Former prestigious collegiate athlete to New England Patriots tight end
star, Aaron Hernandez was found hanged in his prison cell on April 19, 2017.1
He was sentenced to life in prison without parole after being found guilty of
first-degree murder of his associate, Odin Lloyd.1 There are many
unanswered questions that still remain. Why did he do it? What led Hernandez to
so quickly spiral out of control? The Boston Globe’s Spotlight team recently
released a podcast, Gladiator: Aaron Hernandez & Football Inc.2
They use Aaron Hernandez’s story to create awareness of the crisis facing
football: Concussions.2
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| Figure 1: Dr. Ann McKee, director of the CTE Center at Boston University presented this image, comparing Aaron’s brain with a normal, 27-year old’s. She stated that this was the worst case of CTE seen in someone at Hernandez’s age.4 |
If you are a football fan, you should not be unaccustomed to the topic
of football concussions. I am a huge fan myself and am very much familiar with
the matter. However, it was not until I started listening to this podcast a
week and half ago to where it got me thinking. One question I had was how much
of Aaron’s brain damage played a role in his violent behavior? A posthumous
examination of Aaron’s brain had shown that he had a severe form of the
degenerative brain disease, Chronic Traumatic Encephalopathy (CTE).3
His brain was heavily damaged to an extent that resembled that of a player in
their 60’s.3
Aaron Hernandez is not the only football player to have CTE. This
degenerative brain disease is most commonly found in athletes, military
veterans, and individuals with a history of recurring trauma to the brain.5
The major contributor to this disease is a protein known as, Tau. Tau forms clumps (Figure 2) which gradually
spread throughout the brain, ultimately killing brain cells.5 My second
question that arose was “if this is not a newly introduced disease, are there
studies being conducted to produce a drug that will treat this horrible ailment”?
 |
|
Figure
2: Dr. McKee shows Tau proteins surrounding blood vessels in the superior
frontal cortex of Hernandez’s brain.4
|
The currently diagnosis of CTE can only be done only after death, by
performing a brain tissue analysis.5 As of right now, the only recommended
treatment for a concussion is to solely
rest.6 However, Dr. Jacob VanLandingham, a neuroscientist at Florida
State University has developed a drug known as, PRV-002 to hopefully change
this.6 This drug is synthetic neurosteroid.7 He has
invented this medication to be taken nasally within the initial minutes of head
trauma an individual endures.6 Once PRV-002 has been absorbed into
the brain, it is hypothesized to elicit three separate positive responses at a cellular
level: a decline in the amount of inflammation, swelling, and stress.6
Due to PRV-002’s lipophilic characteristic, it can easily cross the blood-brain
barrier to quickly remove the swelling, oxidative stress, and inflammation in
the brain.7 When tested in rats, use of the drug resulted in
evidence of improvement in short-term memory and motor performance, as well as
a decrease in depression and anxiety.6 The suggested timeline of
treatment is administer PRV-002 twice a day for 14 days in order to minimalize
the post-concussion symptoms that will usually develop, such as dizziness,
short-term memory loss, chronic headaches, and sleep disorders.6 The
drug should decrease post-traumatic stress disorder and post-concussion
symptoms, but Dr. VanLandingham states that in time, there is a possibility
that this drug could also reduce chronic traumatic encephalopathy as well.6
The biopharmaceutical company, Prevacus plans to begin a Phase I
clinical trial to investigate use of PRV-002 for treating concussions/mild
traumatic brain injuries.7 An article published in May 2018, released
that the upcoming Phase 1b study formed a new partnership between Prevacus’s
new drug and BrainScope, a medical-neurotechnology company based in Bethsda,
Maryland.8 The company will use its BrainScope One device in this study in order to provide assessments
of the brain’s function.8 These assessments include EEG measures,
cognitive performance tests, and standard, digitized concussion tests.8
This device is vital because it is accompanied with a Brain Function Index
which will permit the scientists to accurately gauge the functional injury
element of the brain after an injury has occurred.8
Although PRV-002 is still in the works, it seems promising compared to
the only current treatment of just resting. Even former NFL football star,
Brett Favre seems confident about the drug’s potential. He has invested about
half a million dollars and has raised a further $800,000 for Prevacus’s
PRV-002.6 If the drug proves to be both, safe and effective in these
upcoming Clinical trials, Prevacus is optimistic in releasing the drug to be on
the market in about three to four years.6
References
1. CNN
Library. Aaron Hernandez Fast Facts. CNN.
https://www.cnn.com/2014/03/09/us/aaron-hernandez-fast-facts/index.html.
