1. Biomarkers for Concussion Detection Jillian Holden BME 281 November 3, 2015

2. What is a concussion? Mild Traumatic Brain Injury (mTBI) “a head trauma resulting in brief loss of consciousness and/or alteration of a mental state”

3. Current Technology Magnetic Resonance Imaging (MRI) Computed Tomography (CT) Scan o Exposure to ionizing radiation o Expensive o Not easily accessible

4. The Problem Concussions affect a growing amount of athletes each year If not detected and treated early concussions can cause long-lasting nerve damage Current technology available is not sufficient

5. What happens during a concussion Brain hits the skull impact results in bruising and possible nerve damage Trauma damages astroglial cells which releases S- 100B o S-100B- calcium binding protein o Protein found in cerebrospinal fluid, saliva and blood

7. How it works Blood sample taken after impact Blood sample centrifuged to obtain plasma Plasma tested for concentration of S-100B Concentration measured to determine if it indicates a concussion

8. Professional Ice Hockey Player Study 47 Swedish hockey players provided baseline blood samples (pre-season) 35 players sustained a concussion and required more blood testing post-concussion o Blood samples taken at 1, 12, 36, and 144 hours post- concussion and also when they returned to play The proteins Total Tau, NSE and S-100B were all measured

9. Results Concentration of S-100B was significantly elevated in concussed individuals, best results of the 3 proteins Blood test taken 1 hour after injury had highest concentration and levels continued to decrease from there

10. Challenges Many times S-100B is elevated after non- impact physical exertion o S-100B released as a result of torn muscles o This elevation can cause false-positive results Not yet FDA approved in the United States

11. Advantages Readily available o could be administered on the sidelines immediately after injury Cost-effective o around $20 per test Time- efficient diagnosis o results within an hour

12. Questions?

13. Works Cited "What Happens in the Brain after a Concussion?" The Hindu. N.p., 21 Dec. 2013. Web. 30 Oct. 2015.. Jones, Chris. "How Concussions Work." HowStuffWorks. N.p., n.d. Web. 30 Oct. 2015.. Schulte, Stephanie, Leslie, W. Podlog, J.Jordan Hamson-Utley, Fredrick G. Strathmann, Heiko K. Struder, “A Systematic Review of the Biomarker S100B: Implications for Sport-Related Concussion Management”, Journal of Athletic Training, 49(6): 830-850; 2014. Zetterberg, Henrik, Douglas H. Smith, Kaj Blennow, “Biomarkers of Mild Traumatic Brain Injury in Cerebrospinal Fluid and Blood”, Nature Reviews Neurology, 9: 201- 210; 2013. Finoff, Jonathan T., Elena J. Jelsing, Jay Smith, “Biomarkers, Genetics, and Risk Factors for Concussion”, American Academy of Physical Medicine and Rehabilitation, 3: S452-S459, 2011. Shahim, Pashtun, Yelverton Tegner, David H. Wilson, Jeffrey Randall, Tobias Skillbäck, David Pazooki, Birgitta Kallberg, Kaj Blennow, Henrik Zetterberg, “Blood Biomarkers for Brain Injury in Concussed Professional Ice Hockey Players”, JAMA Neurology, 71(6): 284-294.