Abstract
Sport-related traumatic brain injury (TBI) elicits a multifaceted inflammatory response leading to brain injury and morbidity. This response could be a predictive tool for the progression of TBI and to stratify the injury of which mild TBI is most prevalent. Therefore, we examined the differential expression of serum inflammatory markers overtime and identified novel markers in repetitively concussed athletes. Neuropsychological assessment by Wechsler Adult Intelligence Scale (WAIS) and Immediate Post Concussion Assessment and Cognitive Test (ImPACT) was performed on rugby players and serum was taken from healthy, concussed and repetitively concussed athletes. Serum was also obtained <1 week and >1 week after trauma and analyzed for 92 inflammatory protein markers. Fibroblast growth factor 21 (FGF21) and interleukin-7 (IL-7) differentiated repetitively concussed athletes. Macrophage chemotactic protein-1 (MCP-1), tumor necrosis factor superfamily member 14 (TNFSF14) were significantly reduced >1 week and chemokine (C-X3-C motif) ligand 1 (CX3CL1) upregulated <1 week after injury. FGF21 and MCP-1 negatively correlated with symptoms and their severity. We have identified dynamic changes in the inflammatory response overtime and in different classes of concussion correlating with disease progression. This data supports the use of inflammatory biomarkers as predictors of symptom development due to secondary complications of sport-related mTBI.
Highlights
Traumatic brain injury (TBI) causes damaging neurological impairments leading to disability and morbidity
In this study we have provided further evidence of circulating inflammatory biomarkers correlating with symptoms following Mild TBI (mTBI) in the serum of athletes who have had multiple concussions
Many investigations have analyzed the immediate inflammatory response after TBI [19,20,21]. This data may aid our understanding of the complex mechanism following mTBI leading to the development of accurate diagnostic and prognostic tools to better define the period of injury and guide a safe return to play objective protocol
Summary
Traumatic brain injury (TBI) causes damaging neurological impairments leading to disability and morbidity. Cytotoxic and ischemic responses enhance axonal death and injury to neurological structures [21] This is associated with the conversion of monocytes to macrophages and the T cell production of cytokines. In this study we have focused analysis on inflammatory markers in the serum of semi-professional and professional Rugby players who suffered mTBI and repeated mTBI These samples were obtained less than one week after injury (1 week) following injury to assess longitudinal inflammatory effects. In addition to investigating the inflammatory network in athletes after a single concussion (C), those who suffered repeated concussions (RC) were investigated This data has been analyzed in conjunction with and contextualized in relation to cognitive performance and symptom severity, with protein expression as a predictive tool for the evolving inflammatory response seen in mTBI. WwFfnaFfWnwaoonniiuueeArrggTAaammrruuccllrIeeIyyooSrrbboSszzseenneeusiiesegrrccgy33ybdduun.noomI.mDlrssfiffeiOfOBNofirssfbobissiiiirauzfcurocyooyotaaalzatasltmnnmsluaclncinibislsgonongsftfiebbteinolonmelmncealooyayiirragerisrfillteefcassattscyiscshhhalchleeattaeoesoennenaanlfrfrppttnecneceeetteaaedddehdrrhttpeeu.ei.eiIuIddeemsDDmsWW nni(n(iapattpnAAesgsettaagaacc))wwctc,,hhhttiitttshsiisshehttttlleehrhreeeeeueessiirrutinnppnitmmAnAoprrottepenhpahnpddssaiiiaauueehrhssiccennrlleeststttedttaattodeeoIIuullTnnddtnntddhThttteeiaayiyyyemmtlls.s.slel((iitFFpttHspHgghhwotouuee)ee)llwnlnlhllasasoommccehenenwweereeeddccerSiiaaSoonnec*cncncnngogoaap*ttaanlnlrrccep
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