Imaging of glial cell activation and white matter integrity in brains of active and recently retired national football league players

Jennifer Marie Coughlin, Y. Yuchuanwang, Il Minn, Nicholas Bienko, Emily Ambinder, Xin Xu, Matthew Peters, John W. Dougherty, Melin Vranesic, Soo Min Koo, Hye Hyun Ahn, Merton Lee, Chris Cottrell, Haris Sair, Akira Sawa, Cynthia Munro, Christopher J. Nowinski, Robert F Dannals, Constantine G Lyketsos, Michael KassiouGwenn Smith, Brian S Caffo, Susumu Mori, Tomas R. Guilarte, Martin Gilbert Pomper

Research output: Contribution to journalArticle

Abstract

IMPORTANCE Microglia, the resident immune cells of the central nervous system, play an important role in the brain's response to injury and neurodegenerative processes. It has been proposed that prolonged microglial activation occurs after single and repeated traumatic brain injury, possibly through sports-related concussive and subconcussive injuries. Limited in vivo brain imaging studies months to years after individuals experience a single moderate to severe traumatic brain injury suggest widespread persistent microglial activation, but there has been little study of persistent glial cell activity in brains of athletes with sports-related traumatic brain injury. OBJECTIVE To measure translocator protein 18 kDa (TSPO), a marker of activated glial cell response, in a cohort of National Football League (NFL) players and control participants, and to report measures of white matter integrity. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, case-control study included young active (n = 4) or former (n = 10) NFL players recruited from across the United States, and 16 age-, sex-, highest educational level-, and body mass index-matched control participants. This study was conducted at an academic research institution in Baltimore, Maryland, from January 29, 2015, to February 18, 2016. MAIN OUTCOMES AND MEASURES Positron emission tomography-based regional measures of TSPO using [11C]DPA-713, diffusion tensor imaging measures of regional white matter integrity, regional volumes on structural magnetic resonance imaging, and neuropsychological performance. RESULTS The mean (SD) ages of the 14 NFL participants and 16 control participants were 31.3 (6.1) years and 27.6 (4.9) years, respectively. Players reported a mean (SD) of 7.0 (6.4) years (range, 1-21 years) since the last self-reported concussion. Using [11C]DPA-713 positron emission tomographic data from 12 active or former NFL players and 11 matched control participants, the NFL players showed higher total distribution volume in 8 of the 12 brain regions examined (P < .004).We also observed limited change in white matter fractional anisotropy and mean diffusivity in 13 players compared with 15 control participants. In contrast, these young players did not differ from control participants in regional brain volumes or in neuropsychological performance. CONCLUSIONS AND RELEVANCE The results suggest that localized brain injury and repair, indicated by higher TSPO signal and white matter changes, may be associated with NFL play. Further study is needed to confirm these findings and to determine whether TSPO signal and white matter changes in young NFL athletes are related to later onset of neuropsychiatric symptoms.

Original languageEnglish (US)
Pages (from-to)67-74
Number of pages8
JournalJAMA Neurology
Volume74
Issue number1
DOIs
StatePublished - Jan 1 2017

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Football
Neuroglia
Brain
Athletes
Sports
Proteins
Baltimore
Diffusion Tensor Imaging
Anisotropy
Wounds and Injuries
Microglia
White Matter
Neuroimaging
Positron-Emission Tomography
Brain Injuries
Case-Control Studies
Body Mass Index
Central Nervous System
Magnetic Resonance Imaging
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Imaging of glial cell activation and white matter integrity in brains of active and recently retired national football league players. / Coughlin, Jennifer Marie; Yuchuanwang, Y.; Minn, Il; Bienko, Nicholas; Ambinder, Emily; Xu, Xin; Peters, Matthew; Dougherty, John W.; Vranesic, Melin; Koo, Soo Min; Ahn, Hye Hyun; Lee, Merton; Cottrell, Chris; Sair, Haris; Sawa, Akira; Munro, Cynthia; Nowinski, Christopher J.; Dannals, Robert F; Lyketsos, Constantine G; Kassiou, Michael; Smith, Gwenn; Caffo, Brian S; Mori, Susumu; Guilarte, Tomas R.; Pomper, Martin Gilbert.

In: JAMA Neurology, Vol. 74, No. 1, 01.01.2017, p. 67-74.

Research output: Contribution to journalArticle

Coughlin, Jennifer Marie ; Yuchuanwang, Y. ; Minn, Il ; Bienko, Nicholas ; Ambinder, Emily ; Xu, Xin ; Peters, Matthew ; Dougherty, John W. ; Vranesic, Melin ; Koo, Soo Min ; Ahn, Hye Hyun ; Lee, Merton ; Cottrell, Chris ; Sair, Haris ; Sawa, Akira ; Munro, Cynthia ; Nowinski, Christopher J. ; Dannals, Robert F ; Lyketsos, Constantine G ; Kassiou, Michael ; Smith, Gwenn ; Caffo, Brian S ; Mori, Susumu ; Guilarte, Tomas R. ; Pomper, Martin Gilbert. / Imaging of glial cell activation and white matter integrity in brains of active and recently retired national football league players. In: JAMA Neurology. 2017 ; Vol. 74, No. 1. pp. 67-74.
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T1 - Imaging of glial cell activation and white matter integrity in brains of active and recently retired national football league players

AU - Coughlin, Jennifer Marie

AU - Yuchuanwang, Y.

