1
|
Rueb M, Rauen K, Koerte IK, Gersing A, Zetterberg H, Simrén J, Brendel M, Adorjan K. Traumatic Encephalopathy Syndrome and Tauopathy in a 19-Year-Old With Child Abuse. Neurotrauma Rep 2023; 4:857-862. [PMID: 38156074 PMCID: PMC10754342 DOI: 10.1089/neur.2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
The majority of traumatic encephalopathy syndrome (TES) cases have been reported in former contact sport athletes. This is the first case with TES in a 19-year-old male patient with progressive cognitive decline after daily domestic physical violence through repeated hits to the head for 15 years. The patient presented with a moderate depressive episode and progressive cognitive decline. Tau positron emission tomography (PET) with 220 MBq of [18F]PI-2620 revealed increased focal signal at the frontal and parietal white/gray matter border. Brain magnetic resonance imaging (MRI) showed a cavum septum pellucidum, reduced left-sided hippocampal volume, and a left midbrain lesion. Cerebrospinal fluid results showed elevated total and p-tau. Neurocognitive testing at admission showed memory deficits clearly below average, and hampered dysfunctions according to the slow processing speed with a low mistake rate, indicating the acquired, thus secondary, attentional deficits. We diagnosed the patient with a TES suggestive of chronic traumatic encephalopathy and classified him as having subtle/mild functional limitation with a most likely transition to mild dementia within the TES criteria. This report underlines child abuse as a relevant criterion in diagnosing TES in cases with repetitive hits to the head. In addition to clinical markers, we show the relevance of fluid tau biomarkers and tau-PET to support the diagnosis of TES according to the recently published diagnosis criteria for TES.
Collapse
Affiliation(s)
- Mike Rueb
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU University Hospital, LMU Munich, Munich, Germany
- Center for International Health (CIH LMU), LMU University Hospital, LMU Munich, Munich, Germany
| | - Katrin Rauen
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Inga Katharina Koerte
- Psychiatric Neuroimaging Laboratory, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, LMU University Hospital, Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Gersing
- Department of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, United Kingdom
- UK Dementia Research Institute, University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Joel Simrén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Matthias Brendel
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE) Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- Center for International Health (CIH LMU), LMU University Hospital, LMU Munich, Munich, Germany
- Institute of Psychiatric Phenomics and Genomics, LMU University Hospital, Munich, Germany
| |
Collapse
|
2
|
Halicki MJ, Hind K, Chazot PL. Blood-Based Biomarkers in the Diagnosis of Chronic Traumatic Encephalopathy: Research to Date and Future Directions. Int J Mol Sci 2023; 24:12556. [PMID: 37628736 PMCID: PMC10454393 DOI: 10.3390/ijms241612556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease consistently associated with repetitive traumatic brain injuries (TBIs), which makes multiple professions, such as contact sports athletes and the military, especially susceptible to its onset. There are currently no approved biomarkers to diagnose CTE, thus it can only be confirmed through a post-mortem brain autopsy. Several imaging and cerebrospinal fluid biomarkers have shown promise in the diagnosis. However, blood-based biomarkers can be more easily obtained and quantified, increasing their clinical feasibility and potential for prophylactic use. This article aimed to comprehensively review the studies into potential blood-based biomarkers of CTE, discussing common themes and limitations, as well as suggesting future research directions. While the interest in blood-based biomarkers of CTE has recently increased, the research is still in its early stages. The main issue for many proposed biomarkers is their lack of selectivity for CTE. However, several molecules, such as different phosphorylated tau isoforms, were able to discern CTE from different neurodegenerative diseases. Further, the results from studies on exosomal biomarkers suggest that exosomes are a promising source of biomarkers, reflective of the internal environment of the brain. Nonetheless, more longitudinal studies combining imaging, neurobehavioral, and biochemical approaches are warranted to establish robust biomarkers for CTE.
