiy
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia
| | - Igor Manzhulo
- Laboratory of Pharmacology, National Scientific Center of Marine Biology, Far East Branch of the Russian Academy of Sciences, Vladivostok, Russia
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
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19
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Yoon JH, Armstrong W, Philippopolous E, Dilworth N, Cheng I. Head Injuries in Rock Climbing: A Scoping Review. Wilderness Environ Med 2022; 33:479-487. [PMID: 36202720 DOI: 10.1016/j.wem.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/21/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022]
Abstract
Rock climbing was recognized as a sport at the 2020 Tokyo Olympics. Despite its increasing participation, there is no knowledge synthesis of head injuries (HIs), defined as any injury to the head, associated with climbing, making it challenging for clinicians to provide evidence-based care. Our aim was to synthesize HI literature within rock climbing and identify knowledge gaps. Six databases (Medline, Embase, Sports Medicine & Education Index, SPORTDiscus, CINAHL, and Cochrane) were searched. Two reviewers screened 345 studies and 31 studies were selected for data abstraction. We found the quality of individual studies mainly "fair" to "good." Both HI and traumatic brain injury (TBI) had inconsistent definitions and categorization. The HIs represented between 0 to 36% of reported climbing injuries. Between 11 to 100% of HIs were TBIs, defined as an HI with permanent or temporary neurological sequelae. The most common causes of HIs were outdoor falls and falling objects. Climbing-specific factors associated with the causes were infrequently examined in the literature. Data sources of safety practices were incomplete. Overall, there was a lack of literature examining HIs, mechanisms of injury, and safety practices associated with climbing. To improve the tracking of HIs in climbing, we suggest the use of consistent reporting standards and the creation of a climbing injury surveillance system.
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Affiliation(s)
- Joo Hyung Yoon
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.
| | - Wes Armstrong
- Division of Emergency Medicine, University of Toronto, Toronto, Canada
| | | | - Neil Dilworth
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada; Cleveland Clinic Midtown, Toronto, Canada; Halton Healthcare, Georgetown, Canada
| | - Ivy Cheng
- Division of Emergency Medicine, University of Toronto, Toronto, Canada; Cleveland Clinic Midtown, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
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A review of molecular and genetic factors for determining mild traumatic brain injury severity and recovery. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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21
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Fernández-Calle R, Konings SC, Frontiñán-Rubio J, García-Revilla J, Camprubí-Ferrer L, Svensson M, Martinson I, Boza-Serrano A, Venero JL, Nielsen HM, Gouras GK, Deierborg T. APOE in the bullseye of neurodegenerative diseases: impact of the APOE genotype in Alzheimer’s disease pathology and brain diseases. Mol Neurodegener 2022; 17:62. [PMID: 36153580 PMCID: PMC9509584 DOI: 10.1186/s13024-022-00566-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/29/2022] [Indexed: 02/06/2023] Open
Abstract
ApoE is the major lipid and cholesterol carrier in the CNS. There are three major human polymorphisms, apoE2, apoE3, and apoE4, and the genetic expression of APOE4 is one of the most influential risk factors for the development of late-onset Alzheimer's disease (AD). Neuroinflammation has become the third hallmark of AD, together with Amyloid-β plaques and neurofibrillary tangles of hyperphosphorylated aggregated tau protein. This review aims to broadly and extensively describe the differential aspects concerning apoE. Starting from the evolution of apoE to how APOE's single-nucleotide polymorphisms affect its structure, function, and involvement during health and disease. This review reflects on how APOE's polymorphisms impact critical aspects of AD pathology, such as the neuroinflammatory response, particularly the effect of APOE on astrocytic and microglial function and microglial dynamics, synaptic function, amyloid-β load, tau pathology, autophagy, and cell–cell communication. We discuss influential factors affecting AD pathology combined with the APOE genotype, such as sex, age, diet, physical exercise, current therapies and clinical trials in the AD field. The impact of the APOE genotype in other neurodegenerative diseases characterized by overt inflammation, e.g., alpha- synucleinopathies and Parkinson's disease, traumatic brain injury, stroke, amyotrophic lateral sclerosis, and multiple sclerosis, is also addressed. Therefore, this review gathers the most relevant findings related to the APOE genotype up to date and its implications on AD and CNS pathologies to provide a deeper understanding of the knowledge in the APOE field.
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22
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Rivera D, Greving S, Arango-Lasprilla JC, von Steinbuechel N, Zeldovich M. Comparability of (Post-Concussion) Symptoms across Time in Individuals after Traumatic Brain Injury: Results from the CENTER-TBI Study. J Clin Med 2022; 11:jcm11144090. [PMID: 35887853 PMCID: PMC9322034 DOI: 10.3390/jcm11144090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
Post-concussion symptoms often occur after TBI, persist and cause disabilities. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is widely used in this population, but little is known about the comparability of the symptoms over time, i.e., longitudinal measurement invariance (MI). The objectives of this study were to analyze the longitudinal MI of RPQ symptoms from three to twelve months after TBI and to find factors related to RPQ symptoms. The study involved 1023 individuals after TBI who took part in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study and completed the RPQ at three, six and twelve months post-injury. Longitudinal confirmatory factor analysis showed that the three-factor structure (somatic, emotional and cognitive) remains stable within one year after TBI. Linear mixed models revealed that sex, injury cause and prior psychiatric problems were related to the RPQ three-factor structure as well as to the RPQ total score. The study strengthens evidence for the RPQ’s factorial structure stability within one year after TBI and identifies sex, injury cause and prior psychiatric problems as important factors that may help clinicians to prevent future complications of symptomatology after TBI.
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Affiliation(s)
- Diego Rivera
- Department of Health Sciences, Public University of Navarre, Arrosadia Campus, 31006 Pamplona, Spain;
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea Street 3, 31008 Pamplona, Spain
| | - Sven Greving
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany; (S.G.); (N.v.S.)
| | | | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany; (S.G.); (N.v.S.)
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany; (S.G.); (N.v.S.)
- Correspondence:
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Sethi NK, Neidecker J. Neuroimaging in professional combat sports: consensus statement from the association of ringside physicians. PHYSICIAN SPORTSMED 2022:1-8. [PMID: 35678314 DOI: 10.1080/00913847.2022.2083922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Professional boxing, kickboxing, and mixed martial arts (MMA) are popular sports with substantial risk for both acute and chronic traumatic brain injury (TBI). Although rare, combat sports athletes have died in the ring or soon after the completion of a bout. Deaths in these instances are usually the result of an acute catastrophic neurological event such as an acute subdural hematoma (SDH). Other causes may include acute epidural hematoma (EDH), subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage (IPH), or a controversial, rare, and still disputed clinical entity called second-impact syndrome (SIS). Neuroimaging or brain imaging is currently included in the process of registering for a license to compete in combat sports in some jurisdictions of the United States of America and around the world. However, the required imaging specifics and frequency vary with no consensus guidelines. The Association of Ringside Physicians (an international, nonprofit organization dedicated to the health and safety of the combat sports athlete) sets forth this consensus statement to establish neuroimaging guidelines in combat sports. Commissions, ringside physicians, combat sports athletes, trainers, promoters, sanctioning bodies, and other healthcare professionals can use this statement for risk stratification of a professional combat sports athlete prior to licensure, identifying high-risk athletes and for prognostication of the brain health of these athletes over the course of their career. Guidelines are also put forth regarding neuroimaging requirements in the immediate aftermath of a bout.
