151
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Hunter LE, Branch CA, Lipton ML. The neurobiological effects of repetitive head impacts in collision sports. Neurobiol Dis 2019; 123:122-126. [PMID: 29936233 PMCID: PMC6453577 DOI: 10.1016/j.nbd.2018.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/30/2018] [Accepted: 06/20/2018] [Indexed: 12/20/2022] Open
Abstract
It is now recognized that repetitive head impacts (RHI) in sport have the potential for long-term neurological impairments. In order to identify targets for intervention and/or pharmacological treatment, it is necessary to characterize the neurobiological mechanisms associated with RHI. This review aims to summarize animal and human studies that specifically address Blood Brain Barrier (BBB) dysfunction, abnormal neuro-metabolic and neuro-inflammatory processes as well as Tau aggregation associated with RHI in collision sports. Additionally, we examine the influence of physical activity and genetics on outcomes of RHI, discuss methodological considerations, and provide suggestions for future directions of this burgeoning area of research.
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Affiliation(s)
- Liane E Hunter
- The Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.
| | - Craig A Branch
- The Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Departments of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Departments of Physiology and Biophysics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Michael L Lipton
- The Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Departments of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Departments of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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152
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Armstrong RA, McKee AC, Stein TD, Alvarez VE, Cairns NJ. Cortical degeneration in chronic traumatic encephalopathy and Alzheimer's disease neuropathologic change. Neurol Sci 2019; 40:529-533. [PMID: 30564964 PMCID: PMC6433808 DOI: 10.1007/s10072-018-3686-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/10/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES An observational study to compare the laminar distributions in frontal and temporal cortex of the tau-immunoreactive pathologies in chronic traumatic encephalopathy (CTE) and Alzheimer's disease neuropathologic change (ADNC). PATIENTS Post-mortem material of (1) four cases of CTE without ADNC, (2) seven cases of CTE with ADNC (CTE/ADNC), and (3) seven cases of ADNC alone. RESULTS In CTE and CTE/ADNC, neurofibrillary tangles (NFT), neuropil threads (NT), and dot-like grains (DLG) were distributed either in upper cortex or across all layers. Low densities of astrocytic tangles (AT) and abnormally enlarged neurons (EN) were not localized to any specific layer. Surviving neurons exhibited peaks of density in both upper and lower cortex, and vacuole density was greatest in superficial layers. In ADNC, neuritic plaques (NP) were more frequent, AT rare, NFT and NT were more widely distributed, NT affected lower layers more frequently, and surviving neurons were less frequently bimodal than in CTE and CTE/ADNC. CONCLUSION Tau pathology in CTE and CTE/ADNC consistently affected the upper cortex but was more widely distributed in ADNC. The presence of CTE may encourage the development of ADNC pathology later in the course of the disease.
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Affiliation(s)
| | - Ann C McKee
- VA Boston HealthCare System, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 02118, USA
- Department of Pathology & Laboratory Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Thor D Stein
- Department of Pathology & Laboratory Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, 01730, USA
| | - Victor E Alvarez
- Department of Neurology, Boston University School of Medicine, Boston, MA, 02118, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, 01730, USA
| | - Nigel J Cairns
- Departments of Neurology and Pathology & Immunology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
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153
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Laffey M, Darby AJ, Cline MG, Teng E, Mendez MF. The utility of clinical criteria in patients with chronic traumatic encephalopathy. NeuroRehabilitation 2019; 43:431-441. [PMID: 30412511 DOI: 10.3233/nre-182452] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Repetitive traumatic brain injury (TBI) is associated with chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disorder characterized by Alzheimer-like changes in the brain. CTE has been defined through neuropathological findings among deceased athletes and others exposed to repetitive TBI, but to date there are no definitive clinical criteria for CTE. OBJECTIVE To evaluate the utility of currently proposed clinical criteria for CTE and suggest improvements. METHODS We describe two well-characterized patients referred for evaluation of CTE and apply the four major proposed criteria for CTE. These criteria were further assessed in a cohort of patients referred to a neurobehavior clinic with or without a history of TBI. RESULTS Without a CTE biomarker, the current criteria were of limited utility when applied to the two patient and the Neurobehavior cohort. Six items were extracted as potentially improving the clinical diagnosis of CTE: length of exposure to head impacts, a progressive course, specific psychiatric symptoms, frontal-executive dysfunction, parkinsonism and tremors, and targeted findings on neuroimaging. CONCLUSIONS The prevention and neurorehabilitation of CTE depends on clinical diagnosis, but, without a biomarker, the clinical diagnosis of CTE remains difficult. This report suggests that clinical criteria for CTE may be greatly improved with emphasis on several critical historical and clinical correlates of CTE.
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Affiliation(s)
- Megan Laffey
- Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Adam J Darby
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Michael G Cline
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Edmond Teng
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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154
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Putukian M, Echemendia RJ, Chiampas G, Dvorak J, Mandelbaum B, Lemak LJ, Kirkendall D. Head Injury in Soccer: From Science to the Field; summary of the head injury summit held in April 2017 in New York City, New York. Br J Sports Med 2019; 53:1332. [DOI: 10.1136/bjsports-2018-100232] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 12/15/2022]
Abstract
There has been an increased focus and awareness of head injury and sport-related concussion (SRC) across all sports from the medical and scientific communities, sports organisations, legislators, the media and the general population. Soccer, in particular, has been a focus of attention due to the popularity of the game, the frequency of SRC and the hypothesised effects of repetitive heading of the ball. Major League Soccer, US Soccer and the National Women’s Soccer League jointly hosted a conference entitled, ‘Head Injury in Soccer: From Science to the Field’, on 21–22 April 2017 in New York City, New York. The mission of this conference was to identify, discuss and disseminate evidence-based science related to the findings and conclusions of the fifth International Conference on Concussion in Sport held by the Concussion in Sport Group and apply them to the sport of soccer. In addition, we reviewed information regarding the epidemiology and mechanism of head injuries in soccer at all levels of play, data regarding the biomechanics and effects of repetitive head impacts and other soccer-specific considerations. We discussed how to release the information raised during the summit to key stakeholders including athletes, parents, coaches and healthcare providers. We identified future areas for research and collaboration to enhance the health and safety of soccer (football) players.
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155
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Wu T, Merkley TL, Wilde EA, Barnes A, Li X, Chu ZD, McCauley SR, Hunter JV, Levin HS. A preliminary report of cerebral white matter microstructural changes associated with adolescent sports concussion acutely and subacutely using diffusion tensor imaging. Brain Imaging Behav 2019; 12:962-973. [PMID: 28812290 DOI: 10.1007/s11682-017-9752-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diffusion tensor imaging (DTI) has demonstrated its utility in detecting microscopic post-concussion cerebral white matter structural changes, which are not routinely evident on conventional neuroimaging modalities. In this study, we compared 10 adolescents with sports concussion (SC) to 12 orthopedically-injured (OI) individuals within 96 h and three months post injury to 12 typically-developing (TD) participants using DTI and volumetric analyses. In terms of volume, no group differences were noted between SC, OI and TD groups at both 96 h and three months post concussion. Results did not show significant differences between SC, OI, and TD groups for both fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in all regions of interest within 96 h post concussion. However, at three months post-injury, the SC group exhibited significantly lower FA than the TD group in various regions of interest. In terms of ADC, significant group differences between SC and TD groups were found in some regions, with SC group having higher ADC than TD. No group differences for FA and ADC were noted between SC and OI groups at three months post-injury. However, several moderate effect sizes on between-group analyses were noted such that FA was lower and ADC was higher in SC relative to OI. Longitudinally, the SC group demonstrated decreased FA and increased ADC in some areas. The findings highlight the fact that the brain continues to change during the post-injury recovery period, and raises the possibility that adverse changes may result from the neurometabolic cascade that purportedly ensues following SC. DTI may potentially be used to characterize the nature of brain changes that occur following sports-related concussions.
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Affiliation(s)
- Trevor Wu
- Mercy Health St. Mary's, Michigan State University, 220 Cherry St SE, Grand Rapids, MI, 49503, USA
| | - Tricia L Merkley
- Barrow Neurological Institute, 222 W. Thomas Road, Suite 315, Phoenix, AZ, 85013, USA
| | - Elisabeth A Wilde
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA.
| | - Amanda Barnes
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1440, Miami, FL, 33136, USA
| | - Xiaoqi Li
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Zili David Chu
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Stephen R McCauley
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Jill V Hunter
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
| | - Harvey S Levin
- Baylor College of Medicine, One Baylor Plaza BCM637, Houston, TX, 77030-3411, USA
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156
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Małkiewicz MA, Szarmach A, Sabisz A, Cubała WJ, Szurowska E, Winklewski PJ. Blood-brain barrier permeability and physical exercise. J Neuroinflammation 2019; 16:15. [PMID: 30678702 PMCID: PMC6345022 DOI: 10.1186/s12974-019-1403-x] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/09/2019] [Indexed: 12/20/2022] Open
Abstract
In this narrative review, a theoretical framework on the crosstalk between physical exercise and blood-brain barrier (BBB) permeability is presented. We discuss the influence of physical activity on the factors affecting BBB permeability such as systemic inflammation, the brain renin-angiotensin and noradrenergic systems, central autonomic function and the kynurenine pathway. The positive role of exercise in multiple sclerosis and Alzheimer’s disease is described. Finally, the potential role of conditioning as well as the effect of exercise on BBB tight junctions is outlined. There is a body of evidence that regular physical exercise diminishes BBB permeability as it reinforces antioxidative capacity, reduces oxidative stress and has anti-inflammatory effects. It improves endothelial function and might increase the density of brain capillaries. Thus, physical training can be emphasised as a component of prevention programs developed for patients to minimise the risk of the onset of neuroinflammatory diseases as well as an augmentation of existing treatment. Unfortunately, despite a sound theoretical background, it remains unclear as to whether exercise training is effective in modulating BBB permeability in several specific diseases. Further research is needed as the impact of exercise is yet to be fully elucidated.
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Affiliation(s)
- Marta A Małkiewicz
- Department of Human Physiology, Faculty of Health Sciences, Medical University of Gdansk, Tuwima Str. 15, 80-210, Gdansk, Poland.,Department of Psychiatry, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Arkadiusz Szarmach
- 2-nd Department of Radiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Sabisz
- 2-nd Department of Radiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Wiesław J Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Edyta Szurowska
- 2-nd Department of Radiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Paweł J Winklewski
- Department of Human Physiology, Faculty of Health Sciences, Medical University of Gdansk, Tuwima Str. 15, 80-210, Gdansk, Poland. .,2-nd Department of Radiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland. .,Department of Clinical Anatomy and Physiology, Faculty of Health Sciences, Pomeranian University of Slupsk, Slupsk, Poland.
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157
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Tribett T, Erskine B, Bailey K, Brown T, Castellani RJ. Chronic Traumatic Encephalopathy Pathology After Shotgun Injury to the Brain. J Forensic Sci 2019; 64:1248-1252. [PMID: 30644555 DOI: 10.1111/1556-4029.14001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/27/2018] [Accepted: 12/28/2018] [Indexed: 12/12/2022]
Abstract
Chronic traumatic encephalopathy (CTE) was initially conceptualized in boxers, but has extended to other athletes in recent years, albeit with limited clinical correlations. It is often asserted that CTE pathology represents the substrate for progressive neurodegenerative disease. We report the case of a shotgun injury to the brain with 42-year survival and no neurological disease progression until shortly before death. The decedent had no other traumatic brain injury (TBI) exposure and did not play football or other high energy collision sport. Neuropathological examination confirmed tissue damage, but additionally demonstrated localized patterns of phosphorylated tau (p-tau) meeting criteria for CTE pathology. P-tau and TDP-43 deposits within marginal tissue of damaged brain were also present focally. No amyloid-β (Aβ) deposits were present. These findings indicate that CTE pathology may occur following a single, severe TBI.
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Affiliation(s)
- Taylor Tribett
- Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Brittany Erskine
- Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Kristi Bailey
- Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Theodore Brown
- Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Rudy J Castellani
- Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
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158
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Smith AM, Farrell KJ, Roberts WO, Moris MR, Stuart MJ. Eliminating Fighting and Head Hits from Hockey: Opportunities and Barriers. Curr Sports Med Rep 2019; 18:35-40. [PMID: 30624333 DOI: 10.1249/jsr.0000000000000556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Removing fighting from ice hockey is an essential concussion prevention strategy that will improve the safety of the game at all levels.