Collapse
Affiliation(s)
| | - Karen Hind
- Durham Wolfson Research Institute for Health and Wellbeing, Stockton-on-Tees TS17 6BH, UK;
| | - Paul L. Chazot
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK
| |
Collapse
|
3
|
Asken BM, Tanner JA, Gaynor LS, VandeVrede L, Mantyh WG, Casaletto KB, Staffaroni AM, Fonseca C, Shankar R, Grant H, Smith K, Lago AL, Xu H, La Joie R, Cobigo Y, Rosen H, Perry DC, Rojas JC, Miller BL, Gardner RC, Wang KKW, Kramer JH, Rabinovici GD. Alzheimer's pathology is associated with altered cognition, brain volume, and plasma biomarker patterns in traumatic encephalopathy syndrome. Alzheimers Res Ther 2023; 15:126. [PMID: 37480088 PMCID: PMC10360257 DOI: 10.1186/s13195-023-01275-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Traumatic encephalopathy syndrome (TES) is a clinical phenotype sensitive but non-specific to underlying chronic traumatic encephalopathy (CTE) neuropathology. However, cognitive symptoms of TES overlap with Alzheimer's disease (AD), and features of AD pathology like beta-amyloid (Aβ) plaques often co-occur with CTE, making clinical-to-pathological conclusions of TES diagnoses challenging. We investigated how Alzheimer's neuropathological changes associated with cognition, brain volume, and plasma biomarkers in patients with repetitive head impacts (RHI)/TES, clinical AD, or typically aging controls. METHODS We studied 154 participants including 33 with RHI/TES (age 61.5 ± 11.5, 100% male, 11/33 Aβ[ +]), 62 with AD and no known prior RHI (age 67.1 ± 10.2, 48% male, 62/62 Aβ[ +]), and 59 healthy controls without RHI (HC; age 73.0 ± 6.2, 40% male, 0/59 Aβ[ +]). Patients completed neuropsychological testing (memory, executive functioning, language, visuospatial) and structural MRI (voxel-based morphometry analysis), and provided plasma samples analyzed for GFAP, NfL, IL-6, IFN-γ, and YKL-40. For cognition and plasma biomarkers, patients with RHI/TES were stratified as Aβ[ +] or Aβ[ -] and compared to each other plus the AD and HC groups (ANCOVA adjusting for age and sex). Differences with at least a medium effect size (Cohen's d > 0.50) were interpreted as potentially meaningful. RESULTS Cognitively, within the TES group, Aβ[ +] RHI/TES performed worse than Aβ[-] RHI/TES on visuospatial (p = .04, d = 0.86) and memory testing (p = .07, d = 0.74). Comparing voxel-wise brain volume, both Aβ[ +] and Aβ[ -] RHI/TES had lower medial and anterior temporal lobe volume than HC and did not significantly differ from AD. Comparing plasma biomarkers, Aβ[ +] RHI/TES had higher plasma GFAP than HC (p = .01, d = 0.88) and did not significantly differ from AD. Conversely, Aβ[ -] RHI/TES had higher NfL than HC (p = .004, d = 0.93) and higher IL-6 than all other groups (p's ≤ .004, d's > 1.0). CONCLUSIONS Presence of Alzheimer's pathology in patients with RHI/TES is associated with altered cognitive and biomarker profiles. Patients with RHI/TES and positive Aβ-PET have cognitive and plasma biomarker changes that are more like patients with AD than patients with Aβ[ -] RHI/TES. Measuring well-validated Alzheimer's biomarkers in patients with RHI/TES could improve interpretation of research findings and heighten precision in clinical management.
Collapse
Affiliation(s)
- Breton M Asken
- Department of Clinical & Health Psychology, 1Florida Alzheimer's Disease Research Center, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA.