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Affiliation(s)
- Nitin K Sethi
- Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - John Neidecker
- Department of Sports Medicine, Orthopedic Specialists of North Carolina, Raleigh NC, USA
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Gallacher J, Pickering J, Bayer A, Heslop L, Morgan G, Watkins A, Martin R, Elwood P. Amateur Boxing and Dementia: Cognitive Impairment Within the 35-Year Caerphilly Cohort Study. Clin J Sport Med 2022; 32:329-333. [PMID: 35470341 DOI: 10.1097/jsm.0000000000000976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 07/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the long-term effects of amateur boxing in a representative population sample of men. DESIGN The sample was examined every 5 years for 35 years. Cognition was assessed repeatedly from the third examination. Previous boxing experience and dementia were assessed at the fifth examination, and dementia assessed subsequently through medical records. SETTING AND ASSESSMENT OF RICK FACTORS The Caerphilly Prospective Study investigates risk factors for a range of chronic diseases of diseases. These include life style and behavior, together with biological factors relevant to vascular disease. PARTICIPANTS 1123 adult men aged 45 to 59 years at baseline, followed for 35 years. MAIN OUTCOME MEASURES Cognitive impairment. RESULTS A report by a subject of having boxed "seriously" when younger was associated with a 2-fold increase in cognitive impairment [odds ratio (OR) = 2.27; 95% confidence intervals = 1.18-4.38]. For amnestic (Alzheimer-like) impairment, this rises to OR = 2.78 (95% confidence limits 1.37-5.65). Having boxed is associated with an "advancement" in the onset of the dementia (4.8 years; 95% confidence limits 0.9-8.8 years). CONCLUSIONS Amateur boxing is associated with an increased risk and an earlier onset of cognitive impairment and dementia.
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Affiliation(s)
- John Gallacher
- Department of Psychiatry, University of Oxford, England, United Kingdom
| | - Janet Pickering
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Anthony Bayer
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Luke Heslop
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Gareth Morgan
- Hywel Dda Health Board, Cardiff, Wales, United Kingdom ; and
| | - Angela Watkins
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
| | - Rhodri Martin
- Cwm Taf University Health Board, Cardiff, Wales, United Kingdom
| | - Peter Elwood
- Division of Population Medicine, PRIME Centre Wales, Cardiff University, Cardiff, Wales, United Kingdom
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Mavroudis I, Kazis D, Chowdhury R, Petridis F, Costa V, Balmus IM, Ciobica A, Luca AC, Radu I, Dobrin RP, Baloyannis S. Post-Concussion Syndrome and Chronic Traumatic Encephalopathy: Narrative Review on the Neuropathology, Neuroimaging and Fluid Biomarkers. Diagnostics (Basel) 2022; 12:diagnostics12030740. [PMID: 35328293 PMCID: PMC8947595 DOI: 10.3390/diagnostics12030740] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 01/08/2023] Open
Abstract
Traumatic brain injury is a significant public health issue and represents the main contributor to death and disability globally among all trauma-related injuries. Martial arts practitioners, military veterans, athletes, victims of physical abuse, and epileptic patients could be affected by the consequences of repetitive mild head injuries (RMHI) that do not resume only to short-termed traumatic brain injuries (TBI) effects but also to more complex and time-extended outcomes, such as post-concussive syndrome (PCS) and chronic traumatic encephalopathy (CTE). These effects in later life are not yet well understood; however, recent studies suggested that even mild head injuries can lead to an elevated risk of later-life cognitive impairment and neurodegenerative disease. While most of the PCS hallmarks consist in immediate consequences and only in some conditions in long-termed processes undergoing neurodegeneration and impaired brain functions, the neuropathological hallmark of CTE is the deposition of p-tau immunoreactive pre-tangles and thread-like neurites at the depths of cerebral sulci and neurofibrillary tangles in the superficial layers I and II which are also one of the main hallmarks of neurodegeneration. Despite different CTE diagnostic criteria in clinical and research approaches, their specificity and sensitivity remain unclear and CTE could only be diagnosed post-mortem. In CTE, case risk factors include RMHI exposure due to profession (athletes, military personnel), history of trauma (abuse), or pathologies (epilepsy). Numerous studies aimed to identify imaging and fluid biomarkers that could assist diagnosis and probably lead to early intervention, despite their heterogeneous outcomes. Still, the true challenge remains the prediction of neurodegeneration risk following TBI, thus in PCS and CTE. Further studies in high-risk populations are required to establish specific, preferably non-invasive diagnostic biomarkers for CTE, considering the aim of preventive medicine.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK; (I.M.); (R.C.)
- Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece; (V.C.); (S.B.)
- Research Institute for Alzheimer’s Disease and Neurodegenerative Diseases, Heraklion Langada, 57200 Thessaloniki, Greece
| | - Dimitrios Kazis
- Third Department of Neurology, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (D.K.); (F.P.)
| | - Rumana Chowdhury
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK; (I.M.); (R.C.)
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (D.K.); (F.P.)
| | - Vasiliki Costa
- Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece; (V.C.); (S.B.)
| | - Ioana-Miruna Balmus
- Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, “Alexandru Ioan Cuza” University of Iași, 700057 Iași, Romania;
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, 700506 Iași, Romania
- Correspondence: (A.C.); (A.-C.L.); (R.P.D.)
| | - Alina-Costina Luca
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
- Correspondence: (A.C.); (A.-C.L.); (R.P.D.)
| | - Iulian Radu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Romeo Petru Dobrin
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
- Correspondence: (A.C.); (A.-C.L.); (R.P.D.)
| | - Stavros Baloyannis
- Laboratory of Neuropathology and Electron Microscopy, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece; (V.C.); (S.B.)
- Research Institute for Alzheimer’s Disease and Neurodegenerative Diseases, Heraklion Langada, 57200 Thessaloniki, Greece
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Cheng R, Bergmann J. Impact and workload are dominating on-field data monitoring techniques to track health and well-being of team-sports athletes. Physiol Meas 2022; 43. [PMID: 35235917 DOI: 10.1088/1361-6579/ac59db] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 03/01/2022] [Indexed: 11/12/2022]
Abstract
Participation in sports has become an essential part of healthy living in today's world. However, injuries can often occur during sports participation. With advancements in sensor technology and data analytics, many sports have turned to technology-aided, data-driven, on-field monitoring techniques to help prevent injuries and plan better player management. This review searched three databases, Web of Science, IEEE, and PubMed, for peer-reviewed articles on on-field data monitoring techniques that are aimed at improving the health and well-being of team-sports athletes. It was found that most on-field data monitoring methods can be categorized as either player workload tracking or physical impact monitoring. Many studies covered during this review attempted to establish correlations between captured physical and physiological data, as well as injury risk. In these studies, workloads are frequently tracked to optimize training and prevent overtraining in addition to overuse injuries, while impacts are most often tracked to detect and investigate traumatic injuries. This review found that current sports monitoring practices often suffer from a lack of standard metrics and definitions. Furthermore, existing data-analysis models are created on data that are limited in both size and diversity. These issues need to be addressed to create ecologically valid approaches in the future.
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Affiliation(s)
- Runbei Cheng
- Department of Engineering Science, University of Oxford, Thom Building, Parks Road, Oxford, OX1 3PJ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Jeroen Bergmann
- Department of Engineering Science, University of Oxford, Thom Building, Parks Road, Oxford, OX1 3PJ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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Ratiu I, Fissel-Brannick S, Whiting M, Murnion L, Azuma T. The impact of mild traumatic brain injury on reading comprehension and eye movements: preliminary results. JOURNAL OF COMMUNICATION DISORDERS 2022; 96:106197. [PMID: 35151226 DOI: 10.1016/j.jcomdis.2022.106197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/21/2021] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Individuals who sustain a mild traumatic brain injury (mTBI) can suffer from executive function, working memory, and attention deficits, which can impact functional task performance, including reading comprehension. Individuals with mTBI commonly report reading difficulties, but such difficulties have been historically difficult to capture using behavioral measures. The current study examined reading performance in those with and without mTBI using eye-tracking measures, which may be more sensitive to reading impairment in mTBI. METHOD/RESULTS In Experiment 1, 26 participants with a history of mTBI and 26 healthy control participants completed working memory (WM) and reading comprehension tasks. We found no differences in behavioral measures but found that spontaneous eye-blinking frequency was lower during the reading task in the mTBI group. In Experiment 2, we explored the impact of auditory distraction (e.g., multi-talker babble) on reading and memory performance. Twenty-three new participants with a history of mTBI and 26 healthy control participants completed a short-term memory (STM) task, a WM task, and a reading comprehension task under two distraction conditions. As in Experiment 1, we found no differences on behavioral measures, but observed significant differences on spontaneous eye-blinking frequency between those with and without mTBI. Group differences in distraction effects were also observed and performance on the WM task predicted reading comprehension performance. CONCLUSIONS The lack of differences on behavioral measures between groups, but lower frequencies of spontaneous eye blinking in the mTBI group suggests that while these individuals successfully completed the reading comprehension task, they may require more cognitive resources to do so.