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Affiliation(s)
- Aynsley M Smith
- Department of Orthopedic Surgery and Physical Medicine and Rehabilitation, Sports Medicine, Mayo Clinic, Rochester, MN
| | | | - William O Roberts
- Department of Family Medicine and Community Health University of Minnesota, Minneapolis, MN
| | | | - Michael J Stuart
- Department of Orthopedic Surgery, Sports Medicine, Mayo Clinic, Rochester, MN
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159
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Castellani RJ, Perry G. Tau Biology, Tauopathy, Traumatic Brain Injury, and Diagnostic Challenges. J Alzheimers Dis 2019; 67:447-467. [PMID: 30584140 PMCID: PMC6398540 DOI: 10.3233/jad-180721] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2018] [Indexed: 12/12/2022]
Abstract
There is considerable interest in the pathobiology of tau protein, given its potential role in neurodegenerative diseases and aging. Tau is an important microtubule associated protein, required for the assembly of tubulin into microtubules and maintaining structural integrity of axons. Tau has other diverse cellular functions involving signal transduction, cellular proliferation, developmental neurobiology, neuroplasticity, and synaptic activity. Alternative splicing results in tau isoforms with differing microtubule binding affinity, differing representation in pathological inclusions in certain disease states, and differing roles in developmental biology and homeostasis. Tau haplotypes confer differing susceptibility to neurodegeneration. Tau phosphorylation is a normal metabolic process, critical in controlling tau's binding to microtubules, and is ongoing within the brain at all times. Tau may be hyperphosphorylated, and may aggregate as detectable fibrillar deposits in tissues, in both aging and neurodegenerative disease. The hypothesis that p-tau is neurotoxic has prompted constructs related to isomers, low-n assembly intermediates or oligomers, and the "tau prion". Human postmortem studies have elucidated broad patterns of tauopathy, with tendencies for those patterns to differ as a function of disease phenotype. However, there is extensive overlap, not only between genuine neurodegenerative diseases, but also between aging and disease. Recent studies highlight uniqueness to pathological patterns, including a pattern attributed to repetitive head trauma, although clinical correlations have been elusive. The diagnostic process for tauopathies and neurodegenerative diseases in general is challenging in many respects, and may be particularly problematic for postmortem evaluation of former athletes and military service members.
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Affiliation(s)
- Rudy J. Castellani
- Departments of Pathology and Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
| | - George Perry
- College of Sciences, University of Texas, San Antonio, San Antonio, TX, USA
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160
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Alosco ML, Stern RA. The long-term consequences of repetitive head impacts: Chronic traumatic encephalopathy. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:337-355. [PMID: 31753141 DOI: 10.1016/b978-0-12-804766-8.00018-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHI). Although described in boxers for almost a century, scientific and public interest in CTE grew tremendously following a report of postmortem evidence of CTE in the first former professional American football player in 2005. Neuropathologic diagnostic criteria for CTE have been defined, with abnormal perivascular deposition of hyperphosphorylated tau at the sulcal depths as the pathognomonic feature. CTE can currently only be diagnosed postmortem, but clinical research criteria for the in vivo diagnosis of CTE have been proposed. The clinical phenotype of CTE is still ill-defined and there are currently no validated biomarkers to support an in-life diagnosis of "Probable CTE." Many knowledge gaps remain regarding the neuropathologic and clinical make-up of CTE. An increased understanding of CTE is critical given the millions that could potentially be impacted by this disease. This chapter describes the state of the literature on CTE. The historical origins of CTE are first presented, followed by a comprehensive description of the neuropathologic and clinical features. The chapter concludes with discussion on future research directions, emphasizing the importance of diagnosing CTE during life to facilitate development of preventative and intervention strategies.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Centers, Department of Neurology, Boston University School of Medicine, Boston, MA, United States; Departments of Neurosurgery, and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, United States.
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161
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Oliver JM, Anzalone AJ, Turner SM. Protection Before Impact: the Potential Neuroprotective Role of Nutritional Supplementation in Sports-Related Head Trauma. Sports Med 2018; 48:39-52. [PMID: 29368186 PMCID: PMC5790849 DOI: 10.1007/s40279-017-0847-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Even in the presence of underreporting, sports-related concussions/mild traumatic brain injuries (mTBI) are on the rise. In the absence of proper diagnosis, an athlete may return to play prior to full recovery, increasing the risk of second-impact syndrome or protracted symptoms. Recent evidence has demonstrated that sub-concussive impacts, those sustained routinely in practice and competition, result in a quantifiable pathophysiological response and the accumulation of both concussive and sub-concussive impacts sustained over a lifetime of sports participation may lead to long-term neurological impairments and an increased risk of developing neurodegenerative diseases. The pathophysiological, neurometabolic, and neurochemical cascade that initiates subsequent to the injury is complex and involves multiple mechanisms. While pharmaceutical treatments may target one mechanism, specific nutrients and nutraceuticals have been discovered to impact several pathways, presenting a broader approach. Several studies have demonstrated the neuroprotective effect of nutritional supplementation in the treatment of mTBI. However, given that many concussions go unreported and sub-concussive impacts result in a pathophysiological response that, too, may contribute to long-term brain health, protection prior to impact is warranted. This review discusses the current literature regarding the role of nutritional supplements that, when provided before mTBI and traumatic brain injury, may provide neurological protection.
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Affiliation(s)
- Jonathan M Oliver
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University (TCU), Box 297730, Fort Worth, TX, 76129, USA.
| | - Anthony J Anzalone
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University (TCU), Box 297730, Fort Worth, TX, 76129, USA
| | - Stephanie M Turner
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University (TCU), Box 297730, Fort Worth, TX, 76129, USA
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162
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Cherry JD, Mez J, Crary JF, Tripodis Y, Alvarez VE, Mahar I, Huber BR, Alosco ML, Nicks R, Abdolmohammadi B, Kiernan PT, Evers L, Svirsky S, Babcock K, Gardner HM, Meng G, Nowinski CJ, Martin BM, Dwyer B, Kowall NW, Cantu RC, Goldstein LE, Katz DI, Stern RA, Farrer LA, McKee AC, Stein TD. Variation in TMEM106B in chronic traumatic encephalopathy. Acta Neuropathol Commun 2018; 6:115. [PMID: 30390709 PMCID: PMC6215686 DOI: 10.1186/s40478-018-0619-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/13/2018] [Indexed: 12/14/2022] Open
Abstract
The genetic basis of chronic traumatic encephalopathy (CTE) is poorly understood. Variation in transmembrane protein 106B (TMEM106B) has been associated with enhanced neuroinflammation during aging and with TDP-43-related neurodegenerative disease, and rs3173615, a missense coding SNP in TMEM106B, has been implicated as a functional variant in these processes. Neuroinflammation and TDP-43 pathology are prominent features in CTE. The purpose of this study was to determine whether genetic variation in TMEM106B is associated with CTE risk, pathological features, and ante-mortem dementia. Eighty-six deceased male athletes with a history of participation in American football, informant-reported Caucasian, and a positive postmortem diagnosis of CTE without comorbid neurodegenerative disease were genotyped for rs3173615. The minor allele frequency (MAF = 0.42) in participants with CTE did not differ from previously reported neurologically normal controls (MAF = 0.43). However, in a case-only analysis among CTE cases, the minor allele was associated with reduced phosphorylated tau (ptau) pathology in the dorsolateral frontal cortex (DLFC) (AT8 density, odds ratio [OR] of increasing one quartile = 0.42, 95% confidence interval [CI] 0.22–0.79, p = 0.008), reduced neuroinflammation in the DLFC (CD68 density, OR of increasing one quartile = 0.53, 95% CI 0.29–0.98, p = 0.043), and increased synaptic protein density (β = 0.306, 95% CI 0.065–0.546, p = 0.014). Among CTE cases, TMEM106B minor allele was also associated with reduced ante-mortem dementia (OR = 0.40, 95% CI 0.16–0.99, p = 0.048), but was not associated with TDP-43 pathology. All case-only models were adjusted for age at death and duration of football play. Taken together, variation in TMEM106B may have a protective effect on CTE-related outcomes.
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163
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Abstract
PURPOSE OF REVIEW Differential diagnosis of atypical Parkinson syndromes (APS) is difficult as clinical presentations may vary and as there is a strong overlap between disease entities. Aggregations of misfolded and hyperphosphorylated tau proteins are the common denominator of many of these diseases. RECENT FINDINGS Several tau targeting positron emission tomography (PET) tracers have been evaluated as possible biomarkers in APS in the recent years. For Parkinson's disease, dementia with Lewy bodies, progressive supranuclear palsy, and corticobasal degeneration, promising results have been reported with regard to the ability to detect the presence of disease and to discriminate patients from controls. However, the discussion about the specificity of the first-generation radiotracers and their value in the clinical context is ongoing. A combined interpretation of signal strength and distribution pattern in PET scans with first- and second-generation tracers may be helpful in clinical diagnosis and follow-up of patients with APS.
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164
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Reynolds BB, Stanton AN, Soldozy S, Goodkin HP, Wintermark M, Druzgal TJ. Investigating the effects of subconcussion on functional connectivity using mass-univariate and multivariate approaches. Brain Imaging Behav 2018; 12:1332-1345. [PMID: 29188492 PMCID: PMC6141348 DOI: 10.1007/s11682-017-9790-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
There are concerns about the effects of subconcussive head impacts in sport, but the effects of subconcussion on brain connectivity are not well understood. We hypothesized that college football players experience changes in brain functional connectivity not found in athletes competing in lower impact sports or healthy controls. These changes may be spatially heterogeneous across participants, requiring analysis methods that go beyond mass-univariate approaches commonly used in functional MRI (fMRI). To test this hypothesis, we analyzed resting-state fMRI data from college football (n = 15), soccer (n = 12), and lacrosse players (n = 16), and controls (n = 29) collected at preseason and postseason time points. Regional homogeneity (ReHo) and degree centrality (DC) were calculated as measures of local and long-range functional connectivity, respectively. Standard voxel-wise analysis and paired support vector machine (SVM) classification studied subconcussion's effects on local and global functional connectivity. Voxel-wise analyses yielded minimal findings, but SVM classification had high accuracy for college football's ReHo (87%, p = 0.009) and no other group. The findings suggest subconcussion results in spatially heterogeneous changes in local functional connectivity that may only be detectible with multivariate analyses. To determine if voxel-wise and SVM analyses had similar spatial patterns, region-average t-statistic and SVM weight values were compared using a measure of ranking distance. T-statistic and SVM weight rankings exhibited significantly low ranking distance values for all groups and metrics, demonstrating that the analyses converged on a similar underlying effect. Overall, this research suggests that subconcussion in football may produce local functional connectivity changes similar to concussion.
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Affiliation(s)
- Bryson B Reynolds
- Department of Radiology and Medical Imaging, Division of Neuroradiology, University of Virginia, Charlottesville, VA, 22908, USA
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Amanda N Stanton
- Department of Radiology and Medical Imaging, Division of Neuroradiology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Sauson Soldozy
- Department of Radiology and Medical Imaging, Division of Neuroradiology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Howard P Goodkin
- Department of Neurology, University of Virginia, Charlottesville, VA, 22908, USA
- UVA Brain Institute, University of Virginia, Charlottesville, VA, 22908, USA
| | | | - T Jason Druzgal
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- UVA Brain Institute, University of Virginia, Charlottesville, VA, 22908, USA.
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165
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Brady RD, Casillas-Espinosa PM, Agoston DV, Bertram EH, Kamnaksh A, Semple BD, Shultz SR. Modelling traumatic brain injury and posttraumatic epilepsy in rodents. Neurobiol Dis 2018; 123:8-19. [PMID: 30121231 DOI: 10.1016/j.nbd.2018.08.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/25/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022] Open
Abstract
Posttraumatic epilepsy (PTE) is one of the most debilitating and understudied consequences of traumatic brain injury (TBI). It is challenging to study the effects, underlying pathophysiology, biomarkers, and treatment of TBI and PTE purely in human patients for a number of reasons. Rodent models can complement human PTE studies as they allow for the rigorous investigation into the causal relationship between TBI and PTE, the pathophysiological mechanisms of PTE, the validation and implementation of PTE biomarkers, and the assessment of PTE treatments, in a tightly controlled, time- and cost-efficient manner in experimental subjects known to be experiencing epileptogenic processes. This article will review several common rodent models of TBI and/or PTE, including their use in previous studies and discuss their relative strengths, limitations, and avenues for future research to advance our understanding and treatment of PTE.
