Serum markers of football-related brain concussions: a pilot study

描述（由申请人提供）：脑震荡是运动中导致脑损伤的主要原因，尤其是在美式足球中。对足球运动员脑震荡频率的估计表明，每年有高达40%的参与者经历脑震荡，其中大部分没有被报道。今天，脑震荡的确认或排除是基于行为相关（脑震荡后立即评估、影响和认知测试），而无需标准化实验室测试的帮助。因此，脑震荡的诊断仍然具有挑战性和主观性。此外，详细的神经学测试可能会在事件发生后延迟数天，从而产生不确定性和潜在风险。通常，脑震荡或创伤性脑损伤（TBI）与脑血管（血脑屏障，BBB）完整性的快速丧失有关，随后发生脑损伤。因此，检测早期血脑屏障变化对预测脑震荡后脑损伤的发展具有重要意义。S100B已成为血脑屏障通透性的候选外周生物标志物。血清S100B水平升高反映血脑屏障受损的存在，并可能预测脑损伤。我们在一群大学球队队员中获得了血清S100B的初步结果。分别在赛前、赛后和赛后一天测量S100B水平。比赛结束后，运动员的平均S100B水平明显高于基线水平，这些球员的位置预示着头对头撞击的可能性最高。本R21的主要目的是验证在足球中隐匿性脑震荡的替代血清标记物的使用。我们将比较血清标志物与公认的脑震荡测试方法（例如，SCAT2）和选定球员的成像数据（DTI）。血液检查可能具有诊断价值，影响治疗医生对恢复比赛的建议，并提供潜在的长期病理性脑变化的指示。

DESCRIPTION (provided by applicant): Concussions are the leading cause of brain damage in sports, particularly in American football. Estimates of the frequency of concussions among football players suggest that up to 40% of participants experience a concussion on an annual basis, the majority of these going unreported. Today, concussions are confirmed or ruled out based on behavioral correlates (Immediate Post-Concussion Assessment, ImPACT and Cognitive Testing) and without the aid of standardized laboratory testing. As a result, the diagnosis of concussion remains challenging and subjective. In addition, detailed neurological testing may be delayed for several days after the event, creating uncertainty and potential risk. Concussions, or traumatic brain injury (TBI) in general, are associated with a rapid loss of cerebrovascular (blood-brain barrier, BBB) integrity followed by the development of brain damage. It is therefore significant to detect early BBB changes to predict development of post-concussion brain damage. S100B has emerged as a candidate peripheral biomarker of BBB permeability. Elevation of S100B serum levels reflect the presence of a damaged BBB and may predict brain injury. We obtained preliminary results measuring serum S100B in a cohort of college team players. S100B levels were measured prior to, immediately after and one day post-game. Average S100B levels immediately after the game were significantly higher than baseline in those players whose position predicts highest likelihood of head-to- head impact. The main goal of this R21 is to validate the use of surrogate serum markers of occult concussion in football. We will compare serum marker to accepted means of concussion testing (e.g., SCAT2) and to imaging data (DTI) obtained in selected players. A blood test could have a diagnostic value influencing the treating physician's recommendation for return to play and providing indication of potential long-term pathological brain changes.