| | - Jeremy A Tanner
- Department of Neurology, Biggs Institute for Alzheimer's and Neurodegenerative Diseases, South Texas Alzheimer's Disease Research Center, University of Texas Health - San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Leslie S Gaynor
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Lawren VandeVrede
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - William G Mantyh
- Department of Neurology, University of Minnesota, PWB 12-100, 516 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Kaitlin B Casaletto
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Adam M Staffaroni
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Corrina Fonseca
- Department of Neuroscience, Helen Wills Neuroscience Institute, University of California, 132 Barker Hall MC#3190, Berkeley, CA, 94720, USA
| | - Ranjani Shankar
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Harli Grant
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Karen Smith
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Argentina Lario Lago
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Haiyan Xu
- Department of Surgery, University of Florida, PO Box 100128, Gainesville, FL, 32610, USA
| | - Renaud La Joie
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Yann Cobigo
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Howie Rosen
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - David C Perry
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Julio C Rojas
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Bruce L Miller
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Raquel C Gardner
- Sheba Medical Center, Tel Hashomer City of Health, Tel Aviv District, Derech Sheba 2, Ramat Gan, Israel
| | - Kevin K W Wang
- Department of Neurobiology, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Joel H Kramer
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| | - Gil D Rabinovici
- Department of Neurology, Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
| |
Collapse
|
4
|
Saletti PG, Mowrey WB, Liu W, Li Q, McCullough J, Aniceto R, Lin I, Eklund M, Casillas‐Espinosa PM, Ali I, Santana‐Gomez C, Coles L, Shultz SR, Jones N, Staba R, O'Brien TJ, Moshé SL, Agoston DV, Galanopoulou AS. Early preclinical plasma protein biomarkers of brain trauma are influenced by early seizures and levetiracetam. Epilepsia Open 2023; 8:586-608. [PMID: 37026764 PMCID: PMC10235584 DOI: 10.1002/epi4.12738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE We used the lateral fluid percussion injury (LFPI) model of moderate-to-severe traumatic brain injury (TBI) to identify early plasma biomarkers predicting injury, early post-traumatic seizures or neuromotor functional recovery (neuroscores), considering the effect of levetiracetam, which is commonly given after severe TBI. METHODS Adult male Sprague-Dawley rats underwent left parietal LFPI, received levetiracetam (200 mg/kg bolus, 200 mg/kg/day subcutaneously for 7 days [7d]) or vehicle post-LFPI, and were continuously video-EEG recorded (n = 14/group). Sham (craniotomy only, n = 6), and naïve controls (n = 10) were also used. Neuroscores and plasma collection were done at 2d or 7d post-LFPI or equivalent timepoints in sham/naïve. Plasma protein biomarker levels were determined by reverse phase protein microarray and classified according to injury severity (LFPI vs. sham/control), levetiracetam treatment, early seizures, and 2d-to-7d neuroscore recovery, using machine learning. RESULTS Low 2d plasma levels of Thr231 -phosphorylated tau protein (pTAU-Thr231 ) and S100B combined (ROC AUC = 0.7790) predicted prior craniotomy surgery (diagnostic biomarker). Levetiracetam-treated LFPI rats were differentiated from vehicle treated by the 2d-HMGB1, 2d-pTAU-Thr231 , and 2d-UCHL1 plasma levels combined (ROC AUC = 0.9394) (pharmacodynamic biomarker). Levetiracetam prevented the seizure effects on two biomarkers that predicted early seizures only among vehicle-treated LFPI rats: pTAU-Thr231 (ROC AUC = 1) and UCHL1 (ROC AUC = 0.8333) (prognostic biomarker of early seizures among vehicle-treated LFPI rats). Levetiracetam-resistant early seizures were predicted by high 2d-IFNγ plasma levels (ROC AUC = 0.8750) (response biomarker). 2d-to-7d neuroscore recovery was best predicted by higher 2d-S100B, lower 2d-HMGB1, and 2d-to-7d increase in HMGB1 or decrease in TNF (P < 0.05) (prognostic biomarkers). SIGNIFICANCE Antiseizure medications and early seizures need to be considered in the interpretation of early post-traumatic biomarkers.