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Affiliation(s)
- Ileana Ratiu
- Midwestern University, USA; Arizona State University, USA.
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28
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McCarthy DM, Zhang L, Wilkes BJ, Vaillancourt DE, Biederman J, Bhide PG. Nicotine and the developing brain: Insights from preclinical models. Pharmacol Biochem Behav 2022; 214:173355. [DOI: 10.1016/j.pbb.2022.173355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
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Zhang L, Levenson CW, Salazar VC, Biederman J, Zafonte R, Bhide PG. Repetitive Mild Traumatic Brain Injury in an Awake, Unanesthetized Mouse Model of Perinatal Nicotine Exposure Produces Transient Novelty-Seeking and Depression-Like Behaviors. J Neurotrauma 2022; 39:954-963. [PMID: 34913733 DOI: 10.1089/neu.2021.0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) can be a risk factor for repetitive mild traumatic brain injury (mTBI) or concussions such as those that can occur in contact sports. Individuals with ADHD also appear to have a higher risk of poor neurocognitive outcomes after repetitive mTBI. Findings from clinical studies examining the interactions between ADHD and repetitive mTBI vary, likely because of variabilities in experimental design and outcome measures. We used a mouse model of perinatal nicotine exposure (PNE), which displays behavioral, neuroanatomical, and neurotransmitter features consistent with ADHD and subjected the mice to repetitive mTBI. We used a closed head model of mTBI in awake, unanesthetized mice to mimic concussions in humans. The mTBI was repeated three times daily for seven days. The mice in the PNE-mTBI group took longer to regain consciousness after the mTBI and showed transient novelty-seeking and depression-like behaviors. Before the repetitive mTBI, the mice in the PNE group showed attention deficit, which persisted after the mTBI. The mice in the control (non-PNE) group showed a transient attention deficit after the repetitive mTBI but not any of the other behavioral changes seen in the PNE-mTBI group. These findings from an unanesthetized mouse model with a pre-existing condition show that ADHD and repetitive mTBI together contribute to transient novelty-seeking and depression-like behavior supporting the notion that untreated ADHD may be a risk factor for poor neurocognitive outcomes after concussions.
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Affiliation(s)
- Lin Zhang
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Cathy W Levenson
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Valentina Cea Salazar
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Joseph Biederman
- Pediatric Psychopharmacology, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Pradeep G Bhide
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida, USA
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Morgan R, Prosapio J, Kara S, Sonty S, Youssef P, Nedd K. Preliminary clinical diagnostic criteria for chronic traumatic encephalopathy: A case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Chary K, Narvaez O, Salo RA, San Martín Molina I, Tohka J, Aggarwal M, Gröhn O, Sierra A. Microstructural Tissue Changes in a Rat Model of Mild Traumatic Brain Injury. Front Neurosci 2021; 15:746214. [PMID: 34899158 PMCID: PMC8662623 DOI: 10.3389/fnins.2021.746214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/27/2021] [Indexed: 12/31/2022] Open
Abstract
Our study investigates the potential of diffusion MRI (dMRI), including diffusion tensor imaging (DTI), fixel-based analysis (FBA) and neurite orientation dispersion and density imaging (NODDI), to detect microstructural tissue abnormalities in rats after mild traumatic brain injury (mTBI). The brains of sham-operated and mTBI rats 35 days after lateral fluid percussion injury were imaged ex vivo in a 11.7-T scanner. Voxel-based analyses of DTI-, fixel- and NODDI-based metrics detected extensive tissue changes in directly affected brain areas close to the primary injury, and more importantly, also in distal areas connected to primary injury and indirectly affected by the secondary injury mechanisms. Histology revealed ongoing axonal abnormalities and inflammation, 35 days after the injury, in the brain areas highlighted in the group analyses. Fractional anisotropy (FA), fiber density (FD) and fiber density and fiber bundle cross-section (FDC) showed similar pattern of significant areas throughout the brain; however, FA showed more significant voxels in gray matter areas, while FD and FDC in white matter areas, and orientation dispersion index (ODI) in areas most damage based on histology. Region-of-interest (ROI)-based analyses on dMRI maps and histology in selected brain regions revealed that the changes in MRI parameters could be attributed to both alterations in myelinated fiber bundles and increased cellularity. This study demonstrates that the combination of dMRI methods can provide a more complete insight into the microstructural alterations in white and gray matter after mTBI, which may aid diagnosis and prognosis following a mild brain injury.
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Affiliation(s)
- Karthik Chary
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Omar Narvaez
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Raimo A. Salo
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Jussi Tohka
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Manisha Aggarwal
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Olli Gröhn
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Alejandra Sierra
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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Evidence of Neuroinflammation and Blood-Brain Barrier Disruption in Women with Preeclampsia and Eclampsia. Cells 2021; 10:cells10113045. [PMID: 34831266 PMCID: PMC8616341 DOI: 10.3390/cells10113045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/16/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
Cerebral complications in preeclampsia are leading causes of maternal mortality. Animal models suggest that an injured blood-brain barrier and neuroinflammation may be important but there is paucity of data from human studies. Therefore, we aimed to evaluate this in women with preeclampsia and eclampsia. We included women recruited to the South African Preeclampsia Obstetric Adverse Events (PROVE) biobank. Blood and cerebrospinal fluid (CSF) were collected around delivery. CSF was analyzed for neuroinflammatory markers interleukin 1β, interleukin 6, interleukin-8 and tumor necrosis factor alpha (TNF-alpha). The CSF to plasma albumin ratio was measured to assess blood-brain barrier function. Women with eclampsia (n = 4) showed increased CSF concentrations of all pro-inflammatory cytokines and TNF-alpha compared to women with normotensive pregnancies (n = 7) and also for interleukin-6 and TNF-alpha compared to women with preeclampsia (n = 4). Women with preeclampsia also showed increases in pro-inflammatory cytokines IL-6 and IL-8 but not TNF-alpha in the CSF compared to women with normotensive pregnancies. In particular, women with eclampsia but also women with preeclampsia showed an increase in the CSF to plasma albumin ratio compared to normotensive women. In conclusion, women with preeclampsia and eclampsia show evidence of neuroinflammation and an injured blood-brain barrier. These findings are seen in particular among women with eclampsia.
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Diekfuss JA, Yuan W, Dudley JA, DiCesare CA, Panzer MB, Talavage TM, Nauman E, Bonnette S, Slutsky-Ganesh AB, Clark J, Anand M, Altaye M, Leach JL, Lamplot JD, Galloway M, Pombo MW, Hammond KE, Myer GD. Evaluation of the Effectiveness of Newer Helmet Designs with Emergent Shell and Padding Technologies Versus Older Helmet Models for Preserving White Matter Following a Season of High School Football. Ann Biomed Eng 2021; 49:2863-2874. [PMID: 34585336 DOI: 10.1007/s10439-021-02863-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/31/2021] [Indexed: 01/04/2023]
Abstract
We aimed to objectively compare the effects of wearing newer, higher-ranked football helmets (HRank) vs. wearing older, lower-ranked helmets (LRank) on pre- to post-season alterations to neuroimaging-derived metrics of athletes' white matter. Fifty-four high-school athletes wore an HRank helmet, and 62 athletes wore an LRank helmet during their competitive football season and completed pre- and post-season diffusion tensor imaging (DTI). Longitudinal within- and between-group DTI metrics [fractional anisotropy (FA) and mean/axial/radial diffusivity (MD, AD, RD)] were analyzed using tract-based spatial statistics. The LRank helmet group exhibited significant pre- to post-season reductions in MD, AD, and RD, the HRank helmet group displayed significant pre- to post-season increases in FA, and both groups showed significant pre- to post-season increases in AD (p's < .05 [corrected]). Between-group analyses revealed the pre- to post-season increase in AD was significantly less for athletes wearing HRank compared to LRank (p < .05 [corrected]). These data provide in vivo evidence that wearing an HRank helmet may be efficacious for preserving white matter from head impact exposure during high school football. Future prospective longitudinal investigations with complimentary imaging and behavioral outcomes are warranted to corroborate these initial in vivo findings.
