Eight research projects investigating various aspects of traumatic brain injury (TBI), including the long-term effects of repeated head injuries, are set to receive funding from the National Institutes of Health (NIH).
The new funding, announced by the NIH, is provided by the Sports and Health Research Program, a partnership of the NIH, the National Football League (NFL), and the Foundation for the National Institutes of Health (FNIH). Last year, the NFL donated $30 million to the FNIH for research studies on injuries affecting athletes, with brain trauma being the primary area of focus.
TBI affects all age groups and is the leading cause of death in young adults. Concern has grown recently about the potential long-term effects of repeated concussion, particularly in those most at risk, including young athletes and men and women in the military.
Physicians currently don't have tests to predict which patients who have a concussion will recover quickly and which ones will experience long-term symptoms. They're also unable to detect the few individuals who will develop chronic traumatic encephalopathy (CTE), a form of progressive brain degeneration.
"We need to be able to predict which patterns of injury are rapidly reversible and which are not," Story Landis, PhD, director, National Institute of Neurological Disorders and Stroke (NINDS), part of the NIH, said in the press release. "This program will help researchers get closer to answering some of the important questions about concussion for our youth who play sports and their parents."
Two of the projects to receive funding are large, cooperative agreements focused on defining the scope of long-term changes that occur in the brain years after a head injury or multiple concussions. These awards form a partnership among NINDS, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and multiple academic medical centers.
Although the 2 projects will focus on different aspects of TBI, their combined results promise to answer critical questions about the chronic effects of single vs repetitive injuries on the brain, said Dr. Landis.
The 2 projects, each of which will receive $6 million, are the following:
CTE and Post-traumatic Neurodegeneration: Neuropathology and Ex Vivo Imaging. Under Principal Investigator Ann C. McKee, MD, Boston University School of Medicine and U.S. Department of Veterans Affairs, Massachusetts, this project's goals include defining a clear set of criteria for the various stages of CTE and to distinguish it from Alzheimer's disease, amyotrophic lateral sclerosis, and other neurodegenerative disorders in postmortem brain tissue. Once these characteristics have been defined in brain tissue, imaging teams will correlate them with brain scans to identify features that might eventually be used to diagnose CTE in individuals during their lifetimes.
Neuropathology of CTE and Delayed Effects of TBI: Toward In Vivo Diagnostics. The goal of this project, under principal investigator Wayne Gordon, PhD, Mount Sinai Hospital in New York, is to identify and describe the chronic effects of mild, moderate, and severe TBIs and compare these with the features of CTE. Dr. Gordon and his colleagues will evaluate brain tissue obtained from an ongoing study of thousands of people (the Adult Changes in Thought study) and will examine brain tissue from donors who sustained severe TBI. Neuroimaging teams at various centers will use sophisticated brain scanning techniques in patients with a range of head injuries, as well as on postmortem tissue, to identify potential markers that may eventually be used to diagnose the degenerative effects of TBI.
Study investigators will also help the NIH develop a registry of individuals with a history of TBI who are interested in donating brain and spinal cord tissue for study after their death. The new NIH Neurobiobankhttps://neurobiobank.nih.gov will coordinate the tissue collection and data gathering and also distribute biospecimens, along with providing relevant information to enable other scientists to access this valuable tissue.
In addition to the 2 cooperative agreements, 6 pilot projects will receive total funding of just over $2 million for up to 2 years. If the early results are encouraging, these projects may become the basis of more comprehensive projects.
The 6 pilot projects are as follows:
Cortical GABA in Pediatric Sports Concussion (Principal Investigator: Jeffrey G. Ojemann, MD, Seattle Children's Hospital, Washington). Gamma-aminobutyric acid (GABA) is important for cognition and movement and may be altered by TBI. The aim of this project is to use magnetic resonance (MR) spectroscopy to monitor GABA levels in adolescents who have sports-related concussions and compare those levels with those in uninjured controls. The researchers will also conduct preliminary comparisons of GABA levels with existing cognitive measures, such as memory tests and structural brain imaging.
Evaluation of Spot Light: A Concussion Injury Management App for Youth Sports (Principal Investigators: Lara McKenzie, PhD, Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, and Dawn Comstock, PhD, Colorado School of Public Health, University of Colorado, Denver). The goal of this project is to test the effectiveness of Spot Light, an easy-to-use mobile application (or app), developed by Inlightened. The app was designed to help doctors, coaches, and others track the progress of a young athlete from the time of a concussion until he or she is cleared to return to play. The researchers want to know whether the app will result in more concussions being reported, increased referrals to doctors, and better adherence to return-to-play guidelines.
Eye Movement Dynamics: A Rapid Objective Involuntary Measure of Concussion/Mild Traumatic Brain Injury (Principal Investigators: Nicholas Port, PhD, and Steven Hitzeman, OD, Indiana University School of Optometry, Bloomington). In collaboration with others, the investigators will develop a portable eye-tracking instrument to help diagnose concussions on the sidelines and to monitor injury progression in young athletes. They will compare the eye-tracking data to results from a commonly used cognitive test to determine whether changes in eye movement can serve as a biomarker for sports-related mild TBI.
Imaging and Biomarkers in Adolescents Cleared for Return to Play After Concussion (Principal Investigator: Harvey Levin, PhD, Baylor College of Medicine, Houston, Texas). Using a variety of neuroimaging techniques, Dr. Levin and his group will look at the effects of sports-related concussions on brain structure and function 1 month following injury in adolescents who have been cleared to play. In addition, this project will evaluate microRNAs, which are small portions of RNA, as potential biomarkers for concussions and recovery.
Somatosensory Processing — Assessing Youth Sport-Related Concussion and Recovery (Principal Investigator: Stacy Jennifer Marcus Suskauer, MD, Kennedy Krieger Institute, Baltimore, Maryland). This research team will use a portable device that delivers vibrations to fingertips to investigate whether somatosensory system information processing (SSIP) could be a biomarker for concussion and recovery in youth ages 13 to 17 years. Perception of the vibrations reflects activity of sensory neurons in the brain, thereby providing a measure of SSIP. The researchers will also investigate whether changes in SSIP are related to differences in certain brain chemicals after head injury.
Characterization of the Brain and Serum Metabolome in Mouse Models of Concussion (Principal Investigator: Michael J. Whalen, MD, Massachusetts General Hospital, Boston). This group plans to use an experimental model of TBI to conduct a detailed analysis of changes in the brain metabolome (the collection of all metabolites in the body) following a concussion. The researchers will compare those differences with serum byproducts to determine whether the changes can be revealed in blood samples. The results of this project may help identify potential targets for detecting and treating concussions.
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Cite this: NIH/NFL Team Up to Fund Concussion-Related Research - Medscape - Dec 18, 2013.