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 MARCH 31,2013 Simple Blood Test May Identify Concussion A simple blood test after a football game may be able to identify players who have suffered brain damage from hits to the head, even if they don't have a concussion. Much attention is being paid to concussions among football players and the big hits that cause them. No single test can reliably diagnose a concussion, says Jeffrey Kutcher, MD, of the University of Michigan in Ann Arbor, the co-author of just-released, newly updated guidelines on concussion by the American Academy of Neurology. Concussions can be difficult to diagnose, relying on player symptoms, cognitive tests, or very costly brain scans. A $40 blood test for a protein normally found only in the brain, called S100B, may offer an objective measure of whether a player has endured head trauma. Researchers at the Cleveland Clinic and University of Rochester have found that elevated blood levels of the S100B protein directly correlate to the number and severity of head hits during college football games. Body contact or simply playing in a football game did not affect S100B levels in the players. "A blood test could be performed anywhere, such as locker rooms or doctors' offices," says senior author Damir Janigro, Ph.D., professor of molecular medicine and the director of cerebrovascular research group at Cleveland Clinic. "More importantly, though, the blood test could offer a yes-or-no determination of whether an athlete requires medical intervention as a result of in-game collisions." In a study of 67 college football players, Janigro and colleagues found that the more hits to the head a player absorbed, the higher the levels of S100B leaked into the bloodstream after a head injury. Typically, S100B is found only in the brain, says Janigro. Finding it in the blood indicates damage to the layer of cells that prevent materials from the blood from entering the brain, the so-called blood-brain barrier. Once in the bloodstream, S100B is seen by the immune system as a foreign invader, triggering an autoimmune response that releases auto-antibodies against it. Those antibodies then seep back into the brain through the damaged blood-brain barrier, attacking brain tissue and leading to long-term brain damage. Four players showed signs of an autoimmune response to S100B. Brain scans confirmed that the presence of S100B antibodies in the players' blood correlated with brain tissue damage. "To our surprise, even when players don’t have a concussion, the blood-brain barrier opens," Janigro said in an interview, adding that many countries in Europe do blood tests for S100B to diagnose mild traumatic brain injury. Janigro and colleagues Nicola Marchi, Ph.D., of the Cleveland Clinic and Jeffrey Bazarian, M.D., M.P.H., of the Clinical and Translational Science Institute at the University of Rochester Medical Center, published their research on March 6, 2013, in the online journal PLOS ONE. "Again to our surprise, a few of the non-concussed players had changes in brain scans and balance tests after the season," says Janigro, noting that these players had the most openings in the blood-brain barrier. With further tests, Janigro says he plans to figure out at what blood level of S100B players should stop playing to prevent further brain damage. He also plans to look at retired college and National Football League players to see whether they have S100B autoantibodies in the brain. |
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