AU - Minn, Il

AU - Bienko, Nicholas

AU - Ambinder, Emily

AU - Xu, Xin

AU - Peters, Matthew

AU - Dougherty, John W.

AU - Vranesic, Melin

AU - Koo, Soo Min

AU - Ahn, Hye Hyun

AU - Lee, Merton

AU - Cottrell, Chris

AU - Sair, Haris

AU - Sawa, Akira

AU - Munro, Cynthia

AU - Nowinski, Christopher J.

AU - Dannals, Robert F

AU - Lyketsos, Constantine G

AU - Kassiou, Michael

AU - Smith, Gwenn

AU - Caffo, Brian S

AU - Mori, Susumu

AU - Guilarte, Tomas R.

AU - Pomper, Martin Gilbert

PY - 2017/1/1

Y1 - 2017/1/1

N2 - IMPORTANCE Microglia, the resident immune cells of the central nervous system, play an important role in the brain's response to injury and neurodegenerative processes. It has been proposed that prolonged microglial activation occurs after single and repeated traumatic brain injury, possibly through sports-related concussive and subconcussive injuries. Limited in vivo brain imaging studies months to years after individuals experience a single moderate to severe traumatic brain injury suggest widespread persistent microglial activation, but there has been little study of persistent glial cell activity in brains of athletes with sports-related traumatic brain injury. OBJECTIVE To measure translocator protein 18 kDa (TSPO), a marker of activated glial cell response, in a cohort of National Football League (NFL) players and control participants, and to report measures of white matter integrity. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, case-control study included young active (n = 4) or former (n = 10) NFL players recruited from across the United States, and 16 age-, sex-, highest educational level-, and body mass index-matched control participants. This study was conducted at an academic research institution in Baltimore, Maryland, from January 29, 2015, to February 18, 2016. MAIN OUTCOMES AND MEASURES Positron emission tomography-based regional measures of TSPO using [11C]DPA-713, diffusion tensor imaging measures of regional white matter integrity, regional volumes on structural magnetic resonance imaging, and neuropsychological performance. RESULTS The mean (SD) ages of the 14 NFL participants and 16 control participants were 31.3 (6.1) years and 27.6 (4.9) years, respectively. Players reported a mean (SD) of 7.0 (6.4) years (range, 1-21 years) since the last self-reported concussion. Using [11C]DPA-713 positron emission tomographic data from 12 active or former NFL players and 11 matched control participants, the NFL players showed higher total distribution volume in 8 of the 12 brain regions examined (P < .004).We also observed limited change in white matter fractional anisotropy and mean diffusivity in 13 players compared with 15 control participants. In contrast, these young players did not differ from control participants in regional brain volumes or in neuropsychological performance. CONCLUSIONS AND RELEVANCE The results suggest that localized brain injury and repair, indicated by higher TSPO signal and white matter changes, may be associated with NFL play. Further study is needed to confirm these findings and to determine whether TSPO signal and white matter changes in young NFL athletes are related to later onset of neuropsychiatric symptoms.

AB - IMPORTANCE Microglia, the resident immune cells of the central nervous system, play an important role in the brain's response to injury and neurodegenerative processes. It has been proposed that prolonged microglial activation occurs after single and repeated traumatic brain injury, possibly through sports-related concussive and subconcussive injuries. Limited in vivo brain imaging studies months to years after individuals experience a single moderate to severe traumatic brain injury suggest widespread persistent microglial activation, but there has been little study of persistent glial cell activity in brains of athletes with sports-related traumatic brain injury. OBJECTIVE To measure translocator protein 18 kDa (TSPO), a marker of activated glial cell response, in a cohort of National Football League (NFL) players and control participants, and to report measures of white matter integrity. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, case-control study included young active (n = 4) or former (n = 10) NFL players recruited from across the United States, and 16 age-, sex-, highest educational level-, and body mass index-matched control participants. This study was conducted at an academic research institution in Baltimore, Maryland, from January 29, 2015, to February 18, 2016. MAIN OUTCOMES AND MEASURES Positron emission tomography-based regional measures of TSPO using [11C]DPA-713, diffusion tensor imaging measures of regional white matter integrity, regional volumes on structural magnetic resonance imaging, and neuropsychological performance. RESULTS The mean (SD) ages of the 14 NFL participants and 16 control participants were 31.3 (6.1) years and 27.6 (4.9) years, respectively. Players reported a mean (SD) of 7.0 (6.4) years (range, 1-21 years) since the last self-reported concussion. Using [11C]DPA-713 positron emission tomographic data from 12 active or former NFL players and 11 matched control participants, the NFL players showed higher total distribution volume in 8 of the 12 brain regions examined (P < .004).We also observed limited change in white matter fractional anisotropy and mean diffusivity in 13 players compared with 15 control participants. In contrast, these young players did not differ from control participants in regional brain volumes or in neuropsychological performance. CONCLUSIONS AND RELEVANCE The results suggest that localized brain injury and repair, indicated by higher TSPO signal and white matter changes, may be associated with NFL play. Further study is needed to confirm these findings and to determine whether TSPO signal and white matter changes in young NFL athletes are related to later onset of neuropsychiatric symptoms.

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