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Affiliation(s)
- Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA. .,Emory Sports Medicine Center, Atlanta, GA, USA. .,Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan A Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Matthew B Panzer
- Center for Applied Biomechanics, Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - Thomas M Talavage
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.,School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA.,Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Eric Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.,School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexis B Slutsky-Ganesh
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA.,Emory Sports Medicine Center, Atlanta, GA, USA.,Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph Clark
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Manish Anand
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA.,Emory Sports Medicine Center, Atlanta, GA, USA.,Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James L Leach
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joseph D Lamplot
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Mathew W Pombo
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kyle E Hammond
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA.,Emory Sports Medicine Center, Atlanta, GA, USA.,Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
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[Experience with 4 clinical cases. Traumatic encephalopathy may be associated with a single traumatic brain injury?]. Rehabilitacion (Madr) 2021; 56:383-387. [PMID: 34538654 DOI: 10.1016/j.rh.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 11/20/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that affects people who had repetitive head trauma. Also, in single traumatic brain injury (TBI), changes may be found during the follow-up visits. We present four clinical cases of patients visited at the Institut Guttmann clinic between 2017 and 2019. They were affected by mild sequelae of severe and unique TBI who have subsequently developed a neurodegenerative disease without a specific diagnosis, and who could meet clinical criteria for chronic traumatic encephalopathy syndrome. Rehabilitation doctors are the professionals with the greatest possibility of identifying a suggestive clinic of this pathology, they can order the appropriate studies and indicate the new rehabilitation goals according to the new neurological situation.
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Small Neuron-Derived Extracellular Vesicles from Individuals with Down Syndrome Propagate Tau Pathology in the Wildtype Mouse Brain. J Clin Med 2021; 10:jcm10173931. [PMID: 34501378 PMCID: PMC8432237 DOI: 10.3390/jcm10173931] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 12/11/2022] Open
Abstract
Individuals with Down syndrome (DS) exhibit Alzheimer's disease (AD) pathology at a young age, including amyloid plaques and neurofibrillary tangles (NFTs). Tau pathology can spread via extracellular vesicles, such as exosomes. The cargo of neuron-derived small extracellular vesicles (NDEVs) from individuals with DS contains p-Tau at an early age. The goal of the study was to investigate whether NDEVs isolated from the blood of individuals with DS can spread Tau pathology in the brain of wildtype mice. We purified NDEVs from the plasma of patients with DS-AD and controls and injected small quantities using stereotaxic surgery into the dorsal hippocampus of adult wildtype mice. Seeding competent Tau conformers were amplified in vitro from DS-AD NDEVs but not NDEVs from controls. One month or 4 months post-injection, we examined Tau pathology in mouse brains. We found abundant p-Tau immunostaining in the hippocampus of the mice injected with DS-AD NDEVs compared to injections of age-matched control NDEVs. Double labeling with neuronal and glial markers showed that p-Tau staining was largely found in neurons and, to a lesser extent, in glial cells and that p-Tau immunostaining was spreading along the corpus callosum and the medio-lateral axis of the hippocampus. These studies demonstrate that NDEVs from DS-AD patients exhibit Tau seeding capacity and give rise to tangle-like intracellular inclusions.
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Oh SS, Lee EH, Kim JH, Seo YB, Choo YJ, Park J, Chang MC. The Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging for the Evaluation of Blood-Brain Barrier Disruption in Traumatic Brain Injury: What Is the Evidence? Brain Sci 2021; 11:brainsci11060775. [PMID: 34208047 PMCID: PMC8230721 DOI: 10.3390/brainsci11060775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Blood brain barrier (BBB) disruption following traumatic brain injury (TBI) results in a secondary injury by facilitating the entry of neurotoxins to the brain parenchyma without filtration. In the current paper, we aimed to review previous dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) studies to evaluate the occurrence of BBB disruption after TBI. (2) Methods: In electronic databases (PubMed, Scopus, Embase, and the Cochrane Library), we searched for the following keywords: dynamic contrast-enhanced OR DCE AND brain injury. We included studies in which BBB disruption was evaluated in patients with TBI using DCE-MRI. (3) Results: Four articles were included in this review. To assess BBB disruption, linear fit, Tofts, extended Tofts, or Patlak models were used. KTrans and ve were increased, and the values of vp were decreased in the cerebral cortex and predilection sites for diffusion axonal injury. These findings are indicative of BBB disruption following TBI. (4) Conclusions: Our analysis supports the possibility of utilizing DCE-MRI for the detection of BBB disruption following TBI.
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Affiliation(s)
- Sung Suk Oh
- Medical Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu 41061, Korea; (S.S.O.); (E.-H.L.); (Y.J.C.)
| | - Eun-Hee Lee
- Medical Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu 41061, Korea; (S.S.O.); (E.-H.L.); (Y.J.C.)
| | - Jong-Hoon Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu 41061, Korea; (J.-H.K.); (Y.B.S.)
| | - Young Beom Seo
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu 41061, Korea; (J.-H.K.); (Y.B.S.)
| | - Yoo Jin Choo
- Medical Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu 41061, Korea; (S.S.O.); (E.-H.L.); (Y.J.C.)
| | - Juyoung Park
- Medical Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu 41061, Korea; (S.S.O.); (E.-H.L.); (Y.J.C.)
- Correspondence: (J.P.); (M.C.C.)
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 41061, Korea
- Correspondence: (J.P.); (M.C.C.)
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Microglia: A Potential Drug Target for Traumatic Axonal Injury. Neural Plast 2021; 2021:5554824. [PMID: 34093701 PMCID: PMC8163545 DOI: 10.1155/2021/5554824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/06/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022] Open
Abstract
Traumatic axonal injury (TAI) is a major cause of death and disability among patients with severe traumatic brain injury (TBI); however, no effective therapies have been developed to treat this disorder. Neuroinflammation accompanying microglial activation after TBI is likely to be an important factor in TAI. In this review, we summarize the current research in this field, and recent studies suggest that microglial activation plays an important role in TAI development. We discuss several drugs and therapies that may aid TAI recovery by modulating the microglial phenotype following TBI. Based on the findings of recent studies, we conclude that the promotion of active microglia to the M2 phenotype is a potential drug target for the treatment of TAI.
