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Sun M, Symons GF, O'Brien WT, Mccullough J, Aniceto R, Lin IH, Eklund M, Brady RD, Costello DM, Chen Z, O'Brien TJ, McDonald SJ, Agoston DV, Shultz SR. Serum protein biomarkers of inflammation, oxidative stress, and cerebrovascular and glial injury in concussed Australian football players. J Neurotrauma 2022; 39:800-808. [PMID: 35176905 DOI: 10.1089/neu.2021.0493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Clinical decisions related to sports-related concussion (SRC) are challenging due to the heterogenous nature of SRC symptoms coupled with the current reliance on subjective self-reported symptom measures. Sensitive and objective methods that can diagnose SRC and determine recovery would aid clinical management, and there is evidence that SRC induces changes in circulating protein biomarkers indicative of neuroaxonal injury. However, potential blood biomarkers related to other pathobiological responses linked to SRC are still poorly understood. Therefore, here we analyzed blood samples from concussed (male = 30; female = 9) and non-concussed (male = 74; female = 27) amateur Australian rules football players collected during the pre-season (i.e., baseline), and at 2-, 6-, and 13-days post-SRC to determine time dependent changes in serum levels of biomarkers related to glial (i.e., brain lipid-binding protein, BLBP; phosphoprotein enriched in astrocytes 15) and cerebrovascular injury (i.e., von Willebrand factor, claudin-5), inflammation (i.e., fibrinogen, high mobility group box protein 1), and oxidative stress (i.e., 4-hydroxynoneal). In females, BLBP levels were significantly decreased at 2-days post-SRC compared to their pre-season baseline; however, area under the receiver operating characteristic curve (AUROC) analysis found that BLBP was unable to distinguish between SRC and controls. In males, AUROC analysis revealed a statistically significant change at 2-days post-SRC in the serum levels of 4-hydroxynoneal, however the associated AUROC value (0.6373) indicated little clinical utility for this biomarker in distinguishing SRC from controls. There were no other statistically significant findings. These results indicate that the serum biomarkers tested in this study hold little clinical value in the management of SRC at 2-, 6-, and 13-days post-injury.
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Affiliation(s)
- Mujun Sun
- Monash University, Department of Neuroscience, Central Clinical School, Melbourne, Australia;
| | - Georgia F Symons
- Monash University, Neuroscience, Melbourne, Victoria, Australia;
| | | | | | | | | | | | - Rhys D Brady
- Monash University, Neuroscience, The Alfred Centre, Level 6, 99 Commercial Rd, Melbourne, Victoria, Australia, 3004;
| | - Daniel M Costello
- The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia;
| | - Zhibin Chen
- Monash University, Neuroscience, Melbourne, Victoria, Australia.,Monash University, 2541, Clinical Epidemiology, Melbourne, Victoria, Australia;
| | - Terence J O'Brien
- Monash University, Neuroscience, Melbourne, Victoria, Australia.,Melbourne Health, 6451, Department of Neurology, Parkville, Victoria, Australia.,Alfred Health, 5392, Department of Neurology, Melbourne, Victoria, Australia.,The University of Melbourne, 2281, Department of Medicine, Melbourne, Victoria, Australia;
| | - Stuart John McDonald
- Monash University Central Clinical School, 161666, Department of Neuroscience, 99 Commercial Road, Melbourne, Victoria, Australia, 3004;
| | - Denes V Agoston
- Uniformed Services University, APG, 4301 Jones Br Rd, Bethesda, Maryland, United States, 20814;
| | - Sandy R Shultz
- Monash University, Neuroscience, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria, Australia, 3004;
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Symons GF, Clough M, O’Brien WT, Ernest J, Salberg S, Costello D, Sun M, Brady RD, McDonald SJ, Wright DK, White O, Abel L, O’Brien TJ, Mccullough J, Aniceto R, Lin IH, Agoston DV, Fielding J, Mychasiuk R, Shultz SR. Shortened telomeres and serum protein biomarker abnormalities in collision sport athletes regardless of concussion history and sex. Journal of Concussion 2020. [DOI: 10.1177/2059700220975609] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mild brain injuries are frequent in athletes engaging in collision sports and have been linked to a range of long-term neurological abnormalities. There is a need to identify how these potential abnormalities manifest using objective measures; determine whether changes are due to concussive and/or sub-concussive injuries; and examine how biological sex affects outcomes. This study investigated cognitive, cellular, and molecular biomarkers in male and female amateur Australian footballers (i.e. Australia’s most participated collision sport). 95 Australian footballers (69 males, 26 females), both with and without a history of concussion, as well as 49 control athletes (28 males, 21 females) with no history of brain trauma or participation in collision sports were recruited to the study. Ocular motor assessment was used to examine cognitive function. Telomere length, a biomarker of cellular senescence and neurological health, was examined in saliva. Serum levels of tau, phosphorylated tau, neurofilament light chain, and 4-hydroxynonenal were used as markers to assess axonal injury and oxidative stress. Australian footballers had reduced telomere length (p = 0.031) and increased serum protein levels of 4-hydroxynonenal (p = 0.001), tau (p = 0.007), and phosphorylated tau (p = 0.036). These findings were independent of concussion history and sex. No significant ocular motor differences were found. Taken together, these findings suggest that engagement in collision sports, regardless of sex or a history of concussion, is associated with shortened telomeres, axonal injury, and oxidative stress. These saliva- and serum-based biomarkers may be useful to monitor neurological injury in collision sport athletes.