Published September 22, 2017. Accessed October 27, 2018.
2. Lewy M,
Lopez H, Lavender G. Gladiator: Aaron Hernandez and Football Inc. The Boston Globe. October
2018.
https://itunes.apple.com/us/podcast/gladiator-aaron-hernandez-and-football-inc/id1437935588?mt=2.
Accessed October 16, 2018.
By Beverly Balasuriya, Master of Medical Sciences Student, University of Kentucky
Another way the football industry is attempting to solve the concussion problem is by implementing the use of football helmets that are custom-made to fit an individual player’s head.
ReplyDeleteCalled Precision Fit, these Riddell helmets are designed to better protect the player from head injuries. The helmet space is filled with an energy-absorbing material instead of “fitting devices such as air bladders or shims or very soft-fitting foam that do not manage the energy in an impact situation.”1
By having a helmet that fits the exact shape of an individual player’s head – “that fits perfectly, is comfortable, moves well with you – there’s no lag, there’s no jiggle with the helmet fit.”1 This is a step in the right direction to raise awareness and improvement regarding concussions in the football sports industry.
What I find interesting is another new technology being implemented in concussion diagnosis that Beverly mentioned, the Brainscope One device that is designed to “aid in the evaluation of patients who sustained a head injury within 72 hours”.2 This is a cutting edge technological advancement that has the potential to radically change brain injury diagnosis and treatment not only regarding concussions in sports but other forms of brain injury as well.
Brainscope One “uses revolutionary EEG-based technology” that can be used as a rapid early indication of traumatic brain injury; some of the benefits it provides include “ability to assess full spectrum of brain injury, results in minutes, non-invasiveness, and use for injuries within a 3-day period.”2 While the product’s website states, it is “not intended as a stand-alone diagnostic or to be used as a replacement for a CT scan”, by training medical professionals in the use of this new equipment, brain injuries may possibly be detected and intervened earlier.2
Can Custom-Fit Football Helmets Protect Athletes From Brain Trauma? (n.d.). Retrieved from https://news.wttw.com/2017/11/02/can-custom-fit-football-helmets-protect-athletes-brain-trauma
Products. (n.d.). Retrieved from http://brainscope.com/products/
I played a couple years of football in high school myself and despite the best attempt at padding and fit, it was still very uncomfortable to be hit in the head. People think of kids just playing in football games but in pee-wee league and high school you are practicing almost daily and taking head shots almost repeatedly during practice. Getting hit everyday in practice definitely was not enjoyable. With some of the new science and information available, I often wonder if some of my mental incapacities are an effect of playing just those couple years of football as my brain technically was still developing. Very hopeful for this drug. I was interested if they are trying to target the tau protein for degradation also but couldn't find anything. I know tau protein is a culprit in Alzheimer's and
ReplyDeleteALS as well.
Brain injuries obtained from football are undoubtedly a hotly debated topic. A study found that 40% of an ex-NFL player population had signs of traumatic brain injury, a percentage almost 3 times larger than the general population. Another study I looked at from Boston University looked at 111 donated brains of ex-NFL players to test for CTE. 110 of 111 were diagnosed with CTE. These numbers may be skewed because the study was a convenience study instead of a random sample with a control, but the numbers are certainly noteworthy.
ReplyDeleteBrain injuries sustained in football has certainly been a neglected area in regards to studying, but if this new concussion drug really works and helps in reducing tau tangles in brains after collisions, that would be an incredible leap in player safety. If the drug is not successful and more discoveries aren't made soon, the sport of football could very well be on its way out.
Mez J, Daneshvar DH, Kiernan PT, et al. Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. JAMA. 2017;318(4):360–370. doi:10.1001/jama.2017.8334
With so many football fans around the world, this is an important topic. My own sister is a huge football fan, but refuses to let her two sons play because of the high risk association of concussions and other brain disorders they may experience.