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Affiliation(s)
- Rhys D Brady
- Departments of Neuroscience and Medicine, Central Clinical School, Monash University, VIC 3004, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3052, Australia.
| | - Pablo M Casillas-Espinosa
- Departments of Neuroscience and Medicine, Central Clinical School, Monash University, VIC 3004, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3052, Australia.
| | - Denes V Agoston
- Anatomy, Physiology & Genetics, Uniformed Services University, Bethesda, MD 20814, USA
| | - Edward H Bertram
- Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA 22908-0394, USA
| | - Alaa Kamnaksh
- Anatomy, Physiology & Genetics, Uniformed Services University, Bethesda, MD 20814, USA
| | - Bridgette D Semple
- Departments of Neuroscience and Medicine, Central Clinical School, Monash University, VIC 3004, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3052, Australia
| | - Sandy R Shultz
- Departments of Neuroscience and Medicine, Central Clinical School, Monash University, VIC 3004, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3052, Australia
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166
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Subsymptomatic Aerobic Exercise for Patients With Postconcussion Syndrome: A Critically Appraised Topic. J Sport Rehabil 2018; 28:211-216. [PMID: 28952858 DOI: 10.1123/jsr.2017-0159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Patients who experience prolonged concussion symptoms can be diagnosed with postconcussion syndrome (PCS) when those symptoms persist longer than 4 weeks. Aerobic exercise protocols have been shown to be effective in improving physical and mental aspects of health. Emerging research suggests that aerobic exercise may be useful as a treatment for PCS, where exercise allows patients to feel less isolated and more active during the recovery process. Clinical Question: Is aerobic exercise more beneficial in reducing symptoms than current standard care in patients with prolonged symptoms or PCS lasting longer than 4 weeks? Summary of Key Findings: After a thorough literature search, 4 studies relevant to the clinical question were selected. Of the 4 studies, 1 study was a randomized control trial and 3 studies were case series. All 4 studies investigated aerobic exercise protocol as treatment for PCS. Three studies demonstrated a greater rate of symptom improvement from baseline assessment to follow-up after a controlled subsymptomatic aerobic exercise program. One study showed a decrease in symptoms in the aerobic exercise group compared with the full-body stretching group. Clinical Bottom Line: There is moderate evidence to support subsymptomatic aerobic exercise as a treatment of PCS; therefore, it should be considered as a clinical option for reducing PCS and prolonged concussion symptoms. A previously validated protocol, such as the Buffalo Concussion Treadmill test, Balke protocol, or rating of perceived exertion, as mentioned in this critically appraised topic, should be used to measure baseline values and treatment progression. Strength of Recommendation: Level C evidence exists that the aerobic exercise protocol is more effective than the current standard of care in treating PCS.
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167
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Pritchard C, Silk A. Patient’s occupation, electric & head trauma in a cohort of 88 multiple system atrophy patients compared with the general population: a hypothesis stimulating pilot study. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/jnsk.2018.08.00305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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168
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Aldag M, Armstrong RC, Bandak F, Bellgowan PSF, Bentley T, Biggerstaff S, Caravelli K, Cmarik J, Crowder A, DeGraba TJ, Dittmer TA, Ellenbogen RG, Greene C, Gupta RK, Hicks R, Hoffman S, Latta RC, Leggieri MJ, Marion D, Mazzoli R, McCrea M, O'Donnell J, Packer M, Petro JB, Rasmussen TE, Sammons-Jackson W, Shoge R, Tepe V, Tremaine LA, Zheng J. The Biological Basis of Chronic Traumatic Encephalopathy following Blast Injury: A Literature Review. J Neurotrauma 2018; 34:S26-S43. [PMID: 28937953 DOI: 10.1089/neu.2017.5218] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The United States Department of Defense Blast Injury Research Program Coordinating Office organized the 2015 International State-of-the-Science meeting to explore links between blast-related head injury and the development of chronic traumatic encephalopathy (CTE). Before the meeting, the planning committee examined articles published between 2005 and October 2015 and prepared this literature review, which summarized broadly CTE research and addressed questions about the pathophysiological basis of CTE and its relationship to blast- and nonblast-related head injury. It served to inform participants objectively and help focus meeting discussion on identifying knowledge gaps and priority research areas. CTE is described generally as a progressive neurodegenerative disorder affecting persons exposed to head injury. Affected individuals have been participants primarily in contact sports and military personnel, some of whom were exposed to blast. The symptomatology of CTE overlaps with Alzheimer's disease and includes neurological and cognitive deficits, psychiatric and behavioral problems, and dementia. There are no validated diagnostic criteria, and neuropathological evidence of CTE has come exclusively from autopsy examination of subjects with histories of exposure to head injury. The perivascular accumulation of hyperphosphorylated tau (p-tau) at the depths of cortical sulci is thought to be unique to CTE and has been proposed as a diagnostic requirement, although the contribution of p-tau and other reported pathologies to the development of clinical symptoms of CTE are unknown. The literature on CTE is limited and is focused predominantly on head injuries unrelated to blast exposure (e.g., football players and boxers). In addition, comparative analyses of clinical case reports has been challenging because of small case numbers, selection biases, methodological differences, and lack of matched controls, particularly for blast-exposed individuals. Consequently, the existing literature is not sufficient to determine whether the development of CTE is associated with head injury frequency (e.g., single vs. multiple exposures) or head injury type (e.g., impact, nonimpact, blast-related). Moreover, the incidence and prevalence of CTE in at-risk populations is unknown. Future research priorities should include identifying additional risk factors, pursuing population-based longitudinal studies, and developing the ability to detect and diagnose CTE in living persons using validated criteria.
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Affiliation(s)
- Matt Aldag
- 1 Booz Allen Hamilton , McLean, Virginia
| | - Regina C Armstrong
- 2 Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Faris Bandak
- 3 Defense Advanced Research Projects Agency , Arlington, Virginia
| | | | | | - Sean Biggerstaff
- 6 Office of the Assistant Secretary of Defense , Health Affairs, Falls Church, Virginia
| | | | - Joan Cmarik
- 7 Office of the Principal Assistant for Acquisition, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | - Alicia Crowder
- 8 Combat Casualty Care Research Program , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | | | | | - Richard G Ellenbogen
- 10 Departments of Neurological Surgery and Global Health Medicine, University of Washington , Seattle, Washington
| | - Colin Greene
- 11 Joint Trauma Analysis and Prevention of Injuries in Combat Program, Frederick, Maryland
| | - Raj K Gupta
- 12 Department of Defense Blast Injury Research Program Coordinating Office, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | | | | | | | - Michael J Leggieri
- 12 Department of Defense Blast Injury Research Program Coordinating Office, United States Army Medical Research and Materiel Command , Frederick, Maryland
| | - Donald Marion
- 16 Defense and Veterans Brain Injury Center , Silver Spring, Maryland
| | | | | | | | - Mark Packer
- 20 Hearing Center of Excellence , Lackland, Texas
| | - James B Petro
- 21 Office of the Assistant Secretary of Defense, Research and Engineering, Arlington, Virginia
| | - Todd E Rasmussen
- 8 Combat Casualty Care Research Program , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Wendy Sammons-Jackson
- 22 Office of the Principal Assistant for Research and Technology , United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Richard Shoge
- 23 Military Operational Medicine Research Program, United States Army Medical Research and Materiel Command , Fort Detrick, Maryland
| | | | | | - James Zheng
- 25 Program Executive Office Soldier , Fort Belvoir, Virginia
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169
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Ling H, Neal JW, Revesz T. Evolving concepts of chronic traumatic encephalopathy as a neuropathological entity. Neuropathol Appl Neurobiol 2018; 43:467-476. [PMID: 28664614 DOI: 10.1111/nan.12425] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/20/2017] [Accepted: 06/30/2017] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a long-term neurodegenerative consequence of repetitive head impacts which can only be definitively diagnosed in post-mortem. Recently, the consensus neuropathological criteria for the diagnosis of CTE was published requiring the presence of the accumulation of abnormal tau in neurons and astroglia distributed around small blood vessels at the depths of cortical sulci in an irregular pattern as the mandatory features. The clinical diagnosis and antemortem prediction of CTE pathology remain challenging if not impossible due to the common co-existing underlying neurodegenerative pathologies and the lack of specific clinical pointers and reliable biomarkers. This review summarizes the historical evolution of CTE as a neuropathological entity and highlights the latest advances and future directions of research studies on the topic of CTE.
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Affiliation(s)
- H Ling
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, University College London, London, UK.,Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, London, UK.,Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, London, UK
| | - J W Neal
- Department of Cellular Pathology, Cardiff University, Wales, UK
| | - T Revesz
- Queen Square Brain Bank for Neurological Disorders, UCL Institute of Neurology, University College London, London, UK.,Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, London, UK.,Department of Molecular Neuroscience, UCL Institute of Neurology, University College London, London, UK
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170
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Chen YH, Huang EYK, Kuo TT, Miller J, Chiang YH, Hoffer BJ. Impact of Traumatic Brain Injury on Dopaminergic Transmission. Cell Transplant 2018; 26:1156-1168. [PMID: 28933212 PMCID: PMC5657731 DOI: 10.1177/0963689717714105] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Brain trauma is often associated with severe morbidity and is a major public health concern. Even when injury is mild and no obvious anatomic disruption is seen, many individuals suffer disabling neuropsychological impairments such as memory loss, mood dysfunction, substance abuse, and adjustment disorder. These changes may be related to subtle disruption of neural circuits as well as functional changes at the neurotransmitter level. In particular, there is considerable evidence that dopamine (DA) physiology in the nigrostriatal and mesocorticolimbic pathways might be impaired after traumatic brain injury (TBI). Alterations in DA levels can lead to oxidative stress and cellular dysfunction, and DA plays an important role in central nervous system inflammation. Therapeutic targeting of DA pathways may offer benefits for both neuronal survival and functional outcome after TBI. The purpose of this review is to discuss the role of DA pathology in acute TBI and the potential impact of therapies that target these systems for the treatment of TBI.
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Affiliation(s)
- Yuan-Hao Chen
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Yuan-Hao Chen, Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, 4F, No. 325, 2nd Sec., Cheng-Kung Road, Nei-Hu District, Taipei City, 114 Taiwan, Republic of China.
| | - Eagle Yi-Kung Huang
- Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tung-Tai Kuo
- Graduate Institute of Computer and Communication Engineering, National Taipei University of Technology, Taipei, Taiwan, Republic of China
| | - Jonathan Miller
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Yung-Hsiao Chiang
- Section of Neurosurgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Barry J. Hoffer
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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171
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Ruprecht R, Scheurer E, Lenz C. Systematic review on the characterization of chronic traumatic encephalopathy by MRI and MRS. J Magn Reson Imaging 2018; 49:212-228. [PMID: 29717792 DOI: 10.1002/jmri.26162] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that is found in people who have suffered from chronic traumatic brain injury (TBI). Up to now, diagnosis of CTE could only be made based on postmortem histopathological examinations. The application of MR techniques might offer a promising possibility for in vivo diagnoses. PURPOSE/HYPOTHESIS To provide a critical systematic review of the characterization of chronic TBI and CTE by considering the range of MR techniques. STUDY TYPE This was a systematic review for which the electronic databases PubMed and Embase were searched using the terms ("chronic traumatic encephalopathy" OR "punch drunk syndrome" OR "chronic traumatic brain injury" OR "dementia pugilistica" OR "chronic head trauma") AND ("magnetic resonance imaging" OR mri OR imaging OR mrs OR "magnetic resonance spectroscopy" OR spectroscopy). POPULATION/SUBJECTS/PHANTOM/SPECIMEN/ANIMAL MODEL Of the 432 studies identified by the database search, 25 were included in this review. FIELD STRENGTH/SEQUENCE Diffusion, structural, and functional MRI sequences and MR spectroscopy were evaluated at 1.5T or 3T and at 11.74T for the ex vivo studies. ASSESSMENT Data were extracted by two reviewers independently. Specific inclusion and exclusion criteria like the study design, publication type, and applied MR techniques were used to select studies for review. STATISTICAL TESTS Results of the original research articles were stated in this review as significant if P ≤ 0.05. RESULTS Of the included articles, two were ex vivo studies focusing on the coregistration of histology and MRI. All other studies were based on in vivo data. DATA CONCLUSION The included studies varied considerably regarding study setup, MR techniques, and results. Nevertheless, this work aims to establish links between the studies and discusses the results and limitations associated with the characterization of chronic TBI and CTE based on MR. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:212-228.
