Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.
J Neurotrauma. 2023 Apr;40(7-8):693-705. doi: 10.1089/neu.2022.0267. Epub 2022 Nov 17.
Blood-based brain biomarkers (BBM) such as glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) have potential to aid in the diagnosis of concussion. Recently developed point-of-care test devices would enable BBMs to be measured in field settings such military and sport environments within minutes of a suspicious head hit. However, head hits in these environments typically occur in the setting of vigorous physical exertion, which can itself increase BBMs levels. Thus, efforts to develop BBMs as acute concussion aids in field settings need to account for the effects of physical exertion. To determine the acute effects of physical exertion on the BBMs, we measured GFAP, UCH-L1, tau, and neurofilament light chain (NF-L) immediately before, immediately after, and 45 min after a single workout session consisting of aerobic and resistance exercises in 30 collegiate football players. Subjects wore body sensors measuring several aspects of exertion and underwent diffusion tensor imaging 24 h before and 48 h after exertion. All subjects were male with a mean age of 19.5 ± 1.2 years. The mean duration of activity during the workout session was 94 ± 31 min. There was a significant decrease in serum GFAP immediately after (median decrease of 27.76%, < 0.0001) and a significant increase in serum UCH-L1 45 min after (median increase of 37.11%, = 0.016) exertion, compared with pre-exertion baseline. No significant changes in tau or NF-L were identified. The duration of exertion had a significant independent linear correlation to the increase in serum UCHL1 from pre-exertion to 45 min after exertion ( = 0.68, = 0.004). There were no significant pre- to post-exertional changes in any of the 39 examined brain white matter regions, and biomarker changes did not correlate to variation in white matter integrity in any of these regions. Thus, exertion appeared to be associated with immediate decreases in serum GFAP and very acute (45 min) increases in UCH-L1. These changes were related to the duration of exertion, but not to changes in brain white matter integrity. Our results have important implications for how these BBMs might be used to aid in the on-scene diagnosis of concussion occurring in the setting of physical exertion.
血液脑生物标志物(BBM),如胶质纤维酸性蛋白(GFAP)和泛素羧基末端水解酶 L1(UCH-L1),具有辅助诊断脑震荡的潜力。最近开发的即时检测设备将使 BBM 能够在军事和运动等现场环境中,在可疑头部撞击后几分钟内进行测量。然而,在这些环境中,头部撞击通常发生在剧烈体力活动的情况下,这本身就会增加 BBM 的水平。因此,在现场环境中开发 BBM 作为急性脑震荡辅助手段的努力需要考虑体力活动的影响。为了确定体力活动对 BBM 的急性影响,我们在 30 名大学生足球运动员进行一次有氧和阻力运动的单次锻炼后,立即在锻炼前、锻炼后立即和 45 分钟后测量 GFAP、UCH-L1、tau 和神经丝轻链(NF-L)。受试者佩戴测量多种用力程度的身体传感器,并在用力前后 24 小时进行弥散张量成像。所有受试者均为男性,平均年龄为 19.5±1.2 岁。锻炼期间的活动持续时间平均为 94±31 分钟。与锻炼前基线相比,血清 GFAP 在锻炼后立即显著下降(中位数下降 27.76%,<0.0001),血清 UCH-L1 在 45 分钟后显著升高(中位数升高 37.11%,=0.016)。tau 或 NF-L 无明显变化。用力时间与锻炼后 45 分钟内血清 UCHL1 从锻炼前的增加呈显著独立线性相关(=0.68,=0.004)。在 39 个检查的脑白质区域中,没有观察到任何一个区域从锻炼前到锻炼后的变化,生物标志物的变化与这些区域中任何一个区域的白质完整性变化均无相关性。因此,用力似乎与血清 GFAP 的立即下降和 UCH-L1 的极急性(45 分钟)升高有关。这些变化与用力时间有关,但与脑白质完整性的变化无关。我们的研究结果对于这些 BBM 如何用于辅助现场诊断体力活动中发生的脑震荡具有重要意义。