ReplyDeleteI found it interesting that the first diagnosis and discovery of CTE was in 1928 and did not occur in football players, but rather, boxers (Concussion Legacy Foundation, 2016). Dr. Harrison Martland described it as "punch drunk syndrome (Concussion Legacy Foundation)." However, it wasn't until 2005 that CTE was discovered in an American football player: former Pittsburgh Steeler Mike Webster (Concussion Legacy Foundation, 2016). My sister may be accurate in her decision to not let my nephews play football because there is evidence that athletes who play contact sports prior to age 12 are much greater risk for the development of CTE later in life.
I do hope this new drug proves effective for the protection of these athletes we love to watch. Do the costs weigh out the benefits for playing football? Probably not for those in the NFL making millions each year.
References:
What is CTE? Concussion Legacy Foundation. https://concussionfoundation.org/CTE-resources/what-is-CTE. Published 2016. Accessed November 20, 2018.
I found it very interesting that Chronic Traumatic Encephalopathy is caused by an aggregation of the tau protein, much like Alzheimer's disease. While researching the connection between these diseases, I found that in CTE the tangles appear around small blood vessels and beta-amyloid plaques are rare, unlike in Alzheimer's. Although there are clearly some differences between the diseases, I wonder if any treatments would be beneficial in treating both Alzheimer's and CTE. I know some novel Alzheimer's treatments have been proposed that focus on monoclonal antibodies that target the amyloid-beta protein. It would be interesting to see if this approach would also be useful for targeting tau and specific proteins associated with CTE. Behavioral approaches and other medications that are already approved for treating Alzheimer's may also be helpful in CTE, considering the similarities between the two conditions.
ReplyDeleteRygiel, K. (2016). Novel strategies for Alzheimers disease treatment: An overview of anti-amyloid beta monoclonal antibodies. Indian Journal of Pharmacology, 48(6), 629. doi:10.4103/0253-7613.194867
Chronic Traumatic Encephalopathy (CTE). (n.d.). Retrieved from https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/chronic-traumatic-encephalopathy-(cte)
The similarities between CTE and Alzheimer's disease are interesting. They are both associated with the development of dementia, even though symptoms of CTE may be experienced years or decades after trauma occurs (Alzheimer's Association, n.d.). I wonder why this is, if the late onset of symptoms could be associated with the brain's decrease in plasticity as an individual ages. However, dementia from CTE begins much sooner than from Alzheimer's, possibly even when the patient is middle aged. Behavioral therapy could be helpful for mood symptoms of CTE like depression, irritability, and aggression the way it is for Alzheimer's patients (Alzheimer's Association, n.d.).
ReplyDeleteAfter NFL retiree David Herman pursued an Alzheimer's clinical trial because of his experience with memory problems, physicians could not agree on his diagnosis. Brain scans showed that he did not have a presence of amyloid plaques, but did have clumps of tau. Soon after his case, the National Institute of of Neurological Disorders and Stroke determined that tau buildup occurred in the wrinkles and deepest crevices in the brain, distinguishing it from other neurological diseases that involve tau clumping. PET scans could detect tau in these specific spots, which could be a novel way of diagnosing CTE before autopsy. With earlier certain detection, intervention could be attainable. More research needs to be done before PET scans can be a reliable method for diagnosing CTE, but it does show promise. An upcoming clinical trial will combine results from MRIs, PET scans, blood and saliva tests, spinal-fluid collections, genetic evaluations, neuropsychological tests, and clinical exams and histories to pin down CTE diagnosis. Multiple methods would be ideal, because PET scans are very expensive, but their promise could be indispensable for athletes and military individuals who are at risk for serious brain trauma (Hruby, 2017).
Alzheimer's Association. (n.d.). Chronic Traumatic Encephalopathy (CTE). Retrieved from https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/chronic-traumatic-encephalopathy-(cte)
Hruby, P. (2017, September 21). The future of detecting brain damage in football. The Atlantic. Retrieved from https://www.theatlantic.com/health/archive/2017/09/football-brain-injury-chronic-traumatic-encephalopathy/540459/
I thought this was a really cool topic! It's very surprising to me that a drug is able to treat neural degeneration from concussions. Unsurprisingly, I have never played football, but I do know that concussions are a serious condition that affect many athletes. Like Catie said, I wonder if this would be an effective treatment for Alzheimer's, or if a new treatment could stem from this research. Another aspect of this topic that I found interesting was the treatment's impact on mental health. Research has shown that depression and neurodegeneration are very often co-morbid conditions "particularly within the aging population." (Hurley and Tizabi, 2013) I wonder if this could also revolutionize how we treat depression/anxiety. Very promising research!