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Affiliation(s)
- Rahel Ruprecht
- Institute of Forensic Medicine, University of Basel, Basel, Switzerland
| | - Eva Scheurer
- Institute of Forensic Medicine, University of Basel, Basel, Switzerland
| | - Claudia Lenz
- Institute of Forensic Medicine, University of Basel, Basel, Switzerland
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172
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Oyegbile TO, Delasobera BE, Zecavati N. Postconcussive Symptoms After Single and Repeated Concussions in 10- to 20-Year-Olds: A Cross-Sectional Study. J Child Neurol 2018; 33:383-388. [PMID: 29552934 DOI: 10.1177/0883073818759436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objective was to characterize cognitive deficits and postconcussive symptoms in a pediatric population with no concussion, a single concussion, and ≥2 concussions, using a cross-sectional design. Cognitive function and postconcussive symptoms were assessed in participants (age 10-20) with no concussion (n = 1118), single concussion (n = 368), and repeated (≥2) concussions (n = 252). Analyses were adjusted for age and gender. Individuals with ≥2 concussions exhibited more total postconcussive symptoms; more loss of consciousness, amnesia and confusion; more headaches; and poorer cognitive function compared to no concussion and single concussion. Postconcussive symptoms may play a modulatory role in cognitive dysfunction after repeated concussions as those with loss of consciousness, amnesia, confusion, or headaches exhibited worse verbal memory, visual memory, visual-motor processing, and poorer impulse control compared to those without these symptoms. This analysis demonstrates that repeated concussions is associated with poorer cognitive function and postconcussive symptoms compared to a single concussion.
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Affiliation(s)
| | | | - Nassim Zecavati
- 1 Medicine & Epilepsy, MedStar Georgetown University Hospital, Washington, DC, USA
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173
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Yin Z, Raj DD, Schaafsma W, van der Heijden RA, Kooistra SM, Reijne AC, Zhang X, Moser J, Brouwer N, Heeringa P, Yi CX, van Dijk G, Laman JD, Boddeke EWGM, Eggen BJL. Low-Fat Diet With Caloric Restriction Reduces White Matter Microglia Activation During Aging. Front Mol Neurosci 2018; 11:65. [PMID: 29593493 PMCID: PMC5857900 DOI: 10.3389/fnmol.2018.00065] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 02/15/2018] [Indexed: 12/31/2022] Open
Abstract
Rodent models of both aging and obesity are characterized by inflammation in specific brain regions, notably the corpus callosum, fornix, and hypothalamus. Microglia, the resident macrophages of the central nervous system, are important for brain development, neural support, and homeostasis. However, the effects of diet and lifestyle on microglia during aging are only partly understood. Here, we report alterations in microglia phenotype and functions in different brain regions of mice on a high-fat diet (HFD) or low-fat diet (LFD) during aging and in response to voluntary running wheel exercise. We compared the expression levels of genes involved in immune response, phagocytosis, and metabolism in the hypothalamus of 6-month-old HFD and LFD mice. We also compared the immune response of microglia from HFD or LFD mice to peripheral inflammation induced by intraperitoneal injection of lipopolysaccharide (LPS). Finally, we investigated the effect of diet, physical exercise, and caloric restriction (40% reduction compared to ad libitum intake) on microglia in 24-month-old HFD and LFD mice. Changes in diet caused morphological changes in microglia, but did not change the microglia response to LPS-induced systemic inflammation. Expression of phagocytic markers (i.e., Mac-2/Lgals3, Dectin-1/Clec7a, and CD16/CD32) in the white matter microglia of 24-month-old brain was markedly decreased in calorically restricted LFD mice. In conclusion, LFD resulted in reduced activation of microglia, which might be an underlying mechanism for the protective role of caloric restriction during aging-associated decline.
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Affiliation(s)
- Zhuoran Yin
- Department of Neurology, Tongji Hospital, Tongji Medical College of HUST, Huazhong University of Science and Technology, Wuhan, China
- Department of Neuroscience, Medical Physiology Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Divya D. Raj
- Department of Neuroscience, Medical Physiology Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Wandert Schaafsma
- Department of Neuroscience, Medical Physiology Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Roel A. van der Heijden
- Department of Pathology and Medical Biology, Medical Biology Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Susanne M. Kooistra
- Department of Neuroscience, Medical Physiology Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Aaffien C. Reijne
- Laboratory of Pediatrics, Systems Medicine of Metabolism and Signaling Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Systems Biology Centre for Energy Metabolism and Ageing, University of Groningen, Groningen, Netherlands
- Groningen Institute for Evolutionary Life Sciences, Department of Behavioral Neuroscience, University of Groningen, Groningen, Netherlands
| | - Xiaoming Zhang
- Department of Neuroscience, Medical Physiology Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jill Moser
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Nieske Brouwer
- Department of Neuroscience, Medical Physiology Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Peter Heeringa
- Department of Pathology and Medical Biology, Medical Biology Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Chun-Xia Yi
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Gertjan van Dijk
- Systems Biology Centre for Energy Metabolism and Ageing, University of Groningen, Groningen, Netherlands
- Groningen Institute for Evolutionary Life Sciences, Department of Behavioral Neuroscience, University of Groningen, Groningen, Netherlands
- ESRIG Centre for Isotope Research, University of Groningen, Groningen, Netherlands
| | - Jon D. Laman
- Department of Neuroscience, Medical Physiology Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Erik W. G. M. Boddeke
- Department of Neuroscience, Medical Physiology Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Bart J. L. Eggen
- Department of Neuroscience, Medical Physiology Section, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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174
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Consequences of Traumatic Brain Injury in Professional American Football Players: A Systematic Review of the Literature. Clin J Sport Med 2018; 28:91-99. [PMID: 28489656 DOI: 10.1097/jsm.0000000000000432] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to systematically review the literature for the consequences Traumatic brain injury (TBI) has on cognitive, psychological, physical, and sports-related functioning in professional American Football players. DATA SOURCES We performed a systematic search in 2 databases, PubMed and SPORTDiscus, to obtain literature from January 1990 to January 2015. To be eligible for inclusion, a study had to examine the relationship between TBI and the consequences for several aspects of functioning in professional American football players older than 18 years. Methodological quality was assessed using a 5-item checklist which assessed selection bias, information bias, and correct reporting of the population and exposure characteristics. MAIN RESULTS The search yielded 21 studies that met our inclusion criteria. An evidence synthesis was performed on the extracted data and resulted in 5 levels of evidence. The evidence synthesis revealed that there is strong evidence that concussions are associated with late-life depression and short-term physical dysfunctions. Evidence for the relationship between concussion and impaired sports-related function, prolonged reaction time, memory impairment, and visual-motor speed was inconclusive. Moderate evidence was found for the association between TBI and mild cognitive impairment (MCI), and limited evidence was found for the association between TBI and executive dysfunction. CONCLUSIONS There is strong evidence that a history of concussion in American football players is associated with depression later in life and short-term physical dysfunctions. Also cognitive dysfunctions such as MCI are seen in older players with a history of TBI. These results provide input for actions to prevent TBI and their consequences in (retired) American football players.
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175
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Armstrong RA. Visual problems associated with traumatic brain injury. Clin Exp Optom 2018; 101:716-726. [PMID: 29488253 DOI: 10.1111/cxo.12670] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) and its associated concussion are major causes of disability and death. All ages can be affected but children, young adults and the elderly are particularly susceptible. A decline in mortality has resulted in many more individuals living with a disability caused by TBI including those affecting vision. This review describes: (1) the major clinical and pathological features of TBI; (2) the visual signs and symptoms associated with the disorder; and (3) discusses the assessment of quality of life and visual rehabilitation of the patient. Defects in primary vision such as visual acuity and visual fields, eye movement including vergence, saccadic and smooth pursuit movements, and in more complex aspects of vision involving visual perception, motion vision ('akinopsia'), and visuo-spatial function have all been reported in TBI. Eye movement dysfunction may be an early sign of TBI. Hence, TBI can result in a variety of visual problems, many patients exhibiting multiple visual defects in combination with a decline in overall health. Patients with chronic dysfunction following TBI may require occupational, vestibular, cognitive and other forms of physical therapy. Such patients may also benefit from visual rehabilitation, including reading-related oculomotor training and the prescribing of spectacles with a variety of tints and prism combinations.
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176
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DeKosky ST, Jaffee M, Bauer R. Long-term Mortality in NFL Professional Football Players: No Significant Increase, but Questions Remain. JAMA 2018; 319:773-775. [PMID: 29392297 PMCID: PMC6218167 DOI: 10.1001/jama.2017.20885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Steven T DeKosky
- McKnight Brain Institute, Department of Neurology, University of Florida College of Medicine, Gainesville
- Department of Cognitive Health and Psychology, University of Florida, Gainesville
| | - Michael Jaffee
- McKnight Brain Institute, Department of Neurology, University of Florida College of Medicine, Gainesville
- Department of Cognitive Health and Psychology, University of Florida, Gainesville
| | - Russell Bauer
- McKnight Brain Institute, Department of Neurology, University of Florida College of Medicine, Gainesville
- College of Public Health and Health Professions, University of Florida, Gainesville
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177
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Tagge CA, Fisher AM, Minaeva OV, Gaudreau-Balderrama A, Moncaster JA, Zhang XL, Wojnarowicz MW, Casey N, Lu H, Kokiko-Cochran ON, Saman S, Ericsson M, Onos KD, Veksler R, Senatorov VV, Kondo A, Zhou XZ, Miry O, Vose LR, Gopaul KR, Upreti C, Nowinski CJ, Cantu RC, Alvarez VE, Hildebrandt AM, Franz ES, Konrad J, Hamilton JA, Hua N, Tripodis Y, Anderson AT, Howell GR, Kaufer D, Hall GF, Lu KP, Ransohoff RM, Cleveland RO, Kowall NW, Stein TD, Lamb BT, Huber BR, Moss WC, Friedman A, Stanton PK, McKee AC, Goldstein LE. Concussion, microvascular injury, and early tauopathy in young athletes after impact head injury and an impact concussion mouse model. Brain 2018; 141:422-458. [PMID: 29360998 PMCID: PMC5837414 DOI: 10.1093/brain/awx350] [Citation(s) in RCA: 258] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 10/02/2017] [Accepted: 10/29/2017] [Indexed: 12/14/2022] Open
Abstract
The mechanisms underpinning concussion, traumatic brain injury, and chronic traumatic encephalopathy, and the relationships between these disorders, are poorly understood. We examined post-mortem brains from teenage athletes in the acute-subacute period after mild closed-head impact injury and found astrocytosis, myelinated axonopathy, microvascular injury, perivascular neuroinflammation, and phosphorylated tau protein pathology. To investigate causal mechanisms, we developed a mouse model of lateral closed-head impact injury that uses momentum transfer to induce traumatic head acceleration. Unanaesthetized mice subjected to unilateral impact exhibited abrupt onset, transient course, and rapid resolution of a concussion-like syndrome characterized by altered arousal, contralateral hemiparesis, truncal ataxia, locomotor and balance impairments, and neurobehavioural deficits. Experimental impact injury was associated with axonopathy, blood-brain barrier disruption, astrocytosis, microgliosis (with activation of triggering receptor expressed on myeloid cells, TREM2), monocyte infiltration, and phosphorylated tauopathy in cerebral cortex ipsilateral and subjacent to impact. Phosphorylated tauopathy was detected in ipsilateral axons by 24 h, bilateral axons and soma by 2 weeks, and distant cortex bilaterally at 5.5 months post-injury. Impact pathologies co-localized with serum albumin extravasation in the brain that was diagnostically detectable in living mice by dynamic contrast-enhanced MRI. These pathologies were also accompanied by early, persistent, and bilateral impairment in axonal conduction velocity in the hippocampus and defective long-term potentiation of synaptic neurotransmission in the medial prefrontal cortex, brain regions distant from acute brain injury. Surprisingly, acute neurobehavioural deficits at the time of injury did not correlate with blood-brain barrier disruption, microgliosis, neuroinflammation, phosphorylated tauopathy, or electrophysiological dysfunction. Furthermore, concussion-like deficits were observed after impact injury, but not after blast exposure under experimental conditions matched for head kinematics. Computational modelling showed that impact injury generated focal point loading on the head and seven-fold greater peak shear stress in the brain compared to blast exposure. Moreover, intracerebral shear stress peaked before onset of gross head motion. By comparison, blast induced distributed force loading on the head and diffuse, lower magnitude shear stress in the brain. We conclude that force loading mechanics at the time of injury shape acute neurobehavioural responses, structural brain damage, and neuropathological sequelae triggered by neurotrauma. These results indicate that closed-head impact injuries, independent of concussive signs, can induce traumatic brain injury as well as early pathologies and functional sequelae associated with chronic traumatic encephalopathy. These results also shed light on the origins of concussion and relationship to traumatic brain injury and its aftermath.awx350media15713427811001.
