Can a concussion be monitored with a urine sample?

"Athletes usually want to get back into their sport, so a lot of times they say, 'I'm feeling fine, doctor,' and put themselves at risk for sustaining a brain injury," said William Mee, MD, a department physician in Boston.
Director of the Micheli Center for Sports Medicine and Sports Injury Prevention at Children's Hospital
.

Between 40 and 60 percent of concussions go unnoticed in acute situations, where more obvious injuries tend to get noticed, said Rebekah Mannix, MD, MPH, of Children's Emergency Medicine in Boston
.

A new study in the Jan.
11 issue of Neurology may conclude that protein "biomarkers" in urine could be used to diagnose concussions and monitor recovery
.

have a chance to meet

In 2015, Meehan's postdoctoral fellow, Dr.
David Howell, gave a presentation at Boston Children's Hospital describing a concussion study that had just begun in college athletes
.

Moses' work dates back more than 20 years, initially as a method of detecting and monitoring various cancers
.

"In many diseases, markers of physical and biological damage enter the bloodstream and can often be found in urine," Moses said
.

A conversation soon unfolded
.

Finding Concussion Biomarkers

Before the pandemic, Moses and her team participated in an annual preseason assessment at a local university
.

"When concussions happen, we wait for those samples to come," said Cassandra Daisy of Moses Lab, who
worked with Howell and Moses Lab member Speros Varinos this study
.

Ultimately, the team collected enough samples to compare urine samples from 95 athletes: 48 athletes with sustained concussions, and 47 controls
.
To measure the protein, they worked with John Froehlich, MD, and Richard Lee, MD, of Boston Children's Urology, using mass spectrometry, along with an enzyme-linked immunosorbent assay (elisa)
.
Of the 71 proteins that differed significantly between the two groups, two were the most predictive of concussion: IGF-1 and igf-binding protein 5 (IGFBP5), both of which had significantly higher levels after concussion.
low
.
They appear to be involved in the repair of brain damage, so the body may retain them after a concussion rather than excrete them
.
Used in combination and added to gait assessments, these proteins discriminate with high reliability between athletes with and without concussions
.

While other proteins found were less predictive, many were scientifically interesting and could help understand the biological effects of concussions
.

"We were surprised what we didn't find," Daisy added
.
"Known markers of severe brain injury did not differ between concussion athletes and controls
.
Concussions appear to be very different
.
"

Testing other groups for concussion biomarkers

Armed with these concussion biomarkers, the team now aims to validate its proof-of-principle study with clinical trials in diverse populations, such as a broader population of collegiate athletes, teens participating in sports, and non-sports-related concussions patients
.
Ultimately, our goal is to develop a test that can be used at the point of care or even at the time of injury
.

"As with COVID-19, if you have symptoms but are unsure of the cause, it's best to get tested to diagnose or rule out a concussion," Howell said
.

Journal Reference :

1. Cassandra C.
   Daisy, Speros Varinos, David R.
   Howell, Katherine Kaplan, Rebekah Mannix, William P.
   Meehan, Francis Wang, Brant Berkstresser, Richard S.
   Lee, John W.
   Froehlich, David Zurakowski, Marsha A.
   Moses.
   Proteomic Discovery of Noninvasive Biomarkers Associated With Sport-Related Concussions .
   Neurology , 2022; 98 (2): e186 DOI: 10.
   1212/WNL.
   0000000000013001