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What is the Center for the Study of Traumatic Encephalopathy (CSTE)?
The CSTE was created in 2008 as a collaborative venture between Boston University School of Medicine and Sports Legacy Institute (SLI). The mission of the CSTE is to conduct state-of-the-art research of Chronic Traumatic Encephalopathy, including its neuropathology and pathogenesis, the clinical presentation and course, the genetics and other risk factors for CTE, and ways of preventing this cause of dementia.
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CSTE in the News
The Minnesota Daily, 11/5/09: "Concussions and Repercussions" featuring Dr. Ann McKee of the CSTE
New York Times, 10/21/09: “Concussion Trauma Risk Seen in Amateur Athlete” featuring Dr. Ann McKee and Chris Nowinski of the CSTE
The New Yorker, 10/19/09: "Offensive Play: How different are dogfighting and football?” featuring Dr. McKee and Chris Nowinski of the CSTE
CBS 60 Minutes, 10/11/09: "A Blow to the Brain” featuring Dr. Ann McKee and Dr. Robert Cantu of the CSTE (video)
Fanhouse.com, 9/30/09: “Extra Caution for Concussions Needed,” featuring Dr. Robert Cantu.
Miami Herald, 9/29/09: “Florida Gators QB Tim Tebow's Status for LSU Game Uncertain,” featuring Dr. Cantu.
Forbes.com, 9/16/09: “Morey: NFL Needs to Aid Brain, Concussion Research”
US News and World Report, 9/14/09: “Three Active NFL Pro Bowl Players to Donate Brains to CSTE”
NPR, 8/26/09: "NFL: Dodging the Concussion Discussion?" featuring Dr. Ann McKee of Boston University School of Medicine (print and audio)
New York Times, 8/24/09: “Sports Imperative: Protecting Young Brains” featuring Dr. Robert Cantu, clinical professor of neurosurgery at Boston University School of Medicine
New York Times, 8/24/09: “Symptom List Helps to Gauge Head Injuries” featuring Dr. Cantu
New York Times, 6/23/09: “A Chance for Clues to Brain Injury in Combat Blasts”
NFL Players Association, 6/16/2009: "Union & League Move Forward in Studying NFL Player Concussions"
Star Tribune, 4/12/09: “More than just a bump on the head” Hockey Start Keith Primeau will donate brain to the CSTE.
New York Times, 3/29/09: “Head Injuries: Looking for Signs and Acting Quickly” featuring Dr. Cantu. Natasha Richardson's sudden death has prompted the medical community, as well as parents and leaders of recreational, youth and college sports to take harder looks at the inherent risks of brain injury.
WCVB-TV, 3/18/09: "Take An Exclusive Look Inside The Brain Bank" featuring Dr. McKee (video)
NPR All Things Considered, 1/30/09: "Sports Injuries May Cause Lasting Brain Damage" featuring Dr. McKee (print and audio)
CNN.com American Morning, 1/29/09: "Young athletes and concussions" featuring Dr. McKee (video)
WBZ-TV, 1/28/09: "Concussions Can Have Serious Long-Term Effects" featuring Dr. Stern (video)
Boston Herald, 1/28/09: "NFL called on concussions: No more head games"
The Takeaway, 1/28/09: "Does pro football cause brain injury?" featuring Dr. Stern (audio)
New York Times, 1/27/09: "New Sign of Brain Damage in N.F.L."
CNN.com, 1/27/09: "Dead athletes' brains show damage from concussions" featuring Dr. McKee and Chris Nowinski (print and video)
ESPN Outside the Lines, 1/27/09: "Brain Trauma Study" featuring Dr. Cantu (video)
TSN Sports Network Canada, 1/25/09: “Sports Legacy Institute CSTE on TSN” featuring Chris Nowinski, Dr. McKee, and athlete advisors Ted Johnson and Pat LaFontaine (YouTube video)
ReachMD, 1/5/09: “Chronic Traumatic Encephalopathy in Elite Athletes” featuring Dr. McKee (audio, requires registration)
NPR Morning Edition, 12/29/08 (audio via RealPlayer)
NPR On Point, 12/19/08: "Concussions and the NFL" featuring Dr. Stern (audio)
New York Times, 9/23/08: "12 Athletes Leaving Brains to Concussion Study," announcing the CSTE
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What is Chronic Traumatic Encephalopathy?
Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive concussions. CTE has been known to affect boxers since the 1920s. However, recent reports have been published of neuropathologically confirmed CTE in retired professional football players and wrestlers who have a history of head trauma. This trauma, which includes multiple concussions, triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last concussion or end of active athletic involvement. The brain degeneration is associated with memory loss, confusion, impaired judgment, paranoia, impulse control problems, aggression, depression, and, eventually, progressive dementia.
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Who are the Co-Directors and Founders of the Center for the Study of Traumatic Encephalopathy?
The multidisciplinary team that initiated the CSTE include the following:
Robert Cantu, M.D., Clinical Professor of Neurosurgery at BUSM; Chief of Neurosurgery Service at Emerson Hospital; and a world-renowned expert on concussion.
Ann McKee, M.D., Associate Professor of Neurology and Pathology at BUSM, and Director of the BU ADC Neuropathology Core, which involves conducting neuropathological analyses of brain tissue and maintaining the ADC Brain Bank.
Chris Nowinski, a former Harvard football player and professional wrestler who retired at age 24 due to multiple concussions; Co-Founder of Sports Legacy Institute and author of the book, Head Games: Football's Concussion Crisis.
Robert A. Stern, Ph.D., Associate Professor of Neurology at BUSM, Acting Director of the BU ADC Clinical Core, and Co-Director of the BU Alzheimer’s Disease Clinical and Research Program (ADCRP).
The non-profit Sports Legacy Institute was founded by Mr. Nowinski and Dr. Cantu. in order to advance the health and wellness of athletes and the safety of sports and athletic endeavors. SLI promotes medical and scientific research, prevention and advocacy of sports injury issues, and education. The organization was conceived after SLI and their colleagues discovered four cases of CTE in professional athletes. At the time of their deaths, all four athletes, who were under 50 years of age, had remarkable early cell death and excessive amounts of the protein, tau, throughout their brains, indicative of CTE.
For a description of these athletes and a detailed overview of SLI, Click Here.
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Initial Support and Funding
The CSTE is grateful for financial and academic support from the BU School of Medicine, as well as the BU Departments of Neurology, Pathology, and Neurosurgery, the Health and Disability Research Institute at the BU School of Public Health, and the VA New England Geriatric Research, Education, and Clinical Center. In addition, Drs. McKee and Stern received a $100,000 award to support CTE research from the National Institute on Aging as a supplement to the BU Alzheimer’s Disease Center. And, more recently, they received a $250,000 grant from the National Operating Committee on Standards for Athletic Equipment (NOCSAE).
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Selected CSTE Publications
McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, Santini VE, Lee H-Y, Kubilus CA, Stern RA. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury. J Neuropath Exp Neurol, 2009; 68(7): 709-735. [PDF]
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What will the new Center for the Study of Traumatic Encephalopathy (CSTE) be working on?
The CSTE will begin by working on three interconnected projects:
- CONTACT - Consent to Offer Neural Tissue of Athletes with Concussive Trauma
This project is a living brain donation program for current and retired college or professional athletes who agree to donate their brains upon death to the CSTE brain bank for neuopathological analysis. Subjects will also complete a yearly interview with study staff during their lifetime describing their athletic and concussion history, their educational and occupational history, as well as medical history and current cognitive, behavioral, and mood symptoms. If you are interested in participating in the CONTACT brain donation registry, please contact Megan Wulff at 617-638-6143 or mawulff@bu.edu.
Family members of deceased athletes may also agree to donate their loved one’s brain and spinal cord after their death to CSTE brain bank to be examined neuropathologically for evidence of CTE or other disorders of the central nervous system. The family member(s) will be interviewed for a history of their loved one, including their loved one’s athletic and concussion history, educational and occupational history, medical history and history of cognitive, behavioral, and mood symptoms.
In the next year, it is expected that approximately ten living current or former athletes who wish to donate their brain upon death to the CSTE brain bank will be enrolled in a more involved research study involving neuropsychological assessment (memory and other cognitive tests), MRI scans of the brain, and examination of cerebrospinal fluid. It is expected that this study will begin recruitment in early 2009