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Affiliation(s)
- Chad A Tagge
- Molecular Aging and Development Laboratory, Boston University School of Medicine, Boston, MA 02118, USA
- Boston University College of Engineering, Boston, MA 02215, USA
| | - Andrew M Fisher
- Molecular Aging and Development Laboratory, Boston University School of Medicine, Boston, MA 02118, USA
- Boston University College of Engineering, Boston, MA 02215, USA
| | - Olga V Minaeva
- Molecular Aging and Development Laboratory, Boston University School of Medicine, Boston, MA 02118, USA
- Boston University College of Engineering, Boston, MA 02215, USA
- Boston University Photonics Center, Boston University, Boston, MA 02215, USA
| | - Amanda Gaudreau-Balderrama
- Molecular Aging and Development Laboratory, Boston University School of Medicine, Boston, MA 02118, USA
- Boston University College of Engineering, Boston, MA 02215, USA
| | - Juliet A Moncaster
- Molecular Aging and Development Laboratory, Boston University School of Medicine, Boston, MA 02118, USA
- Boston University Photonics Center, Boston University, Boston, MA 02215, USA
- Boston University School of Medicine, Boston, MA 02118, USA
| | - Xiao-Lei Zhang
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY 10595, USA
| | - Mark W Wojnarowicz
- Molecular Aging and Development Laboratory, Boston University School of Medicine, Boston, MA 02118, USA
- Boston University School of Medicine, Boston, MA 02118, USA
| | - Noel Casey
- Molecular Aging and Development Laboratory, Boston University School of Medicine, Boston, MA 02118, USA
- The Center for Biometals and Metallomics, Boston University School of Medicine, Boston, MA 02118, USA
| | - Haiyan Lu
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Olga N Kokiko-Cochran
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Sudad Saman
- Department of Biological Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Maria Ericsson
- Electron Microscope Facility, Harvard Medical School, Boston, MA 02115, USA
| | | | - Ronel Veksler
- Departments of Brain and Cognitive Sciences, Physiology and Cell Biology, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Vladimir V Senatorov
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Asami Kondo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Xiao Z Zhou
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Omid Miry
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY 10595, USA
| | - Linnea R Vose
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY 10595, USA
| | - Katisha R Gopaul
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY 10595, USA
| | - Chirag Upreti
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY 10595, USA
| | - Christopher J Nowinski
- Boston University School of Medicine, Boston, MA 02118, USA
- Alzheimer’s Disease Center, CTE Program, Boston University School of Medicine, Boston, MA 02118, USA
| | - Robert C Cantu
- Boston University School of Medicine, Boston, MA 02118, USA
- Alzheimer’s Disease Center, CTE Program, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA 01742, USA
| | - Victor E Alvarez
- Alzheimer’s Disease Center, CTE Program, Boston University School of Medicine, Boston, MA 02118, USA
- VA Boston Healthcare System, Boston, MA 02130, USA
| | | | - Erich S Franz
- Molecular Aging and Development Laboratory, Boston University School of Medicine, Boston, MA 02118, USA
- Boston University College of Engineering, Boston, MA 02215, USA
| | - Janusz Konrad
- Boston University College of Engineering, Boston, MA 02215, USA
| | | | - Ning Hua
- Boston University School of Medicine, Boston, MA 02118, USA
| | - Yorghos Tripodis
- Alzheimer’s Disease Center, CTE Program, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | | | | | - Daniela Kaufer
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA
- Department of Integrative Biology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Garth F Hall
- Department of Biological Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Kun P Lu
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Richard M Ransohoff
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Robin O Cleveland
- Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, UK
| | - Neil W Kowall
- Boston University School of Medicine, Boston, MA 02118, USA
- Alzheimer’s Disease Center, CTE Program, Boston University School of Medicine, Boston, MA 02118, USA
- VA Boston Healthcare System, Boston, MA 02130, USA
| | - Thor D Stein
- Boston University School of Medicine, Boston, MA 02118, USA
- Alzheimer’s Disease Center, CTE Program, Boston University School of Medicine, Boston, MA 02118, USA
- VA Boston Healthcare System, Boston, MA 02130, USA
| | - Bruce T Lamb
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Bertrand R Huber
- Boston University School of Medicine, Boston, MA 02118, USA
- Alzheimer’s Disease Center, CTE Program, Boston University School of Medicine, Boston, MA 02118, USA
- VA Boston Healthcare System, Boston, MA 02130, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
| | - William C Moss
- Lawrence Livermore National Laboratory, Livermore, CA 94551, USA
| | - Alon Friedman
- Departments of Brain and Cognitive Sciences, Physiology and Cell Biology, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
- Department of Medical Neuroscience, Brain Repair Center, Dalhousie University, Halifax, B3H 4R2, Canada
| | - Patric K Stanton
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY 10595, USA
| | - Ann C McKee
- Boston University School of Medicine, Boston, MA 02118, USA
- Alzheimer’s Disease Center, CTE Program, Boston University School of Medicine, Boston, MA 02118, USA
- VA Boston Healthcare System, Boston, MA 02130, USA
| | - Lee E Goldstein
- Molecular Aging and Development Laboratory, Boston University School of Medicine, Boston, MA 02118, USA
- Boston University College of Engineering, Boston, MA 02215, USA
- Boston University Photonics Center, Boston University, Boston, MA 02215, USA
- Boston University School of Medicine, Boston, MA 02118, USA
- The Center for Biometals and Metallomics, Boston University School of Medicine, Boston, MA 02118, USA
- Alzheimer’s Disease Center, CTE Program, Boston University School of Medicine, Boston, MA 02118, USA
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178
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Chronic Traumatic Encephalopathy: Is Latency in Symptom Onset Explained by Tau Propagation? Cold Spring Harb Perspect Med 2018; 8:cshperspect.a024059. [PMID: 28096246 DOI: 10.1101/cshperspect.a024059] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive mild brain trauma. CTE, previously termed "dementia pugilistica," has been identified in American football, ice hockey, baseball, rugby and soccer players, boxers, wrestlers, and military personnel exposed to blast and other traumatic brain injuries. There is often a long latency period between an individual's exposure to repetitive brain trauma and the clinical symptoms of CTE. The pathology of CTE is characterized by a progression from isolated focal perivascular hyperphosphorylated tau lesions in the cerebral cortex to a widespread tauopathy that involves diffuse cortical and medial temporal lobe regions. We hypothesize that the spread of tau from focal perivascular lesions to a widespread tauopathy occurs as a result of intraneuronal and intrasynaptic prion-like protein templating, as well as tau secretion and propagation along glymphatic and cerebrospinal fluid pathways.
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179
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Keene CD, Latimer CS, Steele LM, Mac Donald CL. First confirmed case of chronic traumatic encephalopathy in a professional bull rider. Acta Neuropathol 2018; 135:303-305. [PMID: 29285625 PMCID: PMC5773642 DOI: 10.1007/s00401-017-1801-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 11/09/2022]
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180
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Lucke-Wold BP, Logsdon AF, Nguyen L, Eltanahay A, Turner RC, Bonasso P, Knotts C, Moeck A, Maroon JC, Bailes JE, Rosen CL. Supplements, nutrition, and alternative therapies for the treatment of traumatic brain injury. Nutr Neurosci 2018; 21:79-91. [PMID: 27705610 PMCID: PMC5491366 DOI: 10.1080/1028415x.2016.1236174] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Studies using traditional treatment strategies for mild traumatic brain injury (TBI) have produced limited clinical success. Interest in treatment for mild TBI is at an all time high due to its association with the development of chronic traumatic encephalopathy and other neurodegenerative diseases, yet therapeutic options remain limited. Traditional pharmaceutical interventions have failed to transition to the clinic for the treatment of mild TBI. As such, many pre-clinical studies are now implementing non-pharmaceutical therapies for TBI. These studies have demonstrated promise, particularly those that modulate secondary injury cascades activated after injury. Because no TBI therapy has been discovered for mild injury, researchers now look to pharmaceutical supplementation in an attempt to foster success in human clinical trials. Non-traditional therapies, such as acupuncture and even music therapy are being considered to combat the neuropsychiatric symptoms of TBI. In this review, we highlight alternative approaches that have been studied in clinical and pre-clinical studies of TBI, and other related forms of neural injury. The purpose of this review is to stimulate further investigation into novel and innovative approaches that can be used to treat the mechanisms and symptoms of mild TBI.
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Affiliation(s)
- Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Aric F. Logsdon
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Linda Nguyen
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Ahmed Eltanahay
- Department of Neurosurgery, Oregon Health Sciences University, Portland, USA
| | - Ryan C. Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
| | - Patrick Bonasso
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Chelsea Knotts
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
| | - Adam Moeck
- Department of Surgery, Matigan Army Medical Center, Tacoma, WA, USA
| | - Joseph C. Maroon
- Department of Neurosurgery, University of Pittsburgh Medical Center, PA, USA
| | - Julian E. Bailes
- Department of Neurosurgery, Northshore Healthcare System, Evanston, IL, USA
| | - Charles L. Rosen
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
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181
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Grinberg LT, Anghinah R, Nascimento CF, Amaro E, Leite RP, Martin MDGM, Naslavsky MS, Takada LT, Filho WJ, Pasqualucci CA, Nitrini R. Chronic Traumatic Encephalopathy Presenting as Alzheimer's Disease in a Retired Soccer Player. J Alzheimers Dis 2018; 54:169-74. [PMID: 27472879 DOI: 10.3233/jad-160312] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The relationship between soccer and chronic traumatic encephalopathy (CTE) is not well established. We report clinicopathological correlations in an 83-year-old retired center-back soccer player, with no history of concussion, manifesting typical Alzheimer-type dementia. Examination revealed mixed pathology including widespread CTE, moderate Alzheimer's disease, hippocampal sclerosis, and TDP-43 proteinopathy. This case adds to a few CTE cases described in soccer players. Furthermore, it corroborates that CTE may present clinically as typical Alzheimer-type dementia. Further studies investigating the extent to which soccer is a risk for CTE are needed.