Collapse
Affiliation(s)
- Patricia G. Saletti
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Wenzhu B. Mowrey
- Department of Epidemiology & Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Wei Liu
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Qianyun Li
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Jesse McCullough
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Roxanne Aniceto
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - I‐Hsuan Lin
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Michael Eklund
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Pablo M. Casillas‐Espinosa
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Idrish Ali
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | | | - Lisa Coles
- University of Minnesota Twin CitiesMinneapolisMinnesotaUSA
| | - Sandy R. Shultz
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Nigel Jones
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | | | - Terence J. O'Brien
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
- Department of MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Solomon L. Moshé
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
- Isabelle Rapin Division of Child NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Dominick P Purpura Department of NeuroscienceAlbert Einstein College of MedicineBronxNew YorkUSA
- Department of PediatricsAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Denes V. Agoston
- Department of Anatomy, Physiology and GeneticsUniformed Services UniversityBethesdaMarylandUSA
| | - Aristea S. Galanopoulou
- Saul R. Korey Department of Neurology, Laboratory of Developmental EpilepsyAlbert Einstein College of MedicineBronxNew YorkUSA
- Isabelle Rapin Division of Child NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- Dominick P Purpura Department of NeuroscienceAlbert Einstein College of MedicineBronxNew YorkUSA
| | | |
Collapse
|
5
|
Iverson GL, Castellani RJ, Cassidy JD, Schneider GM, Schneider KJ, Echemendia RJ, Bailes JE, Hayden KA, Koerte IK, Manley GT, McNamee M, Patricios JS, Tator CH, Cantu RC, Dvorak J. Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies. Br J Sports Med 2023; 57:810-821. [PMID: 37316187 DOI: 10.1136/bjsports-2023-106890] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Concern exists about possible problems with later-in-life brain health, such as cognitive impairment, mental health problems and neurological diseases, in former athletes. We examined the future risk for adverse health effects associated with sport-related concussion, or exposure to repetitive head impacts, in former athletes. DESIGN Systematic review. DATA SOURCES Search of MEDLINE, Embase, Cochrane, CINAHL Plus and SPORTDiscus in October 2019 and updated in March 2022. ELIGIBILITY CRITERIA Studies measuring future risk (cohort studies) or approximating that risk (case-control studies). RESULTS Ten studies of former amateur athletes and 18 studies of former professional athletes were included. No postmortem neuropathology studies or neuroimaging studies met criteria for inclusion. Depression was examined in five studies in former amateur athletes, none identifying an increased risk. Nine studies examined suicidality or suicide as a manner of death, and none found an association with increased risk. Some studies comparing professional athletes with the general population reported associations between sports participation and dementia or amyotrophic lateral sclerosis (ALS) as a cause of death. Most did not control for potential confounding factors (eg, genetic, demographic, health-related or environmental), were ecological in design and had high risk of bias. CONCLUSION Evidence does not support an increased risk of mental health or neurological diseases in former amateur athletes with exposure to repetitive head impacts. Some studies in former professional athletes suggest an increased risk of neurological disorders such as ALS and dementia; these findings need to be confirmed in higher quality studies with better control of confounding factors. PROSPERO REGISTRATION NUMBER CRD42022159486.
Collapse
Affiliation(s)
- Grant L Iverson
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Rudolph J Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Geoff M Schneider
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
- University Orthopedic Centre, Concussion Care Clinic, State College, Pennsylvania, USA
| | - Julian E Bailes
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Mass General Brigham, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Michael McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles H Tator
- Department of Surgery and Division of Neurosurgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert C Cantu
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Robert C. Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Jiri Dvorak
- Schulthess Clinic Zurich, Zurich, Switzerland
| |
Collapse
|
6
|
Hossain I, Blennow K, Posti JP, Zetterberg H. Tau as a fluid biomarker of concussion and neurodegeneration. CONCUSSION (LONDON, ENGLAND) 2022; 7:CNC98. [PMID: 36687115 PMCID: PMC9841393 DOI: 10.2217/cnc-2022-0004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
Concussion is predominant among the vast number of traumatic brain injuries that occur worldwide. Difficulties in timely identification, whether concussion led to neuronal injury or not, diagnosis and the lack of prognostic tools for adequate management could lead this type of brain injury to progressive neurodegenerative diseases. Tau has been extensively studied in recent years, particularly in repetitive mild traumatic brain injuries and sports-related concussions. Tauopathies, the group of neurodegenerative diseases, have also been studied with advanced functional imaging. Nevertheless, neurodegenerative diseases, such as chronic traumatic encephalopathy, are still conclusively diagnosed at autopsy. Here, we discuss the diagnostic dilemma and the relationship between concussion and neurodegenerative diseases and review the literature on tau as a promising biomarker for concussion.
