Biomarkers Biomarkers for for

Concussion Concussion Detection Detection

Jillian HoldenBME 281

November 3, 2015

What is a concussion?What is a concussion?• Mild Traumatic Brain Injury (mTBI)• “a head trauma resulting in brief loss of

consciousness and/or alteration of a mental state”

Current TechnologyCurrent Technology•Magnetic Resonance Imaging (MRI)•Computed Tomography (CT) Scan

o Exposure to ionizing radiation o Expensiveo Not easily accessible

The ProblemThe Problem• Concussions affect a growing amount of athletes

each year• If not detected and treated early concussions can

cause long-lasting nerve damage• Current technology available is not sufficient

What happens during What happens during a concussiona concussion

• Brain hits the skull• impact results in bruising and possible nerve

damage• Trauma damages astroglial cells which releases

S-100Bo S-100B- calcium binding

protein o Protein found in cerebrospinal fluid, saliva and blood

How it worksHow it works• Blood sample taken after impact• Blood sample centrifuged to obtain plasma• Plasma tested for concentration of S-100B • Concentration measured to determine if it

indicates a concussion

Professional Ice Professional Ice Hockey Player StudyHockey Player Study

• 47 Swedish hockey players provided baseline blood samples (pre-season)

• 35 players sustained a concussion and required more blood testing post-concussiono Blood samples taken at 1, 12, 36, and 144 hours post- concussion and

also when they returned to play• The proteins Total Tau, NSE and S-100B were all

measured

ResultsResults• Concentration of S-100B was significantly

elevated in concussed individuals, best results of the 3 proteins• Blood test taken 1 hour after injury had

highest concentration and levels continued to decrease from there

ChallengesChallenges• Many times S-100B is elevated after non-

impact physical exertion o S-100B released as a result of torn muscles o This elevation can cause false-positive results

• Not yet FDA approved in the United States

AdvantagesAdvantages• Readily available

o could be administered on the sidelines immediately after injury

• Cost-effectiveo around $20 per test

• Time- efficient diagnosiso results within an hour

Questions?Questions?

Works CitedWorks Cited• "What Happens in the Brain after a Concussion?" The Hindu. N.p., 21 Dec. 2013.

Web. 30 Oct. 2015. <http://www.thehindu.com/todays-paper/tp-international/what-happens-in-the-brain-after-a-concussion/article5488509.ece>.

• Jones, Chris. "How Concussions Work." HowStuffWorks. N.p., n.d. Web. 30 Oct. 2015. <http://science.howstuffworks.com/life/inside-the-mind/human-brain/concussion3.htm>.

• Schulte, Stephanie, Leslie, W. Podlog, J.Jordan Hamson-Utley, Fredrick G. Strathmann, Heiko K. Struder, “A Systematic Review of the Biomarker S100B: Implications for Sport-Related Concussion Management”, Journal of Athletic Training, 49(6): 830-850; 2014.

• Zetterberg, Henrik, Douglas H. Smith, Kaj Blennow, “Biomarkers of Mild Traumatic Brain Injury in Cerebrospinal Fluid and Blood”, Nature Reviews Neurology, 9: 201-210; 2013.

• Finoff, Jonathan T., Elena J. Jelsing, Jay Smith, “Biomarkers, Genetics, and Risk Factors for Concussion”, American Academy of Physical Medicine and Rehabilitation, 3: S452-S459, 2011.

• Shahim, Pashtun, Yelverton Tegner, David H. Wilson, Jeffrey Randall, Tobias Skillbäck, David Pazooki, Birgitta Kallberg, Kaj Blennow, Henrik Zetterberg, “Blood Biomarkers for Brain Injury in Concussed Professional Ice Hockey Players”, JAMA Neurology, 71(6): 284-294.