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Affiliation(s)
- Lea T Grinberg
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA.,Department of Pathology - LIM-22, University of São Paulo Medical School, São Paulo, Brazil.,Hospital Albert Einstein, São Paulo, Brazil
| | - Renato Anghinah
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Edson Amaro
- Institute of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Renata P Leite
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Michel S Naslavsky
- Human Genome Research Center, University of São Paulo, São Paulo, Brazil
| | - Leonel T Takada
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob Filho
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos A Pasqualucci
- Department of Pathology - LIM-22, University of São Paulo Medical School, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
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182
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Yamamoto S, DeWitt DS, Prough DS. Impact & Blast Traumatic Brain Injury: Implications for Therapy. Molecules 2018; 23:E245. [PMID: 29373501 PMCID: PMC6017013 DOI: 10.3390/molecules23020245] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/23/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the most frequent causes of combat casualties in Operations Iraqi Freedom (OIF), Enduring Freedom (OEF), and New Dawn (OND). Although less common than combat-related blast exposure, there have been significant numbers of blast injuries in civilian populations in the United States. Current United States Department of Defense (DoD) ICD-9 derived diagnoses of TBI in the DoD Health Care System show that, for 2016, severe and moderate TBIs accounted for just 0.7% and 12.9%, respectively, of the total of 13,634 brain injuries, while mild TBIs (mTBIs) accounted for 86% of the total. Although there is a report that there are differences in the frequency of long-term complications in mTBI between blast and non-blast TBIs, clinical presentation is classified by severity score rather than mechanism because severity scoring is associated with prognosis in clinical practice. Blast TBI (bTBI) is unique in its pathology and mechanism, but there is no treatment specific for bTBIs-these patients are treated similarly to TBIs in general and therapy is tailored on an individual basis. Currently there is no neuroprotective drug recommended by the clinical guidelines based on evidence.
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Affiliation(s)
- Satoshi Yamamoto
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX 77555, USA.
| | - Douglas S DeWitt
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX 77555, USA.
| | - Donald S Prough
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX 77555, USA.
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183
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Lynch CE, Crynen G, Ferguson S, Mouzon B, Paris D, Ojo J, Leary P, Crawford F, Bachmeier C. Chronic cerebrovascular abnormalities in a mouse model of repetitive mild traumatic brain injury. Brain Inj 2018; 30:1414-1427. [PMID: 27834539 DOI: 10.1080/02699052.2016.1219060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PRIMARY OBJECTIVE To investigate the status of the cerebrovasculature following repetitive mild traumatic brain injury (r-mTBI). RESEARCH DESIGN TBI is a risk factor for development of various neurodegenerative disorders. A common feature of neurodegenerative disease is cerebrovascular dysfunction which includes alterations in cerebral blood flow (CBF). TBI can result in transient reductions in CBF, with severe injuries often accompanied by varying degrees of vascular pathology post-mortem. However, at this stage, few studies have investigated the cerebrovasculature at chronic time points following repetitive mild brain trauma. METHODS AND PROCEDURES r-mTBI was delivered to wild-type mice (12 months old) twice per week for 3 months and tested for spatial memory deficits (Barnes Maze task) at 1 and 6 months post-injury. At 7 months post-injury CBF was assessed via Laser Doppler Imaging and, following euthanasia, the brain was probed for markers of cerebrovascular dysfunction and inflammation. MAIN OUTCOMES AND RESULTS Memory impairment was identified at 1 month post-injury and persisted as late as 6 months post-injury. Furthermore, significant immunopathological insult, reductions in global CBF and down-regulation of cerebrovascular-associated markers were observed. CONCLUSIONS These results demonstrate impaired cognitive behaviour alongside chronic cerebrovascular dysfunction in a mouse model of repetitive mild brain trauma.
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Affiliation(s)
- Cillian E Lynch
- a The Roskamp Institute , Sarasota , FL , USA.,b The Open University , Department of Life Sciences , Milton Keynes , UK.,c James A. Haley Veteran's Administration Center , Tampa , FL , USA
| | - Gogce Crynen
- a The Roskamp Institute , Sarasota , FL , USA.,b The Open University , Department of Life Sciences , Milton Keynes , UK.,c James A. Haley Veteran's Administration Center , Tampa , FL , USA
| | - Scott Ferguson
- a The Roskamp Institute , Sarasota , FL , USA.,b The Open University , Department of Life Sciences , Milton Keynes , UK.,c James A. Haley Veteran's Administration Center , Tampa , FL , USA
| | - Benoit Mouzon
- a The Roskamp Institute , Sarasota , FL , USA.,b The Open University , Department of Life Sciences , Milton Keynes , UK.,c James A. Haley Veteran's Administration Center , Tampa , FL , USA
| | - Daniel Paris
- a The Roskamp Institute , Sarasota , FL , USA.,b The Open University , Department of Life Sciences , Milton Keynes , UK.,c James A. Haley Veteran's Administration Center , Tampa , FL , USA
| | - Joseph Ojo
- a The Roskamp Institute , Sarasota , FL , USA.,b The Open University , Department of Life Sciences , Milton Keynes , UK.,c James A. Haley Veteran's Administration Center , Tampa , FL , USA
| | - Paige Leary
- a The Roskamp Institute , Sarasota , FL , USA
| | - Fiona Crawford
- a The Roskamp Institute , Sarasota , FL , USA.,b The Open University , Department of Life Sciences , Milton Keynes , UK.,c James A. Haley Veteran's Administration Center , Tampa , FL , USA
| | - Corbin Bachmeier
- a The Roskamp Institute , Sarasota , FL , USA.,b The Open University , Department of Life Sciences , Milton Keynes , UK.,c James A. Haley Veteran's Administration Center , Tampa , FL , USA
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184
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Hase Y, Craggs L, Hase M, Stevenson W, Slade J, Chen A, Liang D, Ennaceur A, Oakley A, Ihara M, Horsburgh K, Kalaria RN. The effects of environmental enrichment on white matter pathology in a mouse model of chronic cerebral hypoperfusion. J Cereb Blood Flow Metab 2018; 38:151-165. [PMID: 28273725 PMCID: PMC5757440 DOI: 10.1177/0271678x17694904] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
White matter (WM) disintegration is common in the older population and is associated with vascular cognitive impairment (VCI). This study explored the effects of environmental enrichment (EE) on pathological sequelae in a mouse model of chronic cerebral hypoperfusion induced by bilateral common carotid artery stenosis (BCAS). Male C57BL/6 J mice underwent BCAS or sham surgery. One-week after surgery, mice were exposed to three different degrees of EE; either standard housing conditions (std), limited 3 h exposure to EE per day (3 h) or full-time exposure to EE (full) for 12 weeks. At 13 weeks after surgery, cognitive testing was performed using a three-dimensional 9-arm radial maze. At 16 weeks after surgery, nesting ability was assessed in each mouse immediately before euthanasia. Brains retrieved after perfusion fixation were examined for WM pathology. BCAS caused WM changes, as demonstrated by corpus callosum atrophy and greater WM disintegrity. BCAS also caused impaired nesting ability and cognitive function. These pathological changes and working memory deficits were attenuated, more so by limited rather than full-time exposure to EE regime. Our results suggest that limited exposure to EE delays the onset of WM degeneration. Therefore, the implementation of even limited EE may be beneficial for patients diagnosed with VCI.
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Affiliation(s)
- Yoshiki Hase
- 1 Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Lucinda Craggs
- 1 Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Mai Hase
- 1 Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - William Stevenson
- 1 Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Janet Slade
- 1 Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Aiqing Chen
- 1 Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Di Liang
- 1 Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Abdel Ennaceur
- 2 Department of Pharmacy, Sunderland Pharmacy School, University of Sunderland, Sunderland, UK
| | - Arthur Oakley
- 1 Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Masafumi Ihara
- 3 Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Centre, Osaka, Japan
| | - Karen Horsburgh
- 4 Centre for Neuroregeneration, University of Edinburgh, Edinburgh, UK
| | - Raj N Kalaria
- 1 Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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185
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Shenouda M, Zhang AB, Weichert A, Robertson J. Mechanisms Associated with TDP-43 Neurotoxicity in ALS/FTLD. ADVANCES IN NEUROBIOLOGY 2018; 20:239-263. [PMID: 29916022 DOI: 10.1007/978-3-319-89689-2_9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The discovery of TDP-43 as a major disease protein in amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD) was first made in 2006. Prior to 2006 there were only 11 publications related to TDP-43, now there are over 2000, indicating the importance of TDP-43 to unraveling the complex molecular mechanisms that underpin the pathogenesis of ALS/FTLD. Subsequent to this discovery, TDP-43 pathology was also found in other neurodegenerative diseases, including Alzheimer's disease, the significance of which is still in the early stages of exploration. TDP-43 is a predominantly nuclear DNA/RNA-binding protein, one of a number of RNA-binding proteins that are now known to be linked with ALS/FTLD, including Fused in Sarcoma (FUS), heterogeneous nuclear ribonucleoprotein A1 (hnRNP A1), and heterogeneous nuclear ribonucleoprotein A2/B1 (hnRNP A2/B1). However, what sets TDP-43 apart is the vast number of cases in which TDP-43 pathology is present, providing a point of convergence, the understanding of which could lead to broadly applicable therapeutics. Here we will focus on TDP-43 in ALS/FTLD, its nuclear and cytoplasmic functions, and consequences should these functions go awry.
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Affiliation(s)
- Marc Shenouda
- Tanz Centre for Research in Neurodegenerative Diseases and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Ashley B Zhang
- Tanz Centre for Research in Neurodegenerative Diseases and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Anna Weichert
- Tanz Centre for Research in Neurodegenerative Diseases and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Janice Robertson
- Tanz Centre for Research in Neurodegenerative Diseases and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, M5T 2S8, Canada.
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186
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Abstract
Traumatic brain injury remains a major cause of morbidity and mortality throughout the world, affecting young and old alike. Pathologic data have been developed through observations of human autopsies and developing animal models to investigate mechanisms, although animal models do not represent the polypathology of human brain injury and there are likely to be significant differences in the anatomic basis of injury and cellular responses between species. Traumatic brain injury can be defined pathologically as either focal or diffuse, and can be considered to be either primary, directly related to the force associated with the neurotrauma, or secondary, developing as a downstream consequence of the neurotrauma. While neuropathology has traditionally focused on severe head injury, there is increasing recognition of the long-term consequences of traumatic brain injury, particularly repetitive mild traumatic brain injury, and a possible long-term association with chronic traumatic encephalopathy.
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Affiliation(s)
- Colin Smith
- Department of Neuropathology, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom.
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187
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Mckee AC, Abdolmohammadi B, Stein TD. The neuropathology of chronic traumatic encephalopathy. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:297-307. [DOI: 10.1016/b978-0-444-63954-7.00028-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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188
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Nitrini R. Soccer (Football Association) and chronic traumatic encephalopathy: A short review and recommendation. Dement Neuropsychol 2017; 11:218-220. [PMID: 29213517 PMCID: PMC5674664 DOI: 10.1590/1980-57642016dn11-030002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) was initially described in boxers, but in recent years it has been reported in other settings, particularly in contact sports and military personnel. Soccer (football association) had previously been (and still is) considered relatively safe when compared to other sports, such as American football. However, a few cases of professional soccer players with CTE have been reported in the last few years. It is still unknown how frequent this condition is in soccer players, and the role played by heading the ball remains elusive. Other traumas to the head, face and neck caused by contact with another player's head, arm or other body parts are among the most frequent in soccer. In spite of the lack of more in-depth knowledge, there is reasonable evidence for recommending severe punishment (red card and suspension for several matches) for players causing avoidable trauma to another player's head.
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Affiliation(s)
- Ricardo Nitrini
- MD, PhD. Chefe do Departamento de Neurologia e da Divisão de Clínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
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189
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Effect of Voluntary Wheel Running on Striatal Dopamine Level and Neurocognitive Behaviors after Molar Loss in Rats. Behav Neurol 2017; 2017:6137071. [PMID: 29358845 PMCID: PMC5735578 DOI: 10.1155/2017/6137071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/25/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study is to evaluate the effect of voluntary wheel running on striatal dopamine level and behavior of cognition and emotion in molar loss rats. Twenty-four Sprague-Dawley rats were enrolled in this study and randomly divided into following 4 groups: control group (C group), molar loss group (ML group), 1-week physical exercise before molar loss group (1W-ML group), and 4-week physical exercise before molar loss group (4W-ML group). The rats both in 4W-ML and 1W-ML groups were placed in the voluntary running wheel in order to exercise for 4 weeks and 1 week, respectively. Then, the rats in 4W-ML, 1W-M, and ML groups received bilateral molar loss operation. After 10 days, striatal dopamine level was detected by in vivo microdialysis coupled with high-performance liquid chromatography (HPLC) and electrochemical detection. All the rats received behavior test after microdialysis detection. The behavior tests including passive avoidance test were used to assess cognition and elevated plus maze test for emotion. The results indicated that voluntary wheel running promoted striatal dopamine level in rats of molar loss. Behavioral data indicated that voluntary wheel running promoted cognition and emotion recovery after molar loss. Therefore, we concluded physical exercise significantly improved the neurocognitive behaviors and increased the striatal dopamine level after molar loss in rats.
