An investigation of neuroinjury biomarkers after sport-related concussion: from the subacute phase to clinical recovery

Battista, Alex P. Di; Rhind, Shawn G.; Baker, Andrew J.; Jetly, Rakesh; Debad, Jeff D.; Richards, Doug; Hutchison, Michael

doi:10.1080/02699052.2018.1432892

Cited by 20 publications

(10 citation statements)

References 64 publications

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“…The summation of the results in the present study are consistent with other facets of secondary injury previously observed following SRC by our group, namely oxidative stress 56 , and inflammation 57,58 . Specifically, we have previously identified higher concentrations of the oxidative stress marker PRDX-6 in athletes following SRC 56 , and also found that days to medical clearance was positively correlated with blood concentrations of the inflammatory chemokines monocyte chemoattractant protein (MCP)-1 and MCP-4 59 .…”

Section: Discussionsupporting

confidence: 93%

Peripheral blood neuroendocrine hormones are associated with clinical indices of sport-related concussion

Battista

Rhind

Churchill

et al. 2019

Sci Rep

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The purpose of this study was to evaluate the relationship between neuroendocrine hormones and clinical recovery following sport-related concussion (SRC). Ninety-five athletes (n = 56 male, n = 39 female) from a cohort of 11 interuniversity sport teams at a single institution provided blood samples; twenty six athletes with SRC were recruited 2–7 days post-injury, and 69 uninjured athletes recruited prior to the start of their competitive season. Concentrations of seven neuroendocrine hormones were quantitated in either plasma or serum by solid-phase chemiluminescent immunoassay. The Sport Concussion Assessment Tool version 5 (SCAT-5) was used to evaluate symptoms at the time of blood sampling in all athletes. Multivariate partial least squares (PLS) analyses were used to evaluate the relationship between blood hormone concentrations and both (1) time to physician medical clearance and (2) initial symptom burden. A negative relationship was observed between time to medical clearance and both dehydroepiandrosterone sulfate (DHEA-S) and progesterone; a positive relationship was found between time to medical clearance and prolactin. Cognitive, somatic, fatigue and emotion symptom clusters were associated with distinct neuroendocrine signatures. Perturbations to the neuroendocrine system in athletes following SRC may contribute to initial symptom burden and longer recovery times.

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Section: Discussionsupporting

confidence: 93%

Peripheral blood neuroendocrine hormones are associated with clinical indices of sport-related concussion

Battista

Rhind

Churchill

et al. 2019

Sci Rep

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“…2). Lastly, our study focused on evaluating the relationship between symptom burden and systemic inflammation at a single time point post-injury, therefore follow-up studies are required to characterize this relationship throughout recovery; given our groups' prior findings of persistent symptoms at medical clearance utilizing both advanced neuroimaging [63,64] and blood biomarkers [65], it remains unclear how symptom burden tracks biological recovery.…”

Section: Discussionmentioning

confidence: 99%

The relationship between symptom burden and systemic inflammation differs between male and female athletes following concussion

et al. 2020

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Background: Inflammation appears to be an important component of concussion pathophysiology. However, its relationship to symptom burden is unclear. Therefore, the purpose of this study was to evaluate the relationship between symptoms and inflammatory biomarkers measured in the blood of male and female athletes following a sport-related concussion (SRC). Results: Forty athletes (n = 20 male, n = 20 female) from nine interuniversity sport teams at a single institution provided blood samples within one week of an SRC. Twenty inflammatory biomarkers were quantitated by immunoassay. The Sport Concussion Assessment Tool version 5 (SCAT-5) was used to evaluate symptoms. Partial least squares (PLS) analyses were used to evaluate the relationship(s) between biomarkers and symptoms. In males, a positive correlation between interferon (IFN)-γ and symptom severity was observed following SRC. The relationship between IFN-γ and symptoms was significant among all symptom clusters, with cognitive symptoms displaying the largest effect. In females, a significant negative relationship was observed between symptom severity and cytokines IFN-γ, tumor necrosis factor (TNF)-α, and myeloperoxidase (MPO); a positive relationship was observed between symptom severity and MCP-4. Inflammatory mediators were significantly associated with all symptom clusters in females; the somatic symptom cluster displayed the largest effect. Conclusion: These results provide supportive evidence of a divergent relationship between inflammation and symptom burden in male and female athletes following SRC. Future investigations should be cognizant of the potentially sexspecific pathophysiology underlying symptom presentation.

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“…Our study sample was limited to male participants; future studies should also consider a sample size large enough to explore potential differences between males and females giving the growing body of literature identifying differential responses postconcussion. 22–24 Furthermore, while the clinical decision to medically clear a patient is well established (ie, the achievement of asymptomatic status following a graded exertional protocol), previous research has demonstrated a great degree of variability in individual physician practices with respect to assessment, management and clearance following concussion. 25 Also, there are some practical issues that should be acknowledged with using medical clearance as an outcome measure, such as physician availability and scheduling, patient availability, and urgency.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a postacute structured aerobic exercise intervention following sport concussion in symptomatic adolescents: a randomised controlled study

Micay

Richards

Hutchison

2018

BMJ Open Sport Exerc Med

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ObjectiveThe utility of structured exercise for rehabilitation purposes early in the postacute phase (ie, beyond the initial 24–48 hours of advised rest) following sport-related concussion (SRC) remains largely unexplored. This study examined the feasibility of implementing a standardised aerobic exercise (AE) intervention in the postacute stage of SRC recovery in a sample of adolescent students with SRC compared with usual care.MethodsSymptomatic adolescents with SRC were randomised to one of two groups: Aerobic Exercise (n=8) or Usual Care (n=7). The AE intervention, beginning on day 6 postinjury, comprised eight sessions with progressive increases in intensity and duration on a cycle ergometer. Usual care consisted of rest followed by physician-advised progressions in activity levels in an unsupervised setting. All participants were evaluated by physician at weeks 1, 2, 3 and 4 postconcussion. Outcome measures included: (1) Intervention feasibility: symptom status pre-post exercise sessions and completion of intervention and (2) Clinical recovery: symptom status at weeks 1, 2, 3 and 4 postinjury and medical clearance date.ResultsAll participants completed the exercise sessions as part of the AE intervention and symptom exacerbation was not associated with any exercise session. The AE group experienced greater symptom resolution compared with the Usual Care Group across the recovery timeline.ConclusionA structured AE protocol appears to be safe and feasible to administer in the postacute stage of SRC recovery in adolescents and should be explored as part of a full Phase III Clinical Trial.

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An investigation of neuroinjury biomarkers after sport-related concussion: from the subacute phase to clinical recovery

Cited by 20 publications

References 64 publications

Peripheral blood neuroendocrine hormones are associated with clinical indices of sport-related concussion

Peripheral blood neuroendocrine hormones are associated with clinical indices of sport-related concussion

The relationship between symptom burden and systemic inflammation differs between male and female athletes following concussion

Feasibility of a postacute structured aerobic exercise intervention following sport concussion in symptomatic adolescents: a randomised controlled study

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