Cleveland Clinic receives NIH grant to study effectiveness of concussion diagnostic test

Tests before, after games to measure biomarkers for brain injury

Researchers at Cleveland Clinic have received a grant from the National Institutes of Health (NIH) to continue studying the effectiveness of a blood test that conclusively identifies concussions in college football players.

The test - using blood samples taken before and after a game - searches for a biomarker known as S100B, which signifies brain damage if found in elevated levels in an athlete's blood.

Damir Janigro, Ph.D., and Nicola Marchi, Ph.D., both of Cleveland Clinic's Lerner Research Institute, are the lead researchers on this study, in collaboration with Jeffrey Bazarian, M.D., M.P.H., of the Clinical and Translational Science Institute at the University of Rochester Medical Center.

Concussions are the leading cause of brain damage in sports, particularly in football. Estimates suggest that up to 40 percent of football players experience a concussion annually, the majority of these going unreported. Overall, the U.S. Centers for Disease Control and Prevention estimates that 3.8 million Americans suffer concussions each year.

"The current tools and technology available to identify and diagnose concussions are no longer adequate to handle the public health epidemic that concussions have become," said Janigro, the study's lead researcher. "As these injuries continue to occur in our athletes, we need to discover solutions for faster, more efficient diagnosis, which is what we expect this blood test to do."

Identifying concussions is difficult. Currently, concussion diagnosis relies on subjective cognitive/behavioral tests, as well as CT scans or MRIs, both of which cost thousands of dollars. A blood test will be much less expensive (about $20) and could be performed anywhere, such as locker rooms or doctors' offices. More importantly, though, the blood test will offer a yes-or-no determination of whether an athlete requires medical intervention as a result of in-game collisions.

The test will search for the presence of S100B in the blood. This protein is typically found in the brain, so finding elevated levels of S100B in the blood is a sign of damage to the blood-brain barrier, a protective barricade separating the brain from circulating blood. These results could help doctors, parents and athletes determine the severity of a concussion and when a player is ready to return to play after a concussion, while also providing indication of potential long-term pathological brain changes.

In addition, these new tests and the game-by-game observance of athletes allow for earlier diagnoses and treatment. Currently, detailed neurological and behavioral testing may be delayed for several days after an event, creating uncertainty and potential risk.

In preliminary testing, Cleveland Clinic researchers measured S100B levels prior to, immediately after and one day post-game in 33 college football players. Average S100B levels immediately after the game were significantly higher than baseline only in those players who experienced the most head-to-head impact during the game.

The $250,000 NIH grant will allow researchers to compare players' S100B levels to their brain MRIs, in order to determine whether S100B is predictive of - and able to detect - brain damage.

The S100B blood test is one of several projects Cleveland Clinic is undertaking to better detect and prevent brain injuries across a wide range of sports, including football, boxing, hockey and soccer. Teams of researchers are working to make safer youth football helmets (through a grant from NFL Charities), to create an Intelligent Mouthguard that measures the number and severity of hits to the head among athletes, and to develop an iPad app that uses the device's built-in gyroscope to quantitatively capture pre- and post-game measures of balance, memory and cognition. In Las Vegas, the Cleveland Clinic Lou Ruvo Center for Brain Health has launched a landmark study with professional fighters that will help determine whether MRIs of the brain, along with other tests, can detect subtle changes in brain health that correlate with impaired thinking and functioning. The research teams draw from their experiences of caring for thousands of professional, amateur and youth athletes every year on the sidelines and in clinic.