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Iacono D, Raiciulescu S, Olsen C, Perl DP. Traumatic Brain Injury Exposure Lowers Age of Cognitive Decline in AD and Non-AD Conditions. Front Neurol 2021; 12:573401. [PMID: 34054681 PMCID: PMC8153372 DOI: 10.3389/fneur.2021.573401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to detect the possible accelerating role of previous traumatic brain injury (TBI) exposures on the onset of later cognitive decline assessed across different brain diseases. We analyzed data from the National Alzheimer's Coordinating Center (NACC), which provide information on history of TBI and longitudinal data on cognitive and non-cognitive domains for each available subject. At the time of this investigation, a total of 609 NACC subjects resulted to have a documented history of TBI. We compared subjects with and without a history of previous TBI (of any type) at the time of their first cognitive decline assessment, and termed them, respectively, TBI+ and TBI- subjects. Three hundred and sixty-one TBI+ subjects (229 male/132 female) and 248 TBI- subjects (156 male/92 female) were available. The analyses included TBI+ and TBI- subjects with a clinical diagnosis of Mild Cognitive Impairment, Alzheimer's disease, Dementia with Lewy bodies, Progressive supranuclear palsy, Corticobasal degeneration, Frontotemporal dementia, Vascular dementia, non-AD Impairment, and Parkinson's disease. The data showed that the mean age of TBI+ subjects was lower than TBI- subjects at the time of their first cognitive decline assessment (71.6 ± 11.2 vs. 74.8 ± 9.5 year; p < 0.001). Moreover, the earlier onset of cognitive decline in TBI+ vs. TBI- subjects was independent of sex, race, attained education, APOE genotype, and importantly, clinical diagnoses. As for specific cognitive aspects, MMSE, Trail Making Test part B and WAIS-R scores did not differ between TBI+ and TBI- subjects, whereas Trail Making Test part A (p = 0.013) and Boston Naming test (p = 0.008) did. In addition, data showed that neuropsychiatric symptoms [based on Neuropsychiatry Inventory (NPI)] were much more frequent in TBI+ vs. TBI- subjects, including AD and non-AD neurodegenerative conditions such as PD. These cross-sectional analyses outcomes from longitudinally-assessed cohorts of TBI+ subjects that is, subjects with TBI exposure before the onset of cognitive decline in the contest of different neurodegenerative disorders and associated pathogenetic mechanisms, are novel, and indicate that a previous TBI exposure may act as a significant "age-lowering" factor on the onset of cognitive decline in either AD and non-AD conditions independently of demographic factors, education, APOE genotype, and current or upcoming clinical conditions.
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Affiliation(s)
- Diego Iacono
- Department of Defense/Uniformed Services University (DoD/USU) Brain Tissue Repository & Neuropathology Program, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
- Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
- Neuroscience Graduate Program, Department of Anatomy, Physiology, and Genetics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
- The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, United States
- Complex Neurodegenerative Disorders, Neurodegenerative Disorders Clinic, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD, United States
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
| | - Cara Olsen
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
| | - Daniel P Perl
- Department of Defense/Uniformed Services University (DoD/USU) Brain Tissue Repository & Neuropathology Program, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Science (USU), Bethesda, MD, United States
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Blood Biomarkers of Sports-Related Concussion in Pediatric Athletes. Clin J Sport Med 2021; 31:250-256. [PMID: 30839351 DOI: 10.1097/jsm.0000000000000735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/10/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine changes in blood biomarkers, serum neurofilament light (Nf-L), and plasma tau, as well as the relationship between blood biomarkers and symptom reports, in athletes with a sports-related concussion. DESIGN Prospective cohort study. SETTING Private community-based concussion clinic. PARTICIPANTS Athletes aged 13 to 18 years old with a diagnosed sports-related concussion presenting to a concussion clinic within 7 days of injury and noninjured athletes with no history of concussion aged 13 to 23 years old. ASSESSMENT AND MAIN OUTCOME MEASURES Injured athletes provided a blood sample at the initial clinical evaluation and again at least 6 months after injury. Noninjured athletes provided a single blood sample. All participants completed symptom reports during each visit. Statistical comparisons of biomarker concentrations and symptom reports were conducted. RESULTS The mean rank for tau was significantly lower for concussed athletes compared with nonconcussed athletes. In contrast, the mean rank of Nf-L was higher for concussed athletes than for nonconcussed athletes, although the difference was nonsignificant. Plasma tau was significantly lower postinjury compared with 6 months after injury, whereas serum Nf-L was significantly higher postinjury. There was a weak but significant inverse relationship observed between tau and the number of symptoms reported, but no relationship was observed between Nf-L and the number of symptoms reported. CONCLUSIONS These data indicate that in the days following a sports-related concussion, the blood biomarkers tau and Nf-L display contrasting patterns of change but may not be related to self-reported symptom scores.
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Lehmkuhl EM, Loganathan S, Alsop E, Blythe AD, Kovalik T, Mortimore NP, Barrameda D, Kueth C, Eck RJ, Siddegowda BB, Joardar A, Ball H, Macias ME, Bowser R, Van Keuren-Jensen K, Zarnescu DC. TDP-43 proteinopathy alters the ribosome association of multiple mRNAs including the glypican Dally-like protein (Dlp)/GPC6. Acta Neuropathol Commun 2021; 9:52. [PMID: 33762006 PMCID: PMC7992842 DOI: 10.1186/s40478-021-01148-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/06/2021] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a genetically heterogeneous neurodegenerative disease in which 97% of patients exhibit cytoplasmic aggregates containing the RNA binding protein TDP-43. Using tagged ribosome affinity purifications in Drosophila models of TDP-43 proteinopathy, we identified TDP-43 dependent translational alterations in motor neurons impacting the spliceosome, pentose phosphate and oxidative phosphorylation pathways. A subset of the mRNAs with altered ribosome association are also enriched in TDP-43 complexes suggesting that they may be direct targets. Among these, dlp mRNA, which encodes the glypican Dally like protein (Dlp)/GPC6, a wingless (Wg/Wnt) signaling regulator is insolubilized both in flies and patient tissues with TDP-43 pathology. While Dlp/GPC6 forms puncta in the Drosophila neuropil and ALS spinal cords, it is reduced at the neuromuscular synapse in flies suggesting compartment specific effects of TDP-43 proteinopathy. These findings together with genetic interaction data show that Dlp/GPC6 is a novel, physiologically relevant target of TDP-43 proteinopathy.
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Affiliation(s)
- Erik M. Lehmkuhl
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
| | - Suvithanandhini Loganathan
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
| | - Eric Alsop
- Translational Genomics Research Institute, 445 N 5th St, Phoenix, AZ 85004 USA
| | - Alexander D. Blythe
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
| | - Tina Kovalik
- Department of Neurobiology, Barrow Neurological Institute, 350 W Thomas Rd, Phoenix, AZ 85013 USA
| | - Nicholas P. Mortimore
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
| | - Dianne Barrameda
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
| | - Chuol Kueth
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
| | - Randall J. Eck
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
| | - Bhavani B. Siddegowda
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
| | - Archi Joardar
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
| | - Hannah Ball
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
| | - Maria E. Macias
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
| | - Robert Bowser
- Department of Neurobiology, Barrow Neurological Institute, 350 W Thomas Rd, Phoenix, AZ 85013 USA
| | | | - Daniela C. Zarnescu
- Department of Cellular and Molecular Biology, University of Arizona, 1007 E. Lowell St, LSS RM 548A, Tucson, AZ 85721 USA
- Department of Neuroscience, University of Arizona, 1040 4th St, Tucson, AZ 85721 USA
- Department of Neurology, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724 USA
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Attilio PJ, Snapper DM, Rusnak M, Isaac A, Soltis AR, Wilkerson MD, Dalgard CL, Symes AJ. Transcriptomic Analysis of Mouse Brain After Traumatic Brain Injury Reveals That the Angiotensin Receptor Blocker Candesartan Acts Through Novel Pathways. Front Neurosci 2021; 15:636259. [PMID: 33828448 PMCID: PMC8019829 DOI: 10.3389/fnins.2021.636259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/19/2021] [Indexed: 12/30/2022] Open
Abstract
Traumatic brain injury (TBI) results in complex pathological reactions, where the initial lesion is followed by secondary inflammation and edema. Our laboratory and others have reported that angiotensin receptor blockers (ARBs) have efficacy in improving recovery from traumatic brain injury in mice. Treatment of mice with a subhypotensive dose of the ARB candesartan results in improved functional recovery, and reduced pathology (lesion volume, inflammation and gliosis). In order to gain a better understanding of the molecular mechanisms through which candesartan improves recovery after controlled cortical impact injury (CCI), we performed transcriptomic profiling on brain regions after injury and drug treatment. We examined RNA expression in the ipsilateral hippocampus, thalamus and hypothalamus at 3 or 29 days post injury (dpi) treated with either candesartan (0.1 mg/kg) or vehicle. RNA was isolated and analyzed by bulk mRNA-seq. Gene expression in injured and/or candesartan treated brain region was compared to that in sham vehicle treated mice in the same brain region to identify genes that were differentially expressed (DEGs) between groups. The most DEGs were expressed in the hippocampus at 3 dpi, and the number of DEGs reduced with distance and time from the lesion. Among pathways that were differentially expressed at 3 dpi after CCI, candesartan treatment altered genes involved in angiogenesis, interferon signaling, extracellular matrix regulation including integrins and chromosome maintenance and DNA replication. At 29 dpi, candesartan treatment reduced the expression of genes involved in the inflammatory response. Some changes in gene expression were confirmed in a separate cohort of animals by qPCR. Fewer DEGs were found in the thalamus, and only one in the hypothalamus at 3 dpi. Additionally, in the hippocampi of sham injured mice, 3 days of candesartan treatment led to the differential expression of 384 genes showing that candesartan in the absence of injury had a powerful impact on gene expression specifically in the hippocampus. Our results suggest that candesartan has broad actions in the brain after injury and affects different processes at acute and chronic times after injury. These data should assist in elucidating the beneficial effect of candesartan on recovery from TBI.