Collapse
Affiliation(s)
- Iftakher Hossain
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Finland,Turku Brain Injury Center, Turku University Hospital, Finland,Department of Clinical Neurosciences, University of Turku, Finland,Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK,Author for correspondence: Tel.: +358 2 313 0282;
| | - Kaj Blennow
- Institute of Neuroscience & Physiology, Department of Psychiatry & Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jussi P Posti
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Finland,Turku Brain Injury Center, Turku University Hospital, Finland,Department of Clinical Neurosciences, University of Turku, Finland
| | - Henrik Zetterberg
- Institute of Neuroscience & Physiology, Department of Psychiatry & Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK,UK Dementia Research Institute at UCL, University College London, London, UK,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| |
Collapse
|
7
|
Sriram S, Lucke-Wold B. Advances Research in Traumatic Encephalopathy. Biomedicines 2022; 10:biomedicines10092287. [PMID: 36140388 PMCID: PMC9496579 DOI: 10.3390/biomedicines10092287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
|
8
|
Asken BM, Tanner JA, VandeVrede L, Casaletto KB, Staffaroni AM, Mundada N, Fonseca C, Iaccarino L, La Joie R, Tsuei T, Mladinov M, Grant H, Shankar R, Wang KKW, Xu H, Cobigo Y, Rosen H, Gardner RC, Perry DC, Miller BL, Spina S, Seeley WW, Kramer JH, Grinberg LT, Rabinovici GD. Multi-Modal Biomarkers of Repetitive Head Impacts and Traumatic Encephalopathy Syndrome: A Clinicopathological Case Series. J Neurotrauma 2022; 39:1195-1213. [PMID: 35481808 PMCID: PMC9422800 DOI: 10.1089/neu.2022.0060] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Traumatic encephalopathy syndrome (TES) criteria were developed to aid diagnosis of chronic traumatic encephalopathy (CTE) pathology during life. Interpreting clinical and biomarker findings in patients with TES during life necessitates autopsy-based determination of the neuropathological profile. We report a clinicopathological series of nine patients with previous repetitive head impacts (RHI) classified retrospectively using the recent TES research framework (100% male and white/Caucasian, age at death 49-84) who completed antemortem neuropsychological evaluations, T1-weighted magnetic resonance imaging, diffusion tensor imaging (n = 6), (18)F-fluorodeoxyglucose-positron emission tomography (n = 5), and plasma measurement of neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and total tau (n = 8). Autopsies were performed on all patients. Cognitively, low test scores and longitudinal decline were relatively consistent for memory and executive function. Medial temporal lobe atrophy was observed in all nine patients. Poor white matter integrity was consistently found in the fornix. Glucose hypometabolism was most common in the medial temporal lobe and thalamus. Most patients had elevated plasma GFAP, NfL, and total tau at their initial visit and a subset showed longitudinally increasing concentrations. Neuropathologically, five of the nine patients had CTE pathology (n = 4 "High CTE"/McKee Stage III-IV, n = 1 "Low CTE"/McKee Stage I). Primary neuropathological diagnoses (i.e., the disease considered most responsible for observed symptoms) were frontotemporal lobar degeneration (n = 2 FTLD-TDP, n = 1 FTLD-tau), Alzheimer disease (n = 3), CTE (n = 2), and primary age-related tauopathy (n = 1). In addition, hippocampal sclerosis was a common neuropathological comorbidity (n = 5) and associated with limbic-predominant TDP-43 proteinopathy (n = 4) or FTLD-TDP (n = 1). Memory and executive function decline, limbic system brain changes (atrophy, decreased white matter integrity, hypometabolism), and plasma biomarker alterations are common in RHI and TES but may reflect multiple neuropathologies. In particular, the neuropathological differential for patients with RHI or TES presenting with medial temporal atrophy and memory loss should include limbic TDP-43. Researchers and clinicians should be cautious in attributing cognitive, neuroimaging, or other biomarker changes solely to CTE tau pathology based on previous RHI or a TES diagnosis alone.
