A Game Changer for Diagnosing Concussions in the NFL

A Game Changer for Diagnosing Concussions in the NFLIs asking football players to name the president or state their birthday the best way to diagnose concussions?

Source: Source: WSJ - Matthew Futterman | Published on November 17, 2016

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A soon-to-be-released paper is expected to give a boost to a more scientific approach: a blood test that can quickly diagnose concussions more effectively than simple clinical methods administered by doctors and trainers.

The paper by National Institutes of Health researchers, expected to be published in the coming weeks online in the journal Neurology, raises hopes that eventually a blood test for a concussion will be as objective as diagnosing high cholesterol or a heart attack, according to people who have read the research. It comes amid growing frustration among scientists and even those on National Football League sidelines with the so-called protocols for diagnosing brain injuries.

A breakthrough could help not just $100-million NFL quarterbacks, but also soldiers on the battlefield, victims of auto accidents and children who fall off the monkey bars. It could also help with early identification of the damage that leads to the degenerative brain disease known as chronic traumatic encephalopathy, or CTE.

For the NFL, the emergence of a diagnostic tool based on medical data, rather than judgment, highlights the awkward balancing act it faces in the concussion debate.

The test could help tamp down withering criticism that the league has ignored the effects of head injuries. But it may also reveal more vividly how dangerous the game really is-and potentially sideline more players for longer periods even if they aren't suffering from obvious concussion-related symptoms.

The dire need for better methods of diagnosing brain trauma surfaced again this month when researchers at Boston University announced that Kevin Turner, a former University of Alabama and NFL player, died from a motor neuron disease brought on by CTE. Turner, who was 46-years-old when he died in March, had suffered symptoms of degenerative brain function since at least 2010. He was the lead plaintiff in a class-action settlement with the NFL that is still working its way through the appeals process.

Dr. Ann McKee, director of BU's CTE Center and a neuropathologist who led the examination of Turner's brain, said the case was significant in part because it showed how brain damage can occur not simply as the result of massive hits to the head but from a series of less severe hits over several decades.

"We see a direct correlation between the length of the playing career and the development of CTE," McKee said. "It's looking like that-not the concussions, but the duration, the years of playing-is the most significant factor."

Under fire, NFL Commissioner Roger Goodell has recently cast the league as a health and safety crusader funding research to make the sport safer. He has publicly supported the push for a blood test. Over the past two years, the league awarded $800,000 in funding to a Lexington, Mass. biotech company, Quanterix, whose blood-testing machine features prominently in the NIH study.

The awards were made as part of the so-called Head Health Challenge, a joint venture of the NFL and GE to spark scientific innovation aimed at improving the safety of athletes.

Yet the league hasn't showered Quanterix with attention. Kevin Hrusovsky, chief executive of Quanterix, said the company was invited to set up a booth at an NFL event during Super Bowl week last year in San Francisco, but had little contact with NFL officials or owners while there. He described the experience as "lonely" and said his firm heard almost nothing from the league until recently.

The NFL, which in 2013 established a $300 million investment fund focused on media and technology companies, didn't participate in a recent $50 million fundraising round for Quanterix. In recent weeks, he said, league officials and company executives met. Hrusovsky described the NFL as "supportive and interested in the potential of our technology."

Jeff Miller, the NFL's senior vice president for health and safety, said the guidelines of the Head Health Challenge promised applicants the NFL would not seek to take ownership of their intellectual property, which is why it didn't invest further.

?Miller said the NFL supports the research, even if it shows more clearly the precise dangers that playing football poses on every play. "The science has to go where the science goes," Miller said.

A blood test to diagnose concussions has become the "Holy Grail" of brain-injury science, experts in head injuries say.

"That is the dream," said Dr. Philip Stieg, chairman of the Weill Cornell Brain and Spine Center, who also evaluates players with head injuries during New York Giants games.

According to people who have seen the coming paper, the research led by Dr. Jessica Gill of the NIH marks one of the first times that scientists have been able to use the molecular proteins known as biomarkers to quickly gauge the severity of a brain injury.

The paper shows that a small sample of blood, drawn within six hours of a forceful impact, can be tested with the Quanterix machine to determine whether a concussion victim will be able to return safely to action within 10 days or should sit out for several weeks.

Stieg said having objective, biological criteria to determine the severity of a brain injury could remove a multitude of obstacles that physicians now confront.

"The return to play decision is based on symptoms, and the problem is the players all want to get back yesterday and the question is whether they are being truthful and honest" during their evaluations, Stieg said.

Concrete data on the true impact ?of football collisions has been elusive. The NFL last year stopped having players wear accelerometers in helmets to measure the impact of hits to the head; league officials and engineers with the Players Association agreed the data was flawed.

Quanterix was founded in 2007 to bring to the market the research of Tufts University chemistry and biomedical engineering professor David Walt, who has developed technology to track single molecules and enzyme mechanisms. Walt in 1998 co-founded the biotech company Illumina, a leader in the production of instruments for genotyping and gene sequencing with a market capitalization of $20 billion.

Three years ago Quanterix turned its attention to neurological applications. When the brain experiences a trauma, multiple proteins are released into the blood, including Tau; glial fibrillary acidic protein, known as GFAP; amyloid beta; and neurofilament light, known within the scientific community by an ironic acronym-Nf-L.

Until recently, scientists needed to draw spinal fluid to detect these biomarkers after a brain trauma. Their presence in the blood signals that brain cells have broken down, likely because of repetitive hits to the head or a severe one.

Recent studies suggest that a lot of lower-impact hits can be just as damaging as concussive ones. A recent study from the research group of Robert Stern, a neuropsychologist at Boston University School of Medicine whose studies of long-term brain damage among football players have put him at odds with the NFL, concluded the risk of cognitive impairment, depression, apathy or other behavioral disorders later in life increased steadily every 1,000 impacts.