Decreased myelin proteins in brain donors exposed to football-related repetitive head impacts

Abstract

American football players and other individuals exposed to repetitive head impacts can exhibit a constellation of later-life cognitive and neuropsychiatric symptoms. While tau-based diseases such as chronic traumatic encephalopathy can underpin certain symptoms, contributions from non-tau pathologies from repetitive head impacts are increasingly recognized. We examined cross-sectional associations between myelin integrity using immunoassays for myelin-associated glycoprotein and proteolipid protein 1 with risk factors and clinical outcomes in brain donors exposed to repetitive head impacts from American football. Immunoassays for myelin-associated glycoprotein and proteolipid protein 1 were conducted on dorsolateral frontal white matter tissue samples of 205 male brain donors. Proxies of exposure to repetitive head impacts included years of exposure and age of first exposure to American football play. Informants completed the Functional Activities Questionnaire, Behavior Rating Inventory of Executive Function-Adult Version (Behavioral Regulation Index), and Barratt Impulsiveness Scale-11. Associations between myelin-associated glycoprotein and proteolipid protein 1 with exposure proxies and clinical scales were tested. Of the 205 male brain donors who played amateur and professional football, the mean age was 67.17 (SD = 16.78), and 75.9% (n = 126) were reported by informants to be functionally impaired prior to death. Myelin-associated glycoprotein and proteolipid protein 1 correlated with the ischaemic injury scale score, a global indicator of cerebrovascular disease (r = −0.23 and −0.20, respectively, Ps < 0.01). Chronic traumatic encephalopathy was the most common neurodegenerative disease (n = 151, 73.7%). Myelin-associated glycoprotein and proteolipid protein 1 were not associated with chronic traumatic encephalopathy status, but lower proteolipid protein 1 was associated with more severe chronic traumatic encephalopathy (P = 0.03). Myelin-associated glycoprotein and proteolipid protein 1 were not associated with other neurodegenerative disease pathologies. More years of football play was associated with lower proteolipid protein 1 [beta = −2.45, 95% confidence interval (CI) [−4.52, −0.38]] and compared with those who played <11 years of football (n = 78), those who played 11 or more years (n = 128) had lower myelin-associated glycoprotein (mean difference = 46.00, 95% CI [5.32, 86.69]) and proteolipid protein 1 (mean difference = 24.72, 95% CI [2.40, 47.05]). Younger age of first exposure corresponded to lower proteolipid protein 1 (beta = 4.35, 95% CI [0.25, 8.45]). Among brain donors who were aged 50 or older (n = 144), lower proteolipid protein 1 (beta = −0.02, 95% CI [−0.047, −0.001]) and myelin-associated glycoprotein (beta = −0.01, 95% CI [−0.03, −0.002]) were associated with higher Functional Activities Questionnaire scores. Lower myelin-associated glycoprotein correlated with higher Barratt Impulsiveness Scale-11 scores (beta = −0.02, 95% CI [−0.04, −0.0003]). Results suggest that decreased myelin may represent a late effect of repetitive head impacts that contributes to the manifestation of cognitive symptoms and impulsivity. Clinical–pathological correlation studies with prospective objective clinical assessments are needed to confirm our findings.

Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts

“…In addition, a single nuclear RNA sequencing study found that the number of oligodendrocytes was reduced and altered in relative subtype proportions in the dorsolateral frontal white matter of older athletes with CTE compared with controls. A recent autopsy study of 205 older male brain donors with and without CTE found decreased myelin-associated proteins in frontal white matter that corresponded to years of exposure and age at first exposure to American football. Using high spatial resolution ex vivo diffusion tensor imaging, researchers have reported alterations in fractional anisotropy in white matter underlying sulci with CTE lesions and microscopic evidence of axonal disruption .…”

“…White matter rarefaction was increased in the deceased young athletes with CTE, albeit of marginal significance. White matter changes are also common in older individuals with autopsy-confirmed CTE . White matter rarefaction in older brain donors with CTE is directly associated with RHI exposure, CTE status, and dementia .…”

“…Multiple studies link a longer duration of RHI exposure in US football players with increased odds for the presence of CTE and increased severity of CTE. In older American football players with pathologically diagnosed CTE, RHI exposure is also associated with white matter rarefaction, loss of myelin associated proteins, and oligodendrocyte loss . Emerging data show structural white matter alterations on magnetic resonance imaging (MRI) in young, active, and recently retired contact sport players exposed to RHI, although the pathologic condition underlying these changes is unclear.…”

Relative Contributions of Mixed Pathologies to Cognitive and Functional Symptoms in Brain Donors Exposed to Repetitive Head Impacts

“…These may include environmental factors previously linked to dementia such as depression, air pollution, physical inactivity, diabetes, hypertension, hearing loss, obesity, excessive alcohol consumption, lack of social contact, and insomnia 44,45 . Nontraditional and new measures of pathology such as white matter integrity, synaptic density, and neuroinflammatory measures may mediate some of these effects and require further study 46,47 …”

“…44,45 Nontraditional and new measures of pathology such as white matter integrity, synaptic density, and neuroinflammatory measures may mediate some of these effects and require further study. 46,47…”