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Affiliation(s)
- Georgia F Symons
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Meaghan Clough
- Department of Neuroscience, Monash University, Melbourne, Australia
| | | | - Joel Ernest
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Sabrina Salberg
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Daniel Costello
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Rhys D Brady
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | | | - David K Wright
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Owen White
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Larry Abel
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Terence J O’Brien
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Jesse Mccullough
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, USA
| | - Roxanne Aniceto
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, USA
| | - I-Hsuan Lin
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, USA
| | - Denes V Agoston
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, USA
| | - Joanne Fielding
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
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Major BP, McDonald SJ, O'Brien WT, Symons GF, Clough M, Costello D, Sun M, Brady RD, Mccullough J, Aniceto R, Lin IH, Law M, Mychasiuk R, O'Brien TJ, Agoston DV, Shultz SR. Serum Protein Biomarker Findings Reflective of Oxidative Stress and Vascular Abnormalities in Male, but Not Female, Collision Sport Athletes. Front Neurol 2020; 11:549624. [PMID: 33117257 PMCID: PMC7561422 DOI: 10.3389/fneur.2020.549624] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/28/2020] [Indexed: 12/21/2022] Open
Abstract
Studies have indicated that concussive and sub-concussive brain injuries that are frequent during collision sports may lead to long-term neurological abnormalities, however there is a knowledge gap on how biological sex modifies outcomes. Blood-based biomarkers can help to identify the molecular pathology induced by brain injuries and to better understand how biological sex affects the molecular changes. We therefore analyzed serum protein biomarkers in male (n = 50) and female (n = 33) amateur Australian rules footballers (i.e., Australia's most participated collision sport), both with a history of concussion (HoC) and without a history of concussion (NoHoC). These profiles were compared to those of age-matched control male (n = 24) and female (n = 20) athletes with no history of neurotrauma or participation in collision sports. Serum levels of protein markers indicative of neuronal, axonal and glial injury (UCH-L1, NfL, tau, p-tau, GFAP, BLBP, PEA15), metabolic (4-HNE) and vascular changes (VEGF-A, vWF, CLDN5), and inflammation (HMGB1) were assessed using reverse phase protein microarrays. Male, but not female, footballers had increased serum levels of VEGF-A compared to controls regardless of concussion history. In addition, only male footballers who had HoC had increased serum levels of 4-HNE. These findings being restricted to males may be related to shorter collision sport career lengths for females compared to males. In summary, these findings show that male Australian rules footballers have elevated levels of serum biomarkers indicative of vascular abnormalities (VEGF-A) and oxidative stress (4-HNE) in comparison to non-collision control athletes. While future studies are required to determine how these findings relate to neurological function, serum levels of VEGF-A and 4-HNE may be useful to monitor subclinical neurological injury in males participating in collision sports.
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Affiliation(s)
- Brendan P Major
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, VIC, Australia
| | - William T O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Georgia F Symons
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Meaghan Clough
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Daniel Costello
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Rhys D Brady
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Jesse Mccullough
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - Roxanne Aniceto
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - I-Hsuan Lin
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - Meng Law
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, VIC, Australia.,Departments of Neurological Surgery and Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Denes V Agoston
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University, Bethesda, MD, United States
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
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