Altered Neurochemistry in Former Professional Soccer Players without a History of Concussion

Koerte, Inga K.; Lin, Alexander P.; Muehlmann, Marc; Merugumala, Sai; Liao, Huijun; Starr, Tyler C.; Kaufmann, David; Mayinger, Michael; Steffinger, Denise; Fisch, Barbara; Karch, Susanne; Heinen, Florian; Ertl‐Wagner, Birgit; Reiser, Maximilian; Stern, Robert A.; Zafonte, Ross; Shenton, Martha E.

doi:10.1089/neu.2014.3715

Cited by 142 publications

(151 citation statements)

References 44 publications

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“…74 In a study of 11 former professional soccer players, MRS revealed a significant increase in choline (a marker for cellular proliferation and tissue damage) and myoinositol (a glial activation marker) compared with age-matched controls. 68 No neurocognitive deficits were reported in this study group. Another series, which compared 10 concussed athletes with 10 nonconcussed athletes in both acute and chronic injury phases, demonstrated neurochemical impairment in the prefrontal and motor (M1) cortex, particularly a chronic pathological increase in creatine and myoinositol in the M1 cortex.…”

Section: Magnetic Resonance Spectroscopymentioning

confidence: 51%

Sports-related brain injuries: connecting pathology to diagnosis

Pan¹,

Connolly²,

Dangelmajer³

et al. 2016

FOC

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Neurosurg Focus 40 (4):E14, 2016M any sports-related brain injuries involve mild traumatic brain injuries (mTBIs), which result from physical blows to the head sustained over a period of time. Sports associated with an increased risk of head injury include American football, ice hockey, soccer, rugby, the martial arts, boxing, and bicycling. 21,90 These injuries are often unrecognized, undiagnosed, or underreported, which reflects the fact that this is a growing medical concern, often labeled a "silent epidemic." 8,66 Chronic exposure to mild brain injuries can result in long-term neurological consequences and represents a spectrum of disorders. The most remarkable outcome of mTBI is termed chronic traumatic encephalopathy (CTE), a clinical syndrome that is associated with neurodegeneration and behavioral, cognitive, and/or motor deficits. Although this disease has distinct pathological features, CTE is considered a diagnosis of exclusion because only postmortem biopsies can confirm the diagnosis. Therefore, new diagnostic methods need to be developed to: 1) inform patients of a definitive diagnosis, 2) better understand the epidemiology and risk factors of the disease, and 3) implement intervention programs to prevent any potential long-term complications. This review examines how understanding the pathology and molecular changes associated with repeated head trauma can lead to the discovery of novel imaging techniques and biomarkers. Mild Traumatic Brain Injury and CTEChronic traumatic encephalopathy has evolved from the so-called punch-drunk syndrome, which was used to describe a distinct neuropsychiatric condition that seemed to affect boxers, eventually becoming known as dementia pugilistica during the 1920s and 1930s. Symptoms such ABBrEvIATIoNs AD = Alzheimer's disease; APOE = apolipoprotein E; ASL = arterial spin labeling; BBB = blood-brain barrier; BOLD = blood oxygen level-dependent; CA = cornu ammonis; CTE = chronic traumatic encephalopathy; DTI = diffusion tensor imaging; FA = fractional anisotropy; fMRI = functional MRI; GFAP = glial fibrillary acidic protein; GRE = gradient recall echo; miRNA = microRNA; MRS = MR spectroscopy; mTBI = mild traumatic brain injury; NFL = National Football League; NFT = neurofibrillary tangle; NINDS = National Institute of Neurological Disorders and Stroke; NSE = neuron-specific enolase; p-tau = phosphorylated tau; SWI = susceptibility-weighted imaging; TDP-43 = TAR DNA-binding protein 43;18 F-FDDNP = 2-(1-{6- [(2-[fluorine-18] Brain injuries are becoming increasingly common in athletes and represent an important diagnostic challenge. Early detection and management of brain injuries in sports are of utmost importance in preventing chronic neurological and psychiatric decline. These types of injuries incurred during sports are referred to as mild traumatic brain injuries, which represent a heterogeneous spectrum of disease. The most dramatic manifestation of chronic mild traumatic brain injuries is termed chronic traumatic encephalopathy, which is associated with profo...