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Affiliation(s)
- Peter J. Attilio
- Graduate Program in Neuroscience, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Dustin M. Snapper
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Milan Rusnak
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Akira Isaac
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Anthony R. Soltis
- The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Matthew D. Wilkerson
- The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Clifton L. Dalgard
- The American Genome Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Aviva J. Symes
- Graduate Program in Neuroscience, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Development of brain atlases for early-to-middle adolescent collision-sport athletes. Sci Rep 2021; 11:6440. [PMID: 33742031 PMCID: PMC7979742 DOI: 10.1038/s41598-021-85518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/15/2021] [Indexed: 01/31/2023] Open
Abstract
Human brains develop across the life span and largely vary in morphology. Adolescent collision-sport athletes undergo repetitive head impacts over years of practices and competitions, and therefore may exhibit a neuroanatomical trajectory different from healthy adolescents in general. However, an unbiased brain atlas targeting these individuals does not exist. Although standardized brain atlases facilitate spatial normalization and voxel-wise analysis at the group level, when the underlying neuroanatomy does not represent the study population, greater biases and errors can be introduced during spatial normalization, confounding subsequent voxel-wise analysis and statistical findings. In this work, targeting early-to-middle adolescent (EMA, ages 13-19) collision-sport athletes, we developed population-specific brain atlases that include templates (T1-weighted and diffusion tensor magnetic resonance imaging) and semantic labels (cortical and white matter parcellations). Compared to standardized adult or age-appropriate templates, our templates better characterized the neuroanatomy of the EMA collision-sport athletes, reduced biases introduced during spatial normalization, and exhibited higher sensitivity in diffusion tensor imaging analysis. In summary, these results suggest the population-specific brain atlases are more appropriate towards reproducible and meaningful statistical results, which better clarify mechanisms of traumatic brain injury and monitor brain health for EMA collision-sport athletes.
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43
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Poluyi E, Morgan E, Poluyi C, Ikwuegbuenyi C, Imaguezegie G. Examining the Relationship between Concussion and Neurodegenerative Disorders: A Review on Amyotrophic Lateral Sclerosis (ALS) and Alzheimer’s Disease (AD). INDIAN JOURNAL OF NEUROTRAUMA 2021. [DOI: 10.1055/s-0041-1725571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Background Current epidemiological studies have examined the associations between moderate and severe traumatic brain injury (TBI) and their risks of developing neurodegenerative diseases. Concussion, also known as mild TBI (mTBI), is however quite distinct from moderate or severe TBIs. Only few studies in this burgeoning area have examined concussion—especially repetitive episodes—and neurodegenerative diseases. Thus, no definite relationship has been established between them.
Objectives This review will discuss the available literatures linking concussion and amyotrophic lateral sclerosis (ALS) and Alzheimer’s disease (AD).
Materials and Methods Given the complexity of this subject, a realist review methodology was selected which includes clarifying the scope and developing a theoretical framework, developing a search strategy, selection and appraisal, data extraction, and synthesis. A detailed literature matrix was set out in order to get relevant and recent findings on this topic.
Results Presently, there is no objective clinical test for the diagnosis of concussion because the features are less obvious on physical examination. Absence of an objective test in diagnosing concussion sometimes leads to skepticism when confirming the presence or absence of concussion. Intriguingly, several possible explanations have been proposed in the pathological mechanisms that lead to the development of some neurodegenerative disorders (such as ALS and AD) and concussion but the two major events are deposition of tau proteins (abnormal microtubule proteins) and neuroinflammation, which ranges from glutamate excitotoxicity pathways and inflammatory pathways (which leads to a rise in the metabolic demands of microglia cells and neurons), to mitochondrial function via the oxidative pathways.
Conclusion mTBI constitutes majority of brain injuries. However, studies have focused mostly on moderate-to-severe TBI as highlighted above with inconclusive and paucity of studies linking concussion and neurodegenerative disorders. Although, it is highly probable that repetitive concussion (mTBI) and subconcussive head injuries may be risk factors for ALS) and AD from this review. It will be imperative therefore to conduct more research with a focus on mTBI and its association with ALS and AD.
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Affiliation(s)
- Edward Poluyi
- Department of Clinical Neuroscience, University of Roehampton, London, United Kingdom
| | - Eghosa Morgan
- Department of Neurosurgery, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Charles Poluyi
- MPH Program, University of Buffalo, New York, United States
| | | | - Grace Imaguezegie
- Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
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Iqubal A, Bansal P, Iqubal MK, Pottoo FH, Haque SE. An Overview and Therapeutic Promise of Nutraceuticals against Sports-Related Brain Injury. Curr Mol Pharmacol 2021; 15:3-22. [PMID: 33538684 DOI: 10.2174/1874467214666210203211914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022]
Abstract
Sports-related traumatic brain injury (TBI) is one of the common neurological maladies experienced by athletes. Earlier the term 'punch drunk syndrome' was used in the case TBI of boxers and now this term is replaced by chronic traumatic encephalopathy (CTE). Sports-related brain injury can either be short term or long term. A common instance of brain injury encompasses subdural hematoma, concussion, cognitive dysfunction, amnesia, headache, vision issue, axonopathy, or even death if remain undiagnosed or untreated. Further, chronic TBI may lead to pathogenesis of neuroinflammation and neurodegeneration via tauopathy, formation of neurofibrillary tangles, and damage to the blood-brain barrier, microglial, and astrocyte activation. Thus, altered pathological, neurochemical, and neurometabolic attributes lead to the modulation of multiple signaling pathways and cause neurological dysfunction. Available pharmaceutical interventions are based on one drug one target hypothesis and thereby unable to cover altered multiple signaling pathways. However, in recent time's pharmacological intervention of nutrients and nutraceuticals have been explored as they exert a multifactorial mode of action and maintain over homeostasis of the body. There are various reports available showing the positive therapeutic effect of nutraceuticals in sport-related brain injury. Therefore, in the current article we have discussed the pathology, neurological consequence, sequelae, and perpetuation of sports-related brain injury. Further, we have discussed various nutraceutical supplements as well as available animal models to explore the neuroprotective effect/ upshots of these nutraceuticals in sports-related brain injury.
