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Lember LM, Ntikas M, Mondello S, Wilson L, Di Virgilio TG, Hunter AM, Kobeissy F, Mechref Y, Donaldson DI, Ietswaart M. The Use of Biofluid Markers to Evaluate the Consequences of Sport-Related Subconcussive Head Impact Exposure: A Scoping Review. SPORTS MEDICINE - OPEN 2024; 10:12. [PMID: 38270708 PMCID: PMC10811313 DOI: 10.1186/s40798-023-00665-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Amidst growing concern about the safety of sport-related repetitive subconcussive head impacts (RSHI), biofluid markers may provide sensitive, informative, and practical assessment of the effects of RSHI exposure. OBJECTIVE This scoping review aimed to systematically examine the extent, nature, and quality of available evidence from studies investigating the effects of RSHI on biofluid markers, to identify gaps and to formulate guidelines to inform future research. METHODS PRISMA extension for Scoping Reviews guidelines were adhered to. The protocol was pre-registered through publication. MEDLINE, Scopus, SPORTDiscus, CINAHL, PsycINFO, Cochrane Library, OpenGrey, and two clinical trial registries were searched (until March 30, 2022) using descriptors for subconcussive head impacts, biomarkers, and contact sports. Included studies were assessed for risk of bias and quality. RESULTS Seventy-nine research publications were included in the review. Forty-nine studies assessed the acute effects, 23 semi-acute and 26 long-term effects of RSHI exposure. The most studied sports were American football, boxing, and soccer, and the most investigated markers were (in descending order): S100 calcium-binding protein beta (S100B), tau, neurofilament light (NfL), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), phosphorylated tau (p-tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and hormones. High or moderate bias was found in most studies, and marker-specific conclusions were subject to heterogeneous and limited evidence. Although the evidence is weak, some biofluid markers-such as NfL-appeared to show promise. More markedly, S100B was found to be problematic when evaluating the effects of RSHI in sport. CONCLUSION Considering the limitations of the evidence base revealed by this first review dedicated to systematically scoping the evidence of biofluid marker levels following RSHI exposure, the field is evidently still in its infancy. As a result, any recommendation and application is premature. Although some markers show promise for the assessment of brain health following RSHI exposure, future large standardized and better-controlled studies are needed to determine biofluid markers' utility.
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Affiliation(s)
- Liivia-Mari Lember
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Michail Ntikas
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
- The School of Psychology, University of Aberdeen, Aberdeen, UK
| | - Stefania Mondello
- Biomedical and Dental Sciences and Morphofunctional Imaging, Faculty of Medicine and Surgery, University of Messina, Messina, Italy
| | - Lindsay Wilson
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Thomas G Di Virgilio
- Physiology Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Angus M Hunter
- Physiology Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- Department of Sports Science, Nottingham Trent University, Nottingham, UK
| | - Firas Kobeissy
- Center for Neurotrauma, Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine (MSM), Multiomics & Biomarkers, Atlanta, GA, 30310, USA
| | - Yehia Mechref
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX, USA
| | - David I Donaldson
- School of Psychology and Neuroscience, University of St Andrews, St. Andrews, UK
| | - Magdalena Ietswaart
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK.
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Dennis EL, Keleher F, Tate DF, Wilde EA. The Role of Neuroimaging in Evolving TBI Research and Clinical Practice. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.24.23286258. [PMID: 36865222 PMCID: PMC9980266 DOI: 10.1101/2023.02.24.23286258] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Neuroimaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI) have been widely adopted in the clinical diagnosis and management of traumatic brain injury (TBI), particularly at the more acute and severe levels of injury. Additionally, a number of advanced applications of MRI have been employed in TBI-related clinical research with great promise, and researchers have used these techniques to better understand underlying mechanisms, progression of secondary injury and tissue perturbation over time, and relation of focal and diffuse injury to later outcome. However, the acquisition and analysis time, the cost of these and other imaging modalities, and the need for specialized expertise have represented historical barriers in extending these tools in clinical practice. While group studies are important in detecting patterns, heterogeneity among patient presentation and limited sample sizes from which to compare individual level data to well-developed normative data have also played a role in the limited translatability of imaging to wider clinical application. Fortunately, the field of TBI has benefitted from increased public and scientific awareness of the prevalence and impact of TBI, particularly in head injury related to recent military conflicts and sport-related concussion. This awareness parallels an increase in federal funding in the United States and other countries allocated to investigation in these areas. In this article we summarize funding and publication trends since the mainstream adoption of imaging in TBI to elucidate evolving trends and priorities in the application of different techniques and patient populations. We also review recent and ongoing efforts to advance the field through promoting reproducibility, data sharing, big data analytic methods, and team science. Finally, we discuss international collaborative efforts to combine and harmonize neuroimaging, cognitive, and clinical data, both prospectively and retrospectively. Each of these represent unique, but related, efforts that facilitate closing gaps between the use of advanced imaging solely as a research tool and the use of it in clinical diagnosis, prognosis, and treatment planning and monitoring.
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Affiliation(s)
- Emily L Dennis
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Finian Keleher
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT
| | - David F Tate
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
- Baylor College of Medicine, Houston, TX
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Bonke EM, Bonfert MV, Hillmann SM, Seitz-Holland J, Gaubert M, Wiegand TLT, De Luca A, Cho KIK, Sandmo SB, Yhang E, Tripodis Y, Seer C, Kaufmann D, Kaufmann E, Muehlmann M, Gooijers J, Lin AP, Leemans A, Swinnen SP, Bahr R, Shenton ME, Pasternak O, Tacke U, Heinen F, Koerte IK. Neurological soft signs in adolescents are associated with brain structure. Cereb Cortex 2022; 33:5547-5556. [PMID: 36424865 DOI: 10.1093/cercor/bhac441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022] Open
Abstract
Abstract
Neurological soft signs (NSS) are minor deviations in motor performance. During childhood and adolescence, NSS are examined for functional motor phenotyping to describe development, to screen for comorbidities, and to identify developmental vulnerabilities. Here, we investigate underlying brain structure alterations in association with NSS in physically trained adolescents. Male adolescent athletes (n = 136, 13–16 years) underwent a standardized neurological examination including 28 tests grouped into 6 functional clusters. Non-optimal performance in at least 1 cluster was rated as NSS (NSS+ group). Participants underwent T1- and diffusion-weighted magnetic resonance imaging. Cortical volume, thickness, and local gyrification were calculated using Freesurfer. Measures of white matter microstructure (Free-water (FW), FW-corrected fractional anisotropy (FAt), axial and radial diffusivity (ADt, RDt)) were calculated using tract-based spatial statistics. General linear models with age and handedness as covariates were applied to assess differences between NSS+ and NSS− group. We found higher gyrification in a large cluster spanning the left superior frontal and parietal areas, and widespread lower FAt and higher RDt compared with the NSS− group. This study shows that NSS in adolescents are associated with brain structure alterations. Underlying mechanisms may include alterations in synaptic pruning and axon myelination, which are hallmark processes of brain maturation.
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Affiliation(s)
- Elena M Bonke
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Graduate School of Systemic Neurosciences , Ludwig-Maximilians-Universität, Munich , Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich, Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Michaela V Bonfert
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Stefan M Hillmann
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Johanna Seitz-Holland
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Malo Gaubert
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- CHU Rennes Radiology Department, , Rennes, France
- University of Rennes Inria, CNRS, Inserm, IRISA UMR 6074, Empenn ERL, , Rennes, France
| | - Tim L T Wiegand
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich, Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Alberto De Luca
- University Medical Center Utrecht Image Sciences Institute, , Utrecht, the Netherlands
- University Medical Center Utrecht Department of Neurology, , Utrecht, the Netherlands
| | - Kang Ik K Cho
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
| | - Stian B Sandmo
- Norwegian School of Sport Sciences Oslo Sports Trauma Research Center, Department of Sports Medicine, , Oslo, Norway
- Oslo University Hospital Division of Mental Health and Addiction, , Oslo, Norway
| | - Eukyung Yhang
- Boston University School of Public Health Department of Biostatistics, , Boston, MA , United States
| | - Yorghos Tripodis
- Boston University School of Public Health Department of Biostatistics, , Boston, MA , United States
- Boston University School of Medicine Alzheimer’s Disease and CTE Centers, , Boston, MA , United States
| | - Caroline Seer
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - David Kaufmann
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- University Hospital Augsburg Department of Diagnostic and Interventional Radiology and Neuroradiology, , Augsburg, Germany
| | - Elisabeth Kaufmann
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Ludwig-Maximilians-Universität Department of Neurology, , Munich, Germany
| | - Marc Muehlmann
- University Hospital Department of Clinical Radiology, , Ludwig-Maximilians-Universität, Munich, Germany
| | - Jolien Gooijers
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - Alexander P Lin
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
- Harvard Medical School Center for Clinical Spectroscopy, Brigham and Women’s Hospital, , Boston, MA, United States
| | - Alexander Leemans
- University Medical Center Utrecht Image Sciences Institute, , Utrecht, the Netherlands
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - Roald Bahr
- Norwegian School of Sport Sciences Oslo Sports Trauma Research Center, Department of Sports Medicine, , Oslo, Norway
| | - Martha E Shenton
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
| | - Ofer Pasternak
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
| | - Uta Tacke
- University Children's Hospital (UKBB) , Basel, Switzerland
| | - Florian Heinen
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Inga K Koerte
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Graduate School of Systemic Neurosciences , Ludwig-Maximilians-Universität, Munich, Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich , Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
- Harvard Medical School Department of Psychiatry, Massachusetts General Hospital, , Boston, MA , United States
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Selleri V, Mattioli M, Lo Tartaro D, Paolini A, Zanini G, De Gaetano A, D’Alisera R, Roli L, Melegari A, Maietta P, Tripi F, Guerra E, Chester J, Savino G, Trenti T, Cossarizza A, Mattioli AV, Pinti M, Nasi M. Innate immunity changes in soccer players after whole-body cryotherapy. BMC Sports Sci Med Rehabil 2022; 14:185. [PMID: 36284345 PMCID: PMC9594892 DOI: 10.1186/s13102-022-00578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/30/2022] [Indexed: 11/26/2022]
Abstract
Whole-body cryotherapy (WBC) consists of short exposure (up to 2–3 min) to dry air at cryogenic temperatures (up to -190 °C) and has recently been applied for muscle recovery after injury to reduce the inflammation process. We aimed to determine the impact of cryotherapy on immunological, hormonal, and metabolic responses in non-professional soccer players (NPSPs). Nine male NPSPs (age: 20 ± 2 years) who trained regularly over 5 consecutive days, immediately before and after each training session, were subjected to WBC treatment (WBC-t). Blood samples were collected for the evaluation of fifty analytes including hematologic parameters, serum chemistry, and hormone profiles. Monocytes phenotyping (Mo) was performed and plasmatic markers, usually increased during inflammation [CCL2, IL-18, free mitochondrial (mt)DNA] or with anti-inflammatory effects (IL2RA, IL1RN), were quantified. After WBC-t, we observed reduced levels of ferritin, mean corpuscular hemoglobin, mean platelet volume, testosterone, and estradiol, which however remain within the normal ranges. The percentage of the total, intermediates and non-classical Mo increased, while classical Mo decreased. CXCR4 expression decreased in each Mo subset. Plasma IL18 and IL2RA levels decreased, while IL1RN only exhibited a tendency to decrease and CCL2 showed a tendency to increase. Circulating mtDNA levels were not altered following WBC-t. The differences observed in monocyte subsets after WBC-t may be attributable to their redistribution into the surrounding tissue. Moreover, the decrease of CXCR4 in Mo subpopulations could be coherent with their differentiation process. Thus, WBC through yet unknown mechanisms could promote their differentiation having a role in tissue repair.
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Affiliation(s)
- Valentina Selleri
- grid.7548.e0000000121697570Department of Life Sciences, University of Modena and Reggio Emilia, via Campi, 287, 41125 Modena, Italy ,grid.493113.dNational Institute for Cardiovascular Research - INRC, 40126 Bologna, Italy
| | - Marco Mattioli
- grid.7548.e0000000121697570Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Domenico Lo Tartaro
- grid.7548.e0000000121697570Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Annamaria Paolini
- grid.7548.e0000000121697570Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Giada Zanini
- grid.7548.e0000000121697570Department of Life Sciences, University of Modena and Reggio Emilia, via Campi, 287, 41125 Modena, Italy
| | - Anna De Gaetano
- grid.493113.dNational Institute for Cardiovascular Research - INRC, 40126 Bologna, Italy
| | - Roberta D’Alisera
- grid.476047.60000 0004 1756 2640Department of Public Healthcare, Sports Medicine Service, Azienda USL of Modena, 41121 Modena, Italy
| | - Laura Roli
- grid.476047.60000 0004 1756 2640Department of Laboratory Medicine and Pathology, Azienda USL of Modena, 41121 Modena, Italy
| | - Alessandra Melegari
- grid.476047.60000 0004 1756 2640Department of Laboratory Medicine and Pathology, Azienda USL of Modena, 41121 Modena, Italy
| | - Pasqualino Maietta
- Department of Quality of Life, “Alma Mater Studiorum”, 40126 Bologna, Italy
| | - Ferdinando Tripi
- “La Fratellanza 1874” Not-for-profit sport Association, 41126 Modena, Italy
| | - Emanuele Guerra
- grid.476047.60000 0004 1756 2640Department of Public Healthcare, Sports Medicine Service, Azienda USL of Modena, 41121 Modena, Italy
| | - Johanna Chester
- grid.7548.e0000000121697570Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Gustavo Savino
- grid.476047.60000 0004 1756 2640Department of Public Healthcare, Sports Medicine Service, Azienda USL of Modena, 41121 Modena, Italy
| | - Tommaso Trenti
- grid.476047.60000 0004 1756 2640Department of Laboratory Medicine and Pathology, Azienda USL of Modena, 41121 Modena, Italy
| | - Andrea Cossarizza
- grid.493113.dNational Institute for Cardiovascular Research - INRC, 40126 Bologna, Italy ,grid.7548.e0000000121697570Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Anna Vittoria Mattioli
- grid.493113.dNational Institute for Cardiovascular Research - INRC, 40126 Bologna, Italy ,grid.7548.e0000000121697570Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Marcello Pinti
- grid.7548.e0000000121697570Department of Life Sciences, University of Modena and Reggio Emilia, via Campi, 287, 41125 Modena, Italy
| | - Milena Nasi
- grid.7548.e0000000121697570Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
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