Collapse
Affiliation(s)
- Breton M. Asken
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Jeremy A. Tanner
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Lawren VandeVrede
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Kaitlin B. Casaletto
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Adam M. Staffaroni
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Nidhi Mundada
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Corrina Fonseca
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Leonardo Iaccarino
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Renaud La Joie
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Torie Tsuei
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Miho Mladinov
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Harli Grant
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Ranjani Shankar
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Kevin K. W. Wang
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, Neuroscience, Psychiatry and Chemistry, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Haiyan Xu
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, Neuroscience, Psychiatry and Chemistry, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Yann Cobigo
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Howie Rosen
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Raquel C. Gardner
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - David C. Perry
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Salvatore Spina
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - William W. Seeley
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Lea T. Grinberg
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Gil D. Rabinovici
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
9
|
Asken BM, Tanner JA, VandeVrede L, Mantyh WG, Casaletto KB, Staffaroni AM, La Joie R, Iaccarino L, Soleimani-Meigooni D, Rojas JC, Gardner RC, Miller BL, Grinberg LT, Boxer AL, Kramer JH, Rabinovici GD. Plasma P-tau181 and P-tau217 in Patients With Traumatic Encephalopathy Syndrome With and Without Evidence of Alzheimer Disease Pathology. Neurology 2022; 99:e594-e604. [PMID: 35577574 PMCID: PMC9442622 DOI: 10.1212/wnl.0000000000200678] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/18/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic encephalopathy syndrome (TES) has overlapping clinical symptoms with Alzheimer disease (AD). AD pathology commonly co-occurs with chronic traumatic encephalopathy (CTE) pathology. There are currently no validated CTE biomarkers. AD-specific biomarkers such as plasma P-tau181 and P-tau217 may help to identify patients with TES who have AD pathology. METHODS We measured plasma P-tau181 and P-tau217 (Meso Scale Discovery electrochemiluminescence) in patients with TES, mild cognitive impairment/dementia with biomarker-confirmed AD ("AD"), and healthy controls ("HC"). Patients underwent amyloid-beta (Aβ)-PET and a subset underwent tau-PET using [18F]Flortaucipir. We compared plasma P-tau levels controlling for age and sex and also performed AUC analyses to evaluate the accuracy of group differentiation. In patients with TES, we evaluated associations between plasma P-tau, years of repetitive head impact exposure, and tau-PET. Four TES patients with autopsy-confirmed CTE were described qualitatively. RESULTS The sample included 131 participants (TES, N = 18; AD, N = 65; HC, N = 48). Aβ(+) patients with TES (N = 10), but not Aβ(-) TES, had significantly higher plasma P-tau levels than HC (P-tau181: p < 0.001, d = 1.34; P-tau217: p < 0.001, d = 1.59). There was a trend for Aβ(+) TES having higher plasma P-tau than Aβ(-) TES (P-tau181: p = 0.06, d = 1.06; P-tau217: p = 0.09, d = 0.93). AUC analyses showed good classification of Aβ(+) TES from HC for P-tau181 (AUC = 0.87 [0.71-1.00]) and P-tau217 (AUC = 0.93 [0.86-1.00]). Plasma P-tau217 showed fair differentiation of Aβ(+) TES from Aβ(-) TES (AUC = 0.79 [0.54-1.00], p = 0.04), whereas classification accuracy of P-tau181 was slightly lower and not statistically significant (AUC = 0.71 [0.46-0.96], p = 0.13). Patients with AD had higher tau-PET tracer uptake than Aβ(+) TES and were well differentiated using P-tau181 (AUC = 0.81 [0.68-0.94]) and P-tau217 (AUC = 0.86 [0.73-0.98]). Plasma P-tau correlated with the tau-PET signal in Aβ(+) TES but not in Aβ(-) TES, and there was no association between plasma P-tau and years of repetitive head impact exposure. TES patients with severe CTE and no AD at autopsy had low P-tau181 and P-tau217 levels. DISCUSSION Measuring P-tau181 and P-tau217 in plasma may be a feasible and scalable fluid biomarker for identifying AD pathology in TES. Low plasma P-tau levels may be used to increase clinical suspicion of CTE over AD as a primary pathology in TES. Currently, there is no support for P-tau181 or P-tau217 as in vivo biomarkers of CTE tau. Larger studies of patients with pathologically confirmed CTE are needed. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that (1) among patients with TES and abnormal Aβ-PET scans, elevated plasma P-tau can differentiate between affected individuals and HCs; (2) low plasma P-tau may help identify patients with TES who do not have Alzheimer; and (3) plasma P-tau181 and P-tau217 are not useful biomarkers of patients with TES who do not have AD.