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190
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Bishop SA, Dech RT, Guzik P, Neary JP. Heart rate variability and implication for sport concussion. Clin Physiol Funct Imaging 2017; 38:733-742. [PMID: 29144026 DOI: 10.1111/cpf.12487] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 10/19/2017] [Indexed: 12/12/2022]
Abstract
Finding sensitive and specific markers for sports-related concussion is both challenging and clinically important. Such biomarkers might be helpful in the management of patients with concussion (i.e. diagnosis, monitoring and risk prediction). Among many parameters, blood flow-pressure metrics and heart rate variability (HRV) have been used to gauge concussion outcomes. Reports on the relation between HRV and both acute and prolonged concussion recovery are conflicting. While some authors report on differences in the low-frequency (LF) component of HRV during postural manipulations and postexercise conditions, others observe no significant differences in various HRV measures. Despite the early success of using the HRV LF for concussion recovery, the interpretation of the LF is debated. Recent research suggests the LF power is a net effect of several intrinsic modulatory factors from both sympathetic and parasympathetic branches of the autonomic nervous system, vagally mediated baroreflex and even some respiratory influences at lower respiratory rate. There are only a few well-controlled concussion studies that specifically examine the contribution of the autonomic nervous system branches with HRV for concussion management. This study reviews the most recent HRV- concussion literature and the underlying HRV physiology. It also highlights cerebral blood flow studies related to concussion and the importance of multimodal assessment of various biological signals. It is hoped that a better understanding of the physiology behind HRV might generate cost-effective, repeatable and reliable protocols, all of which will improve the interpretation of HRV throughout concussion recovery.
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Affiliation(s)
- Scott A Bishop
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Ryan T Dech
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Przemyslaw Guzik
- Department of Cardiology-Intensive Care Therapy & Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - J Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
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191
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Pischiutta F, Micotti E, Hay JR, Marongiu I, Sammali E, Tolomeo D, Vegliante G, Stocchetti N, Forloni G, De Simoni MG, Stewart W, Zanier ER. Single severe traumatic brain injury produces progressive pathology with ongoing contralateral white matter damage one year after injury. Exp Neurol 2017; 300:167-178. [PMID: 29126888 DOI: 10.1016/j.expneurol.2017.11.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/27/2017] [Accepted: 11/06/2017] [Indexed: 01/29/2023]
Abstract
There is increasing recognition that traumatic brain injury (TBI) may initiate long-term neurodegenerative processes, particularly chronic traumatic encephalopathy. However, insight into the mechanisms transforming an initial biomechanical injury into a neurodegenerative process remain elusive, partly as a consequence of the paucity of informative pre-clinical models. This study shows the functional, whole brain imaging and neuropathological consequences at up to one year survival from single severe TBI by controlled cortical impact in mice. TBI mice displayed persistent sensorimotor and cognitive deficits. Longitudinal T2 weighted magnetic resonance imaging (MRI) showed progressive ipsilateral (il) cortical, hippocampal and striatal volume loss, with diffusion tensor imaging demonstrating decreased fractional anisotropy (FA) at up to one year in the il-corpus callosum (CC: -30%) and external capsule (EC: -21%). Parallel neuropathological studies indicated reduction in neuronal density, with evidence of microgliosis and astrogliosis in the il-cortex, with further evidence of microgliosis and astrogliosis in the il-thalamus. One year after TBI there was also a decrease in FA in the contralateral (cl) CC (-17%) and EC (-13%), corresponding to histopathological evidence of white matter loss (cl-CC: -68%; cl-EC: -30%) associated with ongoing microgliosis and astrogliosis. These findings indicate that a single severe TBI induces bilateral, long-term and progressive neuropathology at up to one year after injury. These observations support this model as a suitable platform for exploring the mechanistic link between acute brain injury and late and persistent neurodegeneration.
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Affiliation(s)
- Francesca Pischiutta
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Edoardo Micotti
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Jennifer R Hay
- Institute of Neuroscience and Psychology, University of Glasgow, UK; Department of Laboratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ines Marongiu
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Eliana Sammali
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Department of Cerebrovascular Diseases, Fondazione IRCCS - Istituto Neurologico Carlo Besta, Milan, Italy
| | - Daniele Tolomeo
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Gloria Vegliante
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Nino Stocchetti
- Department of Physiopathology and Transplantation, Milan University, Milan, Italy; ICU Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluigi Forloni
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Maria-Grazia De Simoni
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - William Stewart
- Institute of Neuroscience and Psychology, University of Glasgow, UK; Department of Laboratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Elisa R Zanier
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
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192
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Giannuzzi AP, De Simone A, Ricciardi M. Spontaneous nervous system concussion in dogs: a description of two cases and a review of terminology in veterinary medicine. Open Vet J 2017; 7:306-312. [PMID: 29138745 PMCID: PMC5681728 DOI: 10.4314/ovj.v7i4.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022] Open
Abstract
In human medicine, central nervous system (CNS) concussion is defined as a transient neurological dysfunction following a traumatic event, without evidence of structural abnormalities of the affected region on advanced diagnostic imaging. Depending on the anatomical region involved, three forms of concussive syndromes are described: brain concussion, spinal concussion and cerebellar concussion. Although major textbooks of veterinary neurology admit the existence of canine brain concussion, spontaneous cases of this pathological condition have not been reported in small animals so far. This report describes two cases of concussion in dogs: a 9-month-old, intact male, shih-tzu with brain concussion; and a 10-month-old, intact male, poodle with cerebellar concussion. In addition, a brief review of the definition of the term “concussion” in the veterinary medical literature is provided, in comparison to its meaning in the human medical literature. Finally, this paper proposes an appropriate definition of “concussion” in dogs, that may facilitate clinicians in the recognition of such an elusive syndrome.
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Affiliation(s)
| | | | - Mario Ricciardi
- "Pingry" Veterinary Hospital, via Medaglie d'Oro 5, Bari, Italy
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193
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Kulbe JR, Hall ED. Chronic traumatic encephalopathy-integration of canonical traumatic brain injury secondary injury mechanisms with tau pathology. Prog Neurobiol 2017; 158:15-44. [PMID: 28851546 PMCID: PMC5671903 DOI: 10.1016/j.pneurobio.2017.08.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 12/14/2022]
Abstract
In recent years, a new neurodegenerative tauopathy labeled Chronic Traumatic Encephalopathy (CTE), has been identified that is believed to be primarily a sequela of repeated mild traumatic brain injury (TBI), often referred to as concussion, that occurs in athletes participating in contact sports (e.g. boxing, American football, Australian football, rugby, soccer, ice hockey) or in military combatants, especially after blast-induced injuries. Since the identification of CTE, and its neuropathological finding of deposits of hyperphosphorylated tau protein, mechanistic attention has been on lumping the disorder together with various other non-traumatic neurodegenerative tauopathies. Indeed, brains from suspected CTE cases that have come to autopsy have been confirmed to have deposits of hyperphosphorylated tau in locations that make its anatomical distribution distinct for other tauopathies. The fact that these individuals experienced repetitive TBI episodes during their athletic or military careers suggests that the secondary injury mechanisms that have been extensively characterized in acute TBI preclinical models, and in TBI patients, including glutamate excitotoxicity, intracellular calcium overload, mitochondrial dysfunction, free radical-induced oxidative damage and neuroinflammation, may contribute to the brain damage associated with CTE. Thus, the current review begins with an in depth analysis of what is known about the tau protein and its functions and dysfunctions followed by a discussion of the major TBI secondary injury mechanisms, and how the latter have been shown to contribute to tau pathology. The value of this review is that it might lead to improved neuroprotective strategies for either prophylactically attenuating the development of CTE or slowing its progression.
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Affiliation(s)
- Jacqueline R Kulbe
- Spinal Cord & Brain Injury Research Center, University of Kentucky College of Medicine, United States; Department of Neuroscience, University of Kentucky College of Medicine, United States
| | - Edward D Hall
- Spinal Cord & Brain Injury Research Center, University of Kentucky College of Medicine, United States; Department of Neuroscience, University of Kentucky College of Medicine, United States.
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194
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Gouttebarge V, Aoki H, Lambert M, Stewart W, Kerkhoffs G. A history of concussions is associated with symptoms of common mental disorders in former male professional athletes across a range of sports. PHYSICIAN SPORTSMED 2017; 45:443-449. [PMID: 28870119 PMCID: PMC9336050 DOI: 10.1080/00913847.2017.1376572] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Recent reports suggest that exposure to repetitive concussions in sports is associated with an increased risk of symptoms of distress, anxiety and depression, sleep disturbance or substance abuse/dependence (typically referred as symptoms of common mental disorders[CMD]) and of later development of neurodegenerative disease, in particular chronic traumatic encephalopathy (CTE). The primary aim of this study was to explore the relationship between sports career-related concussions and the subsequent occurrence of symptoms of CMD among former male professional athletes retired from football (soccer), ice hockey and rugby (union). METHODS Cross-sectional analyses were performed on baseline electronic questionnaires from three prospective cohort studies among former male professional athletes retired from football (soccer), ice hockey and rugby (union). The number of confirmed concussions was examined through a single question, while symptoms of distress, anxiety and depression, sleep disturbance and adverse alcohol use were assessed using validated questionnaires. RESULTS From 1,957 former professional athletes contacted, a total of 576 (29%) completed the questionnaire. Of these, 23% had not incurred a concussion during their career, 34% had two or three, 18% four or five, and 11% six or more concussions. The number of sports career-related concussions was a predictor for all outcome measures (β = 0.072-0.109; P ≤ 0.040). Specifically, former professional athletes who reported a history of four or five concussions were approximately 1.5 times more likely to report symptoms of CMD, rising to a two- to five-fold increase in those reporting a history of six or more sports career-related concussions. CONCLUSIONS These data demonstrate an association between exposure to sports concussion and subsequent risk of symptoms of CMD in former professional athletes across a range of contact sports. Further work to explore the association between sports concussion and symptoms of CMD is required; in the meanwhile, strategies for effective risk reduction and improved management appear indicated.
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Affiliation(s)
- Vincent Gouttebarge
- Academic Center for Evidence-based Sports medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands,World Players’ Union (FIFPro), Hoofddorp, The Netherlands,Division of Exercise Science and Sports Medicine (ESSM), University of Cape Town, Cape Town, South Africa
| | - Haruhito Aoki
- St Marianna University School of Medicine, Kawazaki, Japan
| | - Michael Lambert
- Division of Exercise Science and Sports Medicine (ESSM), University of Cape Town, Cape Town, South Africa
| | - William Stewart
- Department of Neuropathology, Queen Elizabeth Hospital, Glasgow, UK
| | - Gino Kerkhoffs
- Academic Center for Evidence-based Sports medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands,Amsterdam Collaboration for Health & Safety in Sports (ACHSS), Academic Medical Center / VU University Medical Center, Amsterdam, The Netherlands
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195
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Caccese JB, Buckley TA, Tierney RT, Rose WC, Glutting JJ, Kaminski TW. Sex and age differences in head acceleration during purposeful soccer heading. Res Sports Med 2017; 26:64-74. [PMID: 29067816 DOI: 10.1080/15438627.2017.1393756] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Differences in head-neck segment mass, purposeful heading technique, and cervical strength and stiffness may contribute to differences in head accelerations across sex and age. The purpose of this study was to compare head acceleration across sex and age (youth [12-14 years old], high school and collegiate) during purposeful soccer heading. One-hundred soccer players (42 male, 58 female, 17.1 ± 3.5 years, 168.5 ± 20.3 cm, 61.5 ± 13.7 kg) completed 12 controlled soccer headers at an initial ball velocity of 11.2 m/s. Linear and rotational accelerations were measured using a triaxial accelerometer and gyroscope and were transformed to the head centre-of-mass. A MANOVA revealed a significant multivariate main effect for sex (Pillai's Trace = .165, F(2,91) = 11.868, p < .001), but not for age (Pillai's Trace = .033, F(4,182) = 0.646, p = .630). Peak linear and rotational accelerations were higher in females (40.9 ± 13.3 g; 3279 ± 1065 rad/s2) than males (27.6 ± 8.5 g, 2219 ± 823 rad/s2). These data suggest that under controlled soccer heading conditions, females may be exposed to higher head accelerations than males.
