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. 2024 Jul;41(13-14):1597-1608. doi: 10.1089/neu.2023.0307. Epub 2024 Jun 10.
Repetitive head hits (RHHs) in sports and military settings are increasingly recognized as a risk factor for adverse neurological outcomes, but they are not currently tracked. Blood-based biomarkers of concussion have recently been shown to increase after nonconcussive RHHs during a single sporting contest, raising the possibility that they could be used in real time to monitor the brain's early response to repeated asymptomatic head hits. To test this hypothesis, we measured GFAP in serum immediately before (T0), immediately after (T1) and 45 min (T2) after a single collegiate football game in 30 athletes. Glial fibrillary acidic protein (GFAP) changes were correlated with three measures of head impact exposure (number of hits, total linear acceleration, and total rotational acceleration captured by helmet impact sensors) and to changes in brain white matter (WM) integrity, estimated by regional changes in fractional anisotropy (FA) and mean diffusivity (MD) on diffusion tensor imaging from 24 h before (T1) to 48 h after (T3) the game. To account for the potentially confounding effects of physical exertion on GFAP, correlations were adjusted for kilocalories of energy expended during the game measured by wearable body sensors. All 30 participants were male with a mean age of 19.5 ± 1.2 years. No participant had a concussion during the index game. We observed a significant increase in GFAP from T0 to T1 (mean 79.69 vs. 91.95 pg/mL, = 0.008) and from T0 to T2 (mean 79.69 vs. 99.21 pg/mL, < 0.001). WM integrity decreased in multiple WM regions but was statistically significant in the right fornix (mean % FA change -1.43, 95% confidence interval [CI]: -2.20, -0.66). T0 to T2 increases in GFAP correlated with reduced FA in the left fornix, right fornix, and right medical meniscus and with increased MD in the right fornix (-values ranged from 0.59 to 0.61). Adjustment for exertion had minimal effect on these correlations. GFAP changes did not correlate to head hit exposure, but after adjustment for exertion, T0 to T2 increases correlated with all three hit metrics (-values ranged from 0.69 to 0.74). Thus, acute elevations in GFAP after a single collegiate football game of RHHs correlated with in-game head hit exposure and with reduced WM integrity 2 days later. These results suggest that GFAP may be a biologically relevant indicator of the brain's early response to RHHs during a single sporting event. Developing tools to measure the neurological response to RHHs on an individual level has the potential to provide insight into the heterogeneity in adverse outcomes after RHH exposure and for developing effective and personalized countermeasures. Owing to the small sample size, these findings should be considered preliminary; validation in a larger, independent cohort is necessary.
重复性头部撞击(RHHs)在运动和军事环境中越来越被认为是不良神经结局的危险因素,但目前尚未对其进行监测。最近的研究表明,在单次运动比赛中,非脑震荡性 RHH 后,血液中的脑震荡生物标志物会增加,这增加了它们可以实时用于监测大脑对反复无症状头部撞击的早期反应的可能性。为了验证这一假设,我们在 30 名运动员的单次大学足球比赛前(T0)、后(T1)和 45 分钟(T2)时测量了血清中的 GFAP。胶质纤维酸性蛋白(GFAP)的变化与三种头部撞击暴露测量值(撞击次数、总线性加速度和头盔撞击传感器捕获的总旋转加速度)以及脑白质(WM)完整性的变化相关,后者通过 24 小时前(T1)至 48 小时后(T3)的扩散张量成像上的区域变化来估计,WM 完整性通过各向异性分数(FA)和平均扩散系数(MD)的变化来估计。为了考虑身体活动对 GFAP 的潜在混杂影响,通过可穿戴身体传感器测量的比赛期间消耗的千卡数对相关性进行了调整。所有 30 名参与者均为男性,平均年龄为 19.5±1.2 岁。在指数比赛中,没有参与者出现脑震荡。我们观察到 GFAP 从 T0 到 T1(平均 79.69 与 91.95 pg/mL, = 0.008)和 T0 到 T2(平均 79.69 与 99.21 pg/mL, < 0.001)均显著增加。多个 WM 区域的 WM 完整性下降,但右侧穹窿的变化具有统计学意义(平均 % FA 变化-1.43,95%置信区间[CI]:-2.20,-0.66)。T0 到 T2 的 GFAP 增加与左侧穹窿、右侧穹窿和右侧半月板的 FA 减少以及右侧穹窿的 MD 增加相关( 值范围从 0.59 到 0.61)。对努力的调整对这些相关性的影响很小。GFAP 的变化与头部撞击暴露无关,但在调整了努力之后,T0 到 T2 的增加与所有三种撞击指标相关( 值范围从 0.69 到 0.74)。因此,单次大学足球比赛中 RHH 后的急性 GFAP 升高与比赛中的头部撞击暴露以及两天后 WM 完整性降低有关。这些结果表明,GFAP 可能是单次运动事件中大脑对 RHH 早期反应的生物相关指标。开发用于测量个体 RHH 后神经反应的工具有可能深入了解 RHH 暴露后不良结局的异质性,并开发出有效和个性化的对策。由于样本量较小,这些发现应被视为初步结果;在更大的独立队列中进行验证是必要的。
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