The degenerative brain disease, has been linked to concussions suffered by NFL players aggressiveness, depression and memory loss
Athletes who repeatedly suffer blows to the head face brain injuries and in the most extreme cases, death. Now, a new study has identified a biomarker that could be used to diagnosis a brain disease that affects athletes with repeated head injuries.
CTE (chronic traumatic encephalopathy), which can currently only be diagnosed after death, is a progressive degenerative brain condition found in athletes who have suffered repeated trauma to the head, including concussions. The condition has a number of behavioural symptoms including aggressiveness, depression and memory loss.
The disease is especially prevalent in American football players with a recent study from Boston University finding signs of CTE in 99 per cent of brains from deceased American football players.
While the new study may have been somewhat skewed by the fact the brains were all donated by family members who were likely to have suspected that their relative had CTE, the results still raise major concerns. Just days after the research was published, Baltimore Ravens player John Urschel suddenly announced his early retirement. Urschel, a mathematician, is now pursuing a doctorate at MIT.
“With all the newer information on CTE that is coming out, it isn’t surprising many players are prioritising their long-term health,” says Jonathan Cherry at Boston University School of Medicine, who authored the study. “It is difficult to say how much more widespread this will become in the future”.
In September 2017, a post-mortem examination found that former NFL player Aaron Hernandez had stage three CTE, with stage four being the most severe. The troubled ex-New England Patriots player took his own life in prison in April 2017 days after being acquitted in a double-murder case. He was already serving life without parole after being convicted of a separate murder in 2015. While there’s no definitive evidence to suggest that CTE lead him to commit any crimes, the case certainly raises questions over the impact of serious brain injury.
Bennet Omalu, the forensic pathologist who first published a paper detailing his discovery of CTE in 2005 believes the new research is a positive step, though he urges caution over what the results show. “The biomarker in question is a non-specific marker of inflammation in the brain, which is not specific only to CTE. This is however a good step forward, but is a very preliminary observation that has to be investigated further,” he says.
In 2015, Omalu stated that he believes OJ Simpson likely has CTE. “I would bet my medical license on it,” he told ABC News. Having never examined Simpson, the highly speculative diagnosis was based on observation of behavioural symptoms that Omalu said Simpson exhibits.
The disgraced former NFL star and actor Simpson was quietly released on parole from a Nevada prison this month after serving nine years of a 33-year sentence for kidnapping and armed robbery. In 1995, he was famously acquitted in the double murder of his former wife Nicole Brown Simpson and her friend Ron Goldman. Omalu stressed that though CTE does not cause criminal behaviour, it does cause life-altering damage to the brain.
“My opinion should not be interpreted as an opinion specific to OJ Simpson as an individual, but OJ Simpson as a member of a high-risk epidemiological cohort,” Omalu says. “It was, and remains an opinion founded upon epidemiological science that anyone who plays football through the professional level has a 100 per cent chance of suffering from some type of brain damage, to a certain degree, with or without CTE. CTE is not the only type of brain damage known to man that is caused by exposure to repeated blows to the head”.
Omalu believes so strongly in the potential danger of contact sports that he recently published a book, Truth Doesn’t Have a Side: My Alarming Discovery About the Danger of Contact Sports, containing a stark warning to parents on protecting children from brain injuries caused by activities like American football. “It may only take one concussion to permanently change the brain. This isn’t my opinion. These are the facts,” he said in a statement at the time of publication.
Currently, CTE can only be identified by post-mortem examination, but earlier diagnosis could potentially save lives. The biomarker CCL11 identified in the new study could eventually lead to prevention and treatment of the deadly disease by spotting it in living brains for the first time.
‘The next step is to repeat these experiments using a larger sample size and expand into using CSF from living individuals’
In the study, the researchers examined the brains of 23 former college and professional American football players and compared them to the brains of 50 non-athletes with Alzheimer’s disease and 18 non-athletes. Levels of the biomarker were only raised in those with CTE and they also found a correlation between the level and the number of years they had played American football. The researchers also took cerebrospinal fluid (CSF) samples from a smaller sample of the group, which showed similarly raised CCL11 levels in those with CTE, suggesting that this method could assist with diagnosing the condition in the living.
Further studies will be needed to establish whether the biomarker actually is an indicator of the disease, and if so which stage of the disease it relates to. “The next step is to repeat these experiments using a larger sample size and expand into using CSF from living individuals,” Cherry says. The researchers are hopeful that their research will be able to develop a CTE test for living patients. “A lot of work still needs to be done to validate. We’d hope such a test will be around in a couple years,” he says.
Omalu underlined the importance of identifying CTE in athletes while they are still live. “It is extremely vital to find a method for the diagnosis, evaluation and monitoring of CTE and other types of brain damage in living people. Until we can do that, we may not be able to develop treatment modalities”.
While CTE was identified more than ten years ago, the NFL has been notoriously slow to acknowledge a link between the concussions suffered by players and the condition. And while there is still some way to go, the league has introduced a number of steps to improve player safety, including a revised concussion protocol. The NFL also runs the HeadHealthTECH Challenge II in which it encourages firms to develop concussion-busting tech. Announced last month, this year’s winners include the 2nd Skull cap which is designed to reduce impact forces on the head, Baytech Products which is building a multi-component helmet system concept, and Windpact which is developing an impact liner for use in helmets and protective gear.