ReplyDeleteReference:
Hurley, L. L., & Tizabi, Y. (2013). Neuroinflammation, neurodegeneration, and depression. Neurotoxicity Research, 23(2), 131-144.
Diseases of the CNS have remained elusive despite major advances in medicine. It is promising to see that a drug can be used as a prophylactic measure against neurodegenerative diseases. I was quite intrigued by the use of Brainscope one machine in conjunction with PRV-002. After future research, I’ve learned the Brainscope machine is essentially an EEG machine on steroids, which utilizes algorithms based on brainwaves to carry out quick identification and assessment of brain injuries. In a study conducted by physicians at Washington University Barnes Jewish Medical Center in St. Louis, Brainscope was found to have the potential to reduce the use of unnecessary head CT scans by 33 % in the Emergency Department setting without incurring any false negative cases, i.e. with 100% sensitivity. It has the potential to provide considerable clinical and economic benefits to urgent and emergency care centers.
ReplyDeleteBrainScope One Demonstrated the Potential to Reduce Head CT Scans By One-Third in Emergency Department Use. (2018, April 30). Retrieved December 7, 2018, from https://www.businesswire.com/news/home/20180430005383/en/BrainScope-Demonstrated-Potential-Reduce-Head-CT-Scans
It is almost overwhelming thinking about the severity of damage even a hit with small impact to the head can create. There was an interesting article in Mel Magazine on the connection between concussions and acts of violence... surprisingly enough Aaron Hernandez and OJ Simpson were the stars of the article. There is suspicion that OJ Simpson, too, suffers from CTE. Although this does not excuse the actions of Hernandez and Simpson, at least there is scientific foundation explaining how someone could potentially commit this kind of violence. Doctors explain that this does not mean every football player is going to be violent because of brain damage, it only means there is an increased risk. This topic is so important to modern society for the sole reason that football is such a widely played sport in america and there needs to be increased awareness.
ReplyDeletehttps://melmagazine.com/en-us/story/the-connection-between-concussions-cte-and-acts-of-violence-2
I wanted to comment on the hope this brings for Alzheimer’s and other neurodegenerative diseases, but others have already investigated them. One thing that is of importance, in my opinion, is studying the effects of these types of injuries on behavior. It is no secret that football players have a history of violence, more specifically towards women. Instances such as those of Kareem Hunt and Ray Rice bring the question of whether or not these players where affected by something similar to these. The fear, however, is that this could be a ploy for those convicted of these crimes to be cleared of the charges. One instance that comes to mind is that of a man who killed his child and was cleared of all charges after they found a brain tumor that caused him to have mood swings. Once the tumor was removed, he was his normal self to the point that he mom allowed him to come around her kids again. Unfortunately, I can’t find a source for this but it was covered in my entry level psychology class. The point is, however, that if the players are able to claim this and get away with it, then there may be a bigger issue at hand. I’m still glad to see that pharmaceutical companies are taking time to help find a way to keep atheltes safer.
ReplyDeleteImpressive topic. I had no idea about it before it I read this blog. Like a lot of my peers, I was also thinking about any connection between CTE & Alzheimer's disease. I'm a little skeptical about the reversing of the Neuro-degenerative effects though. But this new drug seems like magic wand for athletes, football player etc. Let's cross our fingers for the clinical trials results to come out as desired.
ReplyDeleteOne thing I'm surprised no one else really mentioned was how many people could really benefit from PRV-002 if it turns out to be both safe and efficacious. In addition to athletes, military personnel and victims of domestic violence are both at increased risk of repeated concussions. Repeated TBIs have been associated with increased incidence of depression, suicide, and the development of Alzheimer's disease. (1) Even those suffering from an isolated TBI (e.g. from a car accident) could receive some benefit. This drug could potentially help to prevent such long-term negative consequences of TBIs in many people.
ReplyDeleteReferences:
1) Committee on Sports-Related Concussions in Youth; Board on Children, Youth, and Families; Institute of Medicine; National Research Council; Graham R, Rivara FP, Ford MA, et al., editors. Sports-Related Concussions in Youth: Improving the Science, Changing the Culture. Washington (DC): National Academies Press (US); 2014 Feb 4. 5, Consequences of Repetitive Head Impacts and Multiple Concussions. Available from: https://www.ncbi.nlm.nih.gov/books/NBK185336/
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