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Affiliation(s)
- Ashif Iqubal
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Pratichi Bansal
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Mohammad Kashif Iqubal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Faheem Hyder Pottoo
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal, University, P.O.BOX 1982, Damman, 31441, . Saudi Arabia
| | - Syed Ehtaishamul Haque
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
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Langevin TL, Antonoff D, Renodin C, Shellene E, Spahr L, Marsh WA, Rosene JM. Head impact exposures in women's collegiate rugby. PHYSICIAN SPORTSMED 2021; 49:68-73. [PMID: 32419585 DOI: 10.1080/00913847.2020.1770568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: To describe the incidence, magnitude, and distribution of head impacts and track concussions sustained in a collegiate level women's rugby season. Methods: Data on head impact incidence and magnitude were collected via Smart Impact Monitors (SIM) (Triax Technologies, Inc., Norwalk, CT) within fitted headbands during practices and games of one competitive season. Magnitude data included peak linear acceleration (PLA) and peak rotational velocity (PRV) measurements and were reported as median [IQR]. Results: Players sustained 120 head impacts ≥15 g (18.1 g - 78.9 g) with 1199 total athlete exposures. In eight games, 67 head impacts were recorded with a mean rate of 0.40 ± 0.22 hits per-player per-match, median PLA of 32.2 g, and PRV of 13.5 rad.sec-1. There were 53 head impacts in 47 practices with a mean rate of 0.05 ± 0.04 hits per-player per-practice, median PLA of 29.8 g and PRV of 15.7 rad.sec-1. Four concussions were reported and monitored. Conclusion: The incidence and magnitude of head impacts in collegiate level women's rugby over one season of practices and games were fewer than those reported in other comparable studies. These findings give insight into the impact burden that female collegiate rugby athletes withstand throughout a competitive season.
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Affiliation(s)
- Taylor L Langevin
- Medical student, University of New England College of Osteopathic Medicine , Biddeford, ME, USA
| | - Daniel Antonoff
- Medical student, University of New England College of Osteopathic Medicine , Biddeford, ME, USA
| | - Christina Renodin
- Medical student, University of New England College of Osteopathic Medicine , Biddeford, ME, USA
| | - Erin Shellene
- Department of Athletics, University of New England , Biddeford, ME, USA
| | - Lee Spahr
- Department of Exercise and Sport Performance, University of New England , Biddeford, ME, USA
| | - Wallace A Marsh
- Associate Dean, University of New England College of Pharmacy , Portland, ME, USA
| | - John M Rosene
- Department of Exercise and Sport Performance, University of New England , Biddeford, ME, USA
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Costanza A, Radomska M, Zenga F, Amerio A, Aguglia A, Serafini G, Amore M, Berardelli I, Ojio Y, Nguyen KD. Severe Suicidality in Athletes with Chronic Traumatic Encephalopathy: A Case Series and Overview on Putative Ethiopathogenetic Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030876. [PMID: 33498520 PMCID: PMC7908343 DOI: 10.3390/ijerph18030876] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) results from repetitive brain injuries and is a common neurotraumatic sequela in contact sports. CTE is often accompanied by neuropsychiatric symptoms, which could escalate to suicidal ideation (SI) and suicidal behaviour (SB). Nevertheless, fairly limited emphasis about the association between suicidality and CTE exists in medical literature. Here, we report two cases of retired professional athletes in high contact sports (boxing and ice hockey) who have developed similar clinical trajectories characterized by progressive neuropsychiatric symptoms compatible with a CTE diagnosis and subsequent SB in its severe forms (medical serious suicide attempt (SA) and completed suicide). In addition to the description of outlining clinical, neuropsychological, neuroimaging, and differential diagnosis elements related to these cases, we also hypothesized some mechanisms that might augment the suicide risk in CTE. They include those related to neurobiological (neuroanatomic/neuroinflammatory) dysfunctions as well as those pertaining to psychiatry and psychosocial maladaptation to neurotraumas and retirement from professional competitive activity. Findings described here can provide clinical pictures to improve the identification of patients with CTE and also potential mechanistic insights to refine the knowledge of eventual severe SB development, which might enable its earlier prevention.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland
- Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy
- Correspondence:
| | - Michalina Radomska
- Faculty of Psychology, University of Geneva (UNIGE), 1206 Geneva, Switzerland;
| | - Francesco Zenga
- Department of Neurosurgery, City of Health and Science Hospital, 10126 Torino, Italy;
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Psychiatry, Tufts University, Boston, MA 02111, USA
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Isabella Berardelli
- Suicide Prevention Center, Department of Neurosciences, Mental Health and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Yasutaka Ojio
- National Center of Neurology and Psychiatry, Department of Community Mental Health Law, National Institute of Mental Health, Tokyo 187-8553, Japan;
| | - Khoa D. Nguyen
- Department of Microbiology and Immunology, Stanford University, Palo Alto, CA 94304, USA;
- Tranquis Therapeutics, Palo Alto, CA 94304, USA
- Hong Kong University of Science and Technology, Hong Kong, China
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Orr R, Bogg T, Fyffe A, Lam LT, Browne GJ. Graded Exercise Testing Predicts Recovery Trajectory of Concussion in Children and Adolescents. Clin J Sport Med 2021; 31:23-30. [PMID: 30439726 DOI: 10.1097/jsm.0000000000000683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether graded exercise testing can predict recovery trajectory of concussion in children and adolescents. DESIGN Prospective study. SETTING Children's Hospital, Westmead, Australia. PARTICIPANTS One hundred thirty-nine children aged 12 to 16 years at 5 to 7 days after an acute concussive injury. INTERVENTION Graded exercise testing on a treadmill at the subacute phase to assess symptom provocation and determine clinical recovery indicating readiness to commence a return to activity (RTA) protocol. Exercise time to symptom exacerbation and clinical recovery were measured. MAIN OUTCOME MEASURES Standard concussion assessment and clinical testing (neurocognitive, vestibular/ocular, and balance) were conducted to determine major clinical drivers/indicators. RESULTS Participants (mean age 12.4 ± 2.8 years, 73% male) had a confirmed sport-related concussion. The main clinical drivers identified on exercise testing were headache, balance, and vestibular dysfunction. Participants fell into 1 of 2 groups, exercise-tolerant (54%) and exercise-intolerant (46%). Exercise-tolerant patients showed mild clinical indicators, no symptom exacerbation during 10.3 ± 3.3 minutes of exercise, were safely transitioned to a RTA protocol, and recovered within 10 days. Exercise-intolerant patients had high clinical indicators, significant symptom exacerbation at 4.2 ± 1.6 minutes of exercise, and prolonged recovery of 45.6 days. No adverse effects from exercise were reported in either group. Combined use of provocative exercise and clinical testing was 93% predictive of outcome. CONCLUSIONS Exercise testing during the subacute phase after a concussion can predict longer recovery. Exercise testing can identify a unique window where patients can be safely transitioned to activity, enabling clinicians to better inform patients and families, allocate resources and streamline care.