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Section: Magnetic Resonance Spectroscopymentioning

confidence: 51%

Sports-related brain injuries: connecting pathology to diagnosis

Pan¹,

Connolly²,

Dangelmajer³

et al. 2016

FOC

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show abstract

“…Relative to healthy controls, chronically elevated levels of neuroinflammation, as detected via PET scan, can persists both years after a single remote TBI as well as years after exposure to repetitive neurotrauama, even in the absence of a clinically evident TBI [61][62][63][64] . Notably, one study that also investigated neuronal white matter integrity found that levels of microglial activations correlated with structural changes in the brain 63 .…”

Section: Immunological Perspectives Of Tbi Sequelaementioning

confidence: 99%

The bidirectional gut-brain-microbiota axis as a potential nexus between traumatic brain injury, inflammation, and disease

Sundman

Chen

Subbian

et al. 2017

Brain, Behavior, and Immunity

155

103

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The bidirectional gut-brain-microbiota axis as a potential nexus between traumatic brain injury, inflammation, and disease. AbstractAs head injuries and their sequelae have become an increasingly salient matter of public health, experts in the field have made great progress elucidating the biological processes occurring within the brain at the moment of injury and throughout the recovery thereafter. Given the extraordinary rate at which our collective knowledge of neurotrauma has grown, new insights may be revealed by examining the existing literature across disciplines with a new perspective. This article will aim to expand the scope of this rapidly evolving field of research beyond the confines of the central nervous system (CNS). Specifically, we will examine the extent to which the bidirectional influence of the gut-brain axis modulates the complex biological processes occurring at the time of traumatic brain injury (TBI) and over the days, months, and years that follow. In addition to local enteric signals originating in the gut, it is well accepted that gastrointestinal (GI) physiology is highly regulated by innervation from the CNS. Conversely, emerging data suggests that the function and health of the CNS is modulated by the interaction between 1) neurotransmitters, immune signaling, hormones, and neuropeptides produced in the gut, 2) the composition of the gut microbiota, and 3) integrity of the intestinal wall serving as a barrier to the external environment. Specific to TBI, existing pre-clinical data indicates that head injuries can cause structural and functional damage to the GI tract, but research directly investigating the neuronal consequences of this intestinal damage is lacking. Despite this void, the proposed mechanisms emanating from a damaged gut are closely implicated in the inflammatory processes known to promote neuropathology in the brain following TBI, which suggests the gut-brain axis may be a therapeutic target to reduce the risk of Chronic Traumatic Encephalopathy and other neurodegenerative diseases following TBI. To better appreciate how various peripheral influences are implicated in the health of the CNS following TBI, this paper will also review the secondary biological injury mechanisms and the dynamic pathophysiological response to neurotrauma. Together, this review article will attempt to connect the dots to reveal novel insights into the bidirectional influence of the gut-brain axis and propose a conceptual model relevant to the recovery from TBI and subsequent risk for future neurological conditions.

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“…However, recent evidence suggests that RHI, especially if they occur in close proximity in time, may lead to structural and functional brain alterations and clinical impairment even if there are no acute symptoms [2][3][4][5] (for review see Koerte et al 6 ). More severe effects are expected when a child with insufficient neck strength attempts to head a ball 7 .…”

Section: Introductionmentioning

confidence: 99%

Impaired Cognitive Performance in Youth Athletes Exposed to Repetitive Head Impacts

Koerte

Nichols

Tripodis

et al. 2017

Journal of Neurotrauma

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Worldwide more than 22 million children and adolescents are exposed to repetitive head impacts (RHI) in soccer. Evidence indicates cumulative effects on brain structure, but it is not known whether exposure to RHI affects cognitive improvement in adolescents. To determine whether exposure to RHI while heading the ball in soccer affects improvement in cognitive performance in adolescents over time.The study group consisted of a convenience sample of 16 male soccer players (mean age 15.7±0.7 years). A comparison cohort of 14 male non-contact sports athletes (mean age 14.9±1.1 years) was recruited from competitive athletic clubs and group-matched on age. Using the ProPoint and AntiPoint tasks, sensorimotor and cognitive functions were measured over both immediate (pre-versus posttraining) as well as across multiple time points within a play season. The number and type of head impacts that occurred during the training were counted. The main outcome measure was the change in response time (RT) in the ProPoint and AntiPoint tasks. The immediate (pre-versus post-training) and longer-term (across a play season) change in RT was analyzed and the effect of the number and type of head impacts was tested.Thirty athletes with and without exposure to RHI demonstrated a decrease in RT in both tasks immediately after training. Over the play season, both groups showed improvement in sensorimotor function. However, while the Control group also improved in cognitive performance, the soccer players did not. Further, the more long headers performed, the slower the improvement in RT over the season.Youth athletes experience an immediate cognitive improvement after training most likely due to physical exercise. Results of this study also suggest an association between exposure to specific RHI (long headers) and lack of improvement in cognitive performance in youth athletes over time.

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Altered Neurochemistry in Former Professional Soccer Players without a History of Concussion

Cited by 142 publications

References 44 publications

Sports-related brain injuries: connecting pathology to diagnosis

Sports-related brain injuries: connecting pathology to diagnosis

The bidirectional gut-brain-microbiota axis as a potential nexus between traumatic brain injury, inflammation, and disease

Impaired Cognitive Performance in Youth Athletes Exposed to Repetitive Head Impacts

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