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Affiliation(s)
- Jaclyn B Caccese
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
| | - Thomas A Buckley
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
| | - Ryan T Tierney
- c Department of Kinesiology , Temple University , Philadelphia , PA , USA
| | - William C Rose
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
| | | | - Thomas W Kaminski
- a Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA.,b Biomechanics and Movement Science Interdisciplinary Program , University of Delaware , Newark , DE , USA
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196
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Neuroimmunology of Traumatic Brain Injury: Time for a Paradigm Shift. Neuron 2017; 95:1246-1265. [PMID: 28910616 DOI: 10.1016/j.neuron.2017.07.010] [Citation(s) in RCA: 458] [Impact Index Per Article: 65.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and disability, with a considerable socioeconomic burden. Heterogeneity of pathoanatomical subtypes and diversity in the pathogenesis and extent of injury contribute to differences in the course and outcome of TBI. Following the primary injury, extensive and lasting damage is sustained through a complex cascade of events referred to as "secondary injury." Neuroinflammation is proposed as an important manipulable aspect of secondary injury in animal and human studies. Because neuroinflammation can be detrimental or beneficial, before developing immunomodulatory therapies, it is necessary to better understand the timing and complexity of the immune responses that follow TBI. With a rapidly increasing body of literature, there is a need for a clear summary of TBI neuroimmunology. This review presents our current understanding of the immune response to TBI in a chronological and compartment-based manner, highlighting early changes in gene expression and initial signaling pathways that lead to activation of innate and adaptive immunity. Based on recent advances in our understanding of innate immune cell activation, we propose a new paradigm to study innate immune cells following TBI that moves away from the existing M1/M2 classification of activation states toward a stimulus- and disease-specific understanding of polarization state based on transcriptomic and proteomic profiling.
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197
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Cherry JD, Stein TD, Tripodis Y, Alvarez VE, Huber BR, Au R, Kiernan PT, Daneshvar DH, Mez J, Solomon TM, Alosco ML, McKee AC. CCL11 is increased in the CNS in chronic traumatic encephalopathy but not in Alzheimer's disease. PLoS One 2017; 12:e0185541. [PMID: 28950005 PMCID: PMC5614644 DOI: 10.1371/journal.pone.0185541] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/14/2017] [Indexed: 12/14/2022] Open
Abstract
CCL11, a protein previously associated with age-associated cognitive decline, is observed to be increased in the brain and cerebrospinal fluid (CSF) in chronic traumatic encephalopathy (CTE) compared to Alzheimer's disease (AD). Using a cohort of 23 deceased American football players with neuropathologically verified CTE, 50 subjects with neuropathologically diagnosed AD, and 18 non-athlete controls, CCL11 was measured with ELISA in the dorsolateral frontal cortex (DLFC) and CSF. CCL11 levels were significantly increased in the DLFC in subjects with CTE (fold change = 1.234, p < 0.050) compared to non-athlete controls and AD subjects with out a history of head trauma. This increase was also seen to correlate with years of exposure to American football (β = 0.426, p = 0.048) independent of age (β = -0.046, p = 0.824). Preliminary analyses of a subset of subjects with available post-mortem CSF showed a trend for increased CCL11 among individuals with CTE (p = 0.069) mirroring the increase in the DLFC. Furthermore, an association between CSF CCL11 levels and the number of years exposed to football (β = 0.685, p = 0.040) was observed independent of age (β = -0.103, p = 0.716). Finally, a receiver operating characteristic (ROC) curve analysis demonstrated CSF CCL11 accurately distinguished CTE subjects from non-athlete controls and AD subjects (AUC = 0.839, 95% CI 0.62-1.058, p = 0.028). Overall, the current findings provide preliminary evidence that CCL11 may be a novel target for future CTE biomarker studies.
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Affiliation(s)
- Jonathan D. Cherry
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States of America
- Department of Neurology, Boston University School of Medicine, Boston, MA. United States of America
- VA Boston Healthcare System, Boston, MA, United States of America
- * E-mail:
| | - Thor D. Stein
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States of America
- Department of Neurology, Boston University School of Medicine, Boston, MA. United States of America
- Department of Veterans Affairs Medical Center, Bedford, MA, United States of America
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Victor E. Alvarez
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States of America
- Department of Neurology, Boston University School of Medicine, Boston, MA. United States of America
- VA Boston Healthcare System, Boston, MA, United States of America
- Department of Veterans Affairs Medical Center, Bedford, MA, United States of America
| | - Bertrand R. Huber
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States of America
- Department of Neurology, Boston University School of Medicine, Boston, MA. United States of America
- VA Boston Healthcare System, Boston, MA, United States of America
| | - Rhoda Au
- Department of Neurology, Boston University School of Medicine, Boston, MA. United States of America
- Framingham Heart Study, Boston University School of Medicine, Boston, MA, United States of America
| | - Patrick T. Kiernan
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Daniel H. Daneshvar
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Jesse Mez
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States of America
- Department of Neurology, Boston University School of Medicine, Boston, MA. United States of America
| | - Todd M. Solomon
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Michael L. Alosco
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States of America
- Department of Neurology, Boston University School of Medicine, Boston, MA. United States of America
| | - Ann C. McKee
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, United States of America
- Department of Neurology, Boston University School of Medicine, Boston, MA. United States of America
- VA Boston Healthcare System, Boston, MA, United States of America
- Department of Veterans Affairs Medical Center, Bedford, MA, United States of America
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, United States of America
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198
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Mahar I, Alosco ML, McKee AC. Psychiatric phenotypes in chronic traumatic encephalopathy. Neurosci Biobehav Rev 2017; 83:622-630. [PMID: 28888534 DOI: 10.1016/j.neubiorev.2017.08.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 08/12/2017] [Accepted: 08/30/2017] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder involving cognitive, motor, and psychiatrically-relevant symptoms resulting from repetitive head impacts. Psychiatric phenotypes of CTE, including depression and suicidality, present particular challenges for CTE research, given that the diagnosis requires postmortem neuropathological examination. The pathognomonic lesion of CTE is the perivascular accumulation of hyperphosphorylated tau (ptau) protein at the depths of cortical sulci. These lesions are found in the earliest disease stages, and with advancing pathological severity, ptau deposition occurs in widespread brain regions in a four-stage scheme of severity. We review the psychiatric phenotypes of individuals neuropathologically diagnosed with CTE, and suggest that earlier CTE stages hold particular interest for psychiatric CTE research. In the early CTE stages, there is ptau pathology in frontal cortex and axonal loss in the frontal white matter, followed by progressive ptau neurofibrillary degeneration in the amygdala and hippocampus. Neuropathological changes in the frontal and medial temporal lobes may underlie psychiatric phenotypes. Additional insight into the association between CTE pathology and psychiatric sequelae may come from advancements in in vivo methods of CTE detection. Further epidemiological, clinical, and postmortem studies are needed to validate the nature of psychiatric sequelae in CTE.
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Affiliation(s)
- Ian Mahar
- Dept. of Neurology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease and Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, MA, USA
| | - Michael L Alosco
- Dept. of Neurology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease and Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, MA, USA
| | - Ann C McKee
- Dept. of Neurology, Boston University School of Medicine, Boston, MA, USA; Dept. of Pathology, Boston University School of Medicine, Boston, MA, USA; Alzheimer's Disease and Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, VA Boston Healthcare System, Boston, MA, USA.
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199
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Abstract
There is a long history linking traumatic brain injury (TBI) with the development of dementia. Despite significant reservations, such as recall bias or concluding causality for TBI, a summary of recent research points to several conclusions on the TBI-dementia relationship. 1) Increasing severity of a single moderate-to-severe TBI increases the risk of subsequent Alzheimer's disease (AD), the most common type of dementia. 2) Repetitive, often subconcussive, mild TBIs increases the risk for chronic traumatic encephalopathy (CTE), a degenerative neuropathology. 3) TBI may be a risk factor for other neurodegenerative disorders that can be associated with dementia. 4) TBI appears to lower the age of onset of TBI-related neurocognitive syndromes, potentially adding "TBI cognitive-behavioral features". The literature further indicates several specific risk factors for TBI-associated dementia: 5) any blast or blunt physical force to the head as long as there is violent head displacement; 6) decreased cognitive and/or neuronal reserve and the related variable of older age at TBI; and 7) the presence of apolipoprotein E ɛ4 alleles, a genetic risk factor for AD. Finally, there are neuropathological features relating TBI with neurocognitive syndromes: 8) acute TBI results in amyloid pathology and other neurodegenerative proteinopathies; 9) CTE shares features with neurodegenerative dementias; and 10) TBI results in white matter tract and neural network disruptions. Although further research is needed, these ten findings suggest that dose-dependent effects of violent head displacement in vulnerable brains predispose to dementia; among several potential mechanisms is the propagation of abnormal proteins along damaged white matter networks.
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Affiliation(s)
- Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Neurology, Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Deshpande SK, Hasegawa RB, Rabinowitz AR, Whyte J, Roan CL, Tabatabaei A, Baiocchi M, Karlawish JH, Master CL, Small DS. Association of Playing High School Football With Cognition and Mental Health Later in Life. JAMA Neurol 2017; 74:909-918. [PMID: 28672325 DOI: 10.1001/jamaneurol.2017.1317] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance American football is the largest participation sport in US high schools and is a leading cause of concussion among adolescents. Little is known about the long-term cognitive and mental health consequences of exposure to football-related head trauma at the high school level. Objective To estimate the association of playing high school football with cognitive impairment and depression at 65 years of age. Design, Setting, and Participants A representative sample of male high school students who graduated from high school in Wisconsin in 1957 was studied. In this cohort study using data from the Wisconsin Longitudinal Study, football players were matched between March 1 and July 1, 2017, with controls along several baseline covariates such as adolescent IQ, family background, and educational level. For robustness, 3 versions of the control condition were considered: all controls, those who played a noncollision sport, and those who did not play any sport. Exposures Athletic participation in high school football. Main Outcomes and Measures A composite cognition measure of verbal fluency and memory and attention constructed from results of cognitive assessments administered at 65 years of age. A modified Center for Epidemiological Studies' Depression Scale score was used to measure depression. Secondary outcomes include results of individual cognitive tests, anger, anxiety, hostility, and heavy use of alcohol. Results Among the 3904 men (mean [SD] age, 64.4 [0.8] years at time of primary outcome measurement) in the study, after matching and model-based covariate adjustment, compared with each control condition, there was no statistically significant harmful association of playing football with a reduced composite cognition score (-0.04 reduction in cognition vs all controls; 97.5% CI, -0.14 to 0.05) or an increased modified Center for Epidemiological Studies' Depression Scale depression score (-1.75 reduction vs all controls; 97.5% CI, -3.24 to -0.26). After adjustment for multiple testing, playing football did not have a significant adverse association with any of the secondary outcomes, such as the likelihood of heavy alcohol use at 65 years of age (odds ratio, 0.68; 95% CI, 0.32-1.43). Conclusions and Relevance Cognitive and depression outcomes later in life were found to be similar for high school football players and their nonplaying counterparts from mid-1950s in Wisconsin. The risks of playing football today might be different than in the 1950s, but for current athletes, this study provides information on the risk of playing sports today that have a similar risk of head trauma as high school football played in the 1950s.
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Affiliation(s)
- Sameer K Deshpande
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia
| | - Raiden B Hasegawa
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia
| | - Amanda R Rabinowitz
- Brain Injury Neuropsychology Laboratory, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
| | - John Whyte
- TBI Rehabilitation Research Laboratory, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
| | - Carol L Roan
- Center for Demography and Ecology, University of Wisconsin-Madison
| | | | - Michael Baiocchi
- Standard Prevention Research Center, Stanford School of Medicine, Stanford University, Palo Alto, California
| | - Jason H Karlawish
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Christina L Master
- Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Dylan S Small
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia
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