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Affiliation(s)
- Rhonda Orr
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, and Discipline of Emergency Medicine, The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Tina Bogg
- Sydney Children's Hospital Network, Children's Hospital Institute of Sports Medicine, The Royal Alexandra Hospital for Children, Children's Hospital Westmead, Sydney, Australia
| | - Andrew Fyffe
- Sydney Children's Hospital Network, Children's Hospital Institute of Sports Medicine, The Royal Alexandra Hospital for Children, Children's Hospital Westmead, Sydney, Australia
| | - Lawrence T Lam
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia ; and
| | - Gary J Browne
- Sydney Children's Hospital Network, Children's Hospital Institute of Sports Medicine, The Royal Alexandra Hospital for Children, Children's Hospital Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
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Sur C, Kost J, Scott D, Adamczuk K, Fox NC, Cummings JL, Tariot PN, Aisen PS, Vellas B, Voss T, Mahoney E, Mukai Y, Kennedy ME, Lines C, Michelson D, Egan MF. BACE inhibition causes rapid, regional, and non-progressive volume reduction in Alzheimer's disease brain. Brain 2020; 143:3816-3826. [PMID: 33253354 PMCID: PMC8453290 DOI: 10.1093/brain/awaa332] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 01/26/2023] Open
Abstract
In the phase 3 EPOCH trial (Clinicaltrials.gov; NCT01739348), treatment with the BACE inhibitor verubecestat failed to improve cognition in patients with mild-to-moderate Alzheimer's disease, but was associated with reduced hippocampal volume after 78 weeks as assessed by MRI. The aims of the present exploratory analyses were to: (i) characterize the effect of verubecestat on brain volume by evaluating the time course of volumetric MRI changes for a variety of brain regions; and (ii) understand the mechanism through which verubecestat might cause hippocampal (and other brain region) volume loss by assessing its relationship to measures of amyloid, neurodegeneration, and cognition. Participants were aged 55-85 years with probable Alzheimer's disease dementia and a Mini Mental State Examination score ≥15 and ≤26. MRIs were obtained at baseline and at Weeks 13, 26, 52 and 78 of treatment. MRIs were segmented using Freesurfer and analysed using a tensor-based morphometry method. PET amyloid data were obtained with 18F-flutemetamol (Vizamyl®) at baseline and Week 78. Standardized uptake value ratios were generated with subcortical white matter as a reference region. Neurofilament light chain in the CSF was assessed as a biomarker of neurodegeneration. Compared with placebo, verubecestat showed increased MRI brain volume loss at Week 13 with no evidence of additional loss through Week 78. The verubecestat-related volumetric MRI loss occurred predominantly in amyloid-rich brain regions. Correlations between amyloid burden at baseline and verubecestat-related volumetric MRI reductions were not significant (r = 0.05 to 0.26, P-values > 0.27). There were no significant differences between verubecestat and placebo in changes from baseline in CSF levels of neurofilament light chain at Week 78 (increases of 7.2 and 14.6 pg/ml for verubecestat versus 19.7 pg/ml for placebo, P-values ≥ 0.1). There was a moderate correlation between volumetric MRI changes and cognitive decline in all groups including placebo at Week 78 (e.g. r = -0.45 to -0.55, P < 0.001 for whole brain), but the correlations were smaller at Week 13 and significant only for the verubecestat groups (e.g. r = -0.15 and -0.11, P < 0.04 for whole brain). Our results suggest that the verubecestat-associated MRI brain volume loss is not due to generalized, progressive neurodegeneration, but may be mediated by specific effects on BACE-related amyloid processes.
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Affiliation(s)
| | - James Kost
- Merck and Co., Inc., Kenilworth, NJ, USA
| | | | | | - Nick C Fox
- Institute of Neurology and UK Dementia Research Institute, University College London, London, UK
| | - Jeffrey L Cummings
- University of Nevada Las Vegas (UNLV) School of Integrated Health Sciences, Las Vegas, NV, USA
- UNLV Department of Brain Health, Las Vegas, NV, USA
- UNLV, Chambers-Grundy Center for Transformative Neuroscience, Las Vegas, NV, USA
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Pierre N Tariot
- Banner Alzheimer’s Institute, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Paul S Aisen
- University of Southern California, San Diego, CA, USA
| | - Bruno Vellas
- Gerontopole, INSERM U 1027, Alzheimer’s Disease Research and Clinical Center, Toulouse University Hospital, Toulouse, France
| | | | | | - Yuki Mukai
- Merck and Co., Inc., Kenilworth, NJ, USA
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Chakraborty N, Hammamieh R, Gautam A, Miller SA, Condlin ML, Jett M, Scrimgeour AG. TBI weight-drop model with variable impact heights differentially perturbs hippocampus-cerebellum specific transcriptomic profile. Exp Neurol 2020; 335:113516. [PMID: 33172833 DOI: 10.1016/j.expneurol.2020.113516] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/28/2020] [Accepted: 10/21/2020] [Indexed: 01/14/2023]
Abstract
The degree of brain injury is the governing factor for the magnitude of the patient's psycho- and physiological deficits post-injury, and the associated long-term consequences. The present scaling method used to segregate the patients among mild, moderate and severe phases of traumatic brain injury (TBI) has major limitations; however, a more continuous stratification of TBI is still elusive. With the anticipation that differentiating molecular markers could be the backbone of a robust method to triage TBI, we used a modified closed-head injury (CHI) Marmarou model with two impact heights (IH). By definition, IH directly correlates with the impact force causing TBI. In our modified CHI model, the rat skull was fitted with a helmet to permit a diffuse axonal injury. With the frontal cortex as the focal point of injury, the adjacent brain regions (hippocampus, HC and cerebellum, CB) were susceptible to diffuse secondary shock injury. At 8 days post injury (po.i.), rats impacted by 120 cm IH (IH120) took a longer time to find an escape route in the Barnes maze as compared to those impacted by 100 cm IH (IH100). Using a time-resolved interrogation of the transcriptomic landscape of HC and CB tissues, we mined those genes that altered their regulations in correlation with the variable IHs. At 14 days po.i., when all rats demonstrated nearly normal visuomotor performance, the bio-functional analysis suggested an advanced healing mechanism in the HC of IH100 group. In contrast, the HC of IH120 group displayed a delayed healing with evidence of active cell death networks. Combining whole genome rat microarrays with behavioral analysis provided the insight of neuroprotective signals that could be the foundation of the next generation triage for TBI patients.
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Affiliation(s)
- Nabarun Chakraborty
- Geneva Foundation, Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, United States of America; Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, United States of America.
| | - Rasha Hammamieh
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, United States of America
| | - Aarti Gautam
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, United States of America
| | - Stacy-Ann Miller
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, United States of America; ORISE, Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, United States of America
| | - Michelle L Condlin
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Bldg 42, Natick, MA 01760, United States of America
| | - Marti Jett
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, United States of America
| | - Angus G Scrimgeour
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Bldg 42, Natick, MA 01760, United States of America
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50
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Major BP, McDonald SJ, O'Brien WT, Symons GF, Clough M, Costello D, Sun M, Brady RD, Mccullough J, Aniceto R, Lin IH, Law M, Mychasiuk R, O'Brien TJ, Agoston DV, Shultz SR. Serum Protein Biomarker Findings Reflective of Oxidative Stress and Vascular Abnormalities in Male, but Not Female, Collision Sport Athletes. Front Neurol 2020; 11:549624. [PMID: 33117257 PMCID: PMC7561422 DOI: 10.3389/fneur.2020.549624] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/28/2020] [Indexed: 12/21/2022] Open
Abstract
Studies have indicated that concussive and sub-concussive brain injuries that are frequent during collision sports may lead to long-term neurological abnormalities, however there is a knowledge gap on how biological sex modifies outcomes. Blood-based biomarkers can help to identify the molecular pathology induced by brain injuries and to better understand how biological sex affects the molecular changes. We therefore analyzed serum protein biomarkers in male (n = 50) and female (n = 33) amateur Australian rules footballers (i.e., Australia's most participated collision sport), both with a history of concussion (HoC) and without a history of concussion (NoHoC). These profiles were compared to those of age-matched control male (n = 24) and female (n = 20) athletes with no history of neurotrauma or participation in collision sports. Serum levels of protein markers indicative of neuronal, axonal and glial injury (UCH-L1, NfL, tau, p-tau, GFAP, BLBP, PEA15), metabolic (4-HNE) and vascular changes (VEGF-A, vWF, CLDN5), and inflammation (HMGB1) were assessed using reverse phase protein microarrays. Male, but not female, footballers had increased serum levels of VEGF-A compared to controls regardless of concussion history. In addition, only male footballers who had HoC had increased serum levels of 4-HNE. These findings being restricted to males may be related to shorter collision sport career lengths for females compared to males. In summary, these findings show that male Australian rules footballers have elevated levels of serum biomarkers indicative of vascular abnormalities (VEGF-A) and oxidative stress (4-HNE) in comparison to non-collision control athletes. While future studies are required to determine how these findings relate to neurological function, serum levels of VEGF-A and 4-HNE may be useful to monitor subclinical neurological injury in males participating in collision sports.
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Affiliation(s)
- Brendan P Major
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, VIC, Australia
| | - William T O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Georgia F Symons
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Meaghan Clough
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Daniel Costello
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Rhys D Brady
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Jesse Mccullough
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - Roxanne Aniceto
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - I-Hsuan Lin
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - Meng Law
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, VIC, Australia.,Departments of Neurological Surgery and Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Denes V Agoston
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
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