Collapse
Affiliation(s)
- Breton M Asken
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco.
| | - Jeremy A Tanner
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Lawren VandeVrede
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - William G Mantyh
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Kaitlin B Casaletto
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Adam M Staffaroni
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Renaud La Joie
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Leonardo Iaccarino
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - David Soleimani-Meigooni
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Julio C Rojas
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Raquel C Gardner
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Bruce L Miller
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Lea T Grinberg
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Adam L Boxer
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Joel H Kramer
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| | - Gil D Rabinovici
- From the Memory and Aging Center (B.M.A.T.C., J.A.T., L.V., W.G.M., K.B.C., A.M.S., R.L.J., L.I., D.S.-M., J.C.R., R.C.G., B.L.M., L.T.G., A.L.B., J.H.K., G.D.R.), Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco; Department of Neurology (W.G.M.), University of Minnesota, Minneapolis; San Francisco Veterans Affairs Medical Center (R.C.G.); and Department of Radiology & Biomedical Imaging, University of California (G.D.R.), San Francisco
| |
Collapse
|
10
|
Buckland ME, Affleck AJ, Pearce AJ, Suter CM. Chronic Traumatic Encephalopathy as a Preventable Environmental Disease. Front Neurol 2022; 13:880905. [PMID: 35769361 PMCID: PMC9234108 DOI: 10.3389/fneur.2022.880905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
In this Perspective we explore the evolution of our understanding of chronic traumatic encephalopathy (CTE) and its relationship with repetitive head injury. As with many neurodegenerative conditions, there is an imperfect correspondence between neuropathology and clinical phenotype, but unlike other neurodegenerative diseases, CTE has a discrete and easily modifiable risk factor: exposure to repetitive head injury. Consequently, evaluation of the evidence regarding exposure to repetitive head injury and CTE risk should be undertaken using public or occupational health frameworks of medical knowledge. The current debate over the existence of CTE as a disease of concern is fuelled in part by immediate medico-legal considerations, and the involvement of high-profile athletes, with inevitable media interest. Moving beyond this debate has significant potential to address and reduce disease impact in the near future, and provide novel insights into mechanisms underlying abnormal protein accumulation in CTE and other neurodegenerative diseases.
Collapse
Affiliation(s)
- Michael E. Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
- *Correspondence: Michael E. Buckland
| | - Andrew J. Affleck
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alan J. Pearce
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Catherine M. Suter
- Department of Neuropathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
11
|
Shahim P, Zetterberg H, Simren J, Ashton NJ, Norato G, Schöll M, Tegner Y, Diaz-Arrastia R, Blennow K. Association of Plasma Biomarker Levels With Their CSF Concentration and the Number and Severity of Concussions in Professional Athletes. Neurology 2022; 99:e347-e354. [PMID: 35654597 DOI: 10.1212/wnl.0000000000200615] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine whether the brain biomarkers total-tau (T-tau), glial fibrillary acidic protein (GFAP), and β-amyloid (Aβ) isomers 40 and 42 in plasma relate to the corresponding concentrations in cerebrospinal fluid (CSF), blood-brain barrier integrity, and duration of post-concussion syndrome (PCS) due to repetitive head impacts (RHI) in professional athletes. METHOD In this cross-sectional study, professional athletes with persistent PCS due to RHI (median of 1.5 years after recent concussion) and uninjured controls were assessed with blood and CSF sampling. The diagnosis of PCS was based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). The athletes were enrolled through information flyers about the study sent to the Swedish hockey league (SHL) and the SHL Medicine Committee. The controls were enrolled through flyers at University of Gothenburg and Sahlgrenska University Hospital, Sweden. The participants underwent lumbar puncture and blood assessment at Sahlgrenska University Hospital. The main outcome measures were history of RHI and PCS severity (PCS> 1 year versus PCS< 1 year) in relation to plasma and CSF concentrations of T-tau, GFAP, Aβ40, and Aβ42. Plasma T-tau, GFAP, Aβ40, and Aβ42 were quantified using an ultrasensitive assay technology. RESULTS A total of 47 participants (28 athletes [median age 28 years, range 18-52] with persistent PCS, due to RHI and 19 controls [median age, 25 years, range 21-35]) underwent paired blood and cerebrospinal fluid (CSF) sampling. T-tau, Aβ40 and Aβ42 concentrations measured in plasma did not correlate with the corresponding CSF concentrations, while there was a correlation between plasma and CSF levels of GFAP (r=0.45, p=0.020). There were no significant relationships between plasma T-tau, GFAP, and blood-brain barrier integrity as measured by CSF:serum albumin ratio. T-tau, GFAP, Aβ40, and Aβ42 measured in plasma did not relate to PCS severity. None of the markers measured in plasma correlated with number of concussions, except decreased Aβ42 in those with higher number of concussions (r=-0.40, p=0.04). CONCLUSIONS T-tau, GFAP, Aβ40 and Aβ42 measured in plasma do not correspond to CSF measures, and may have limited utility for the evaluation of the late effects of RHI, compared with when measured in CSF. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in professional athletes with post-concussion symptoms, plasma concentrations of T-tau, GFAP, Aβ40, and Aβ42 are not informative in the diagnosis of late effects of repetitive head injuries.
Collapse
Affiliation(s)
- Pashtun Shahim
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden .,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute, London, UK
| | - Joel Simren
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Nicholas J Ashton
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Institute Clinical Neuroscience Institute, London, UK.,NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
| | - Gina Norato
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Michael Schöll
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Yelverton Tegner
- Division of Health, Medicine and Rehabilitation, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, the Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| |
Collapse
|
12
|
Morgan R, Prosapio J, Kara S, Sonty S, Youssef P, Nedd K. Preliminary clinical diagnostic criteria for chronic traumatic encephalopathy: A case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
13
|
Iqubal A, Bansal P, Iqubal MK, Pottoo FH, Haque SE. An Overview and Therapeutic Promise of Nutraceuticals against Sports-Related Brain Injury. Curr Mol Pharmacol 2021; 15:3-22. [PMID: 33538684 DOI: 10.2174/1874467214666210203211914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022]
Abstract
Sports-related traumatic brain injury (TBI) is one of the common neurological maladies experienced by athletes. Earlier the term 'punch drunk syndrome' was used in the case TBI of boxers and now this term is replaced by chronic traumatic encephalopathy (CTE). Sports-related brain injury can either be short term or long term. A common instance of brain injury encompasses subdural hematoma, concussion, cognitive dysfunction, amnesia, headache, vision issue, axonopathy, or even death if remain undiagnosed or untreated. Further, chronic TBI may lead to pathogenesis of neuroinflammation and neurodegeneration via tauopathy, formation of neurofibrillary tangles, and damage to the blood-brain barrier, microglial, and astrocyte activation. Thus, altered pathological, neurochemical, and neurometabolic attributes lead to the modulation of multiple signaling pathways and cause neurological dysfunction. Available pharmaceutical interventions are based on one drug one target hypothesis and thereby unable to cover altered multiple signaling pathways. However, in recent time's pharmacological intervention of nutrients and nutraceuticals have been explored as they exert a multifactorial mode of action and maintain over homeostasis of the body. There are various reports available showing the positive therapeutic effect of nutraceuticals in sport-related brain injury. Therefore, in the current article we have discussed the pathology, neurological consequence, sequelae, and perpetuation of sports-related brain injury. Further, we have discussed various nutraceutical supplements as well as available animal models to explore the neuroprotective effect/ upshots of these nutraceuticals in sports-related brain injury.
Collapse
Affiliation(s)
- Ashif Iqubal
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Pratichi Bansal
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Mohammad Kashif Iqubal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Faheem Hyder Pottoo
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal, University, P.O.BOX 1982, Damman, 31441, . Saudi Arabia
| | - Syed Ehtaishamul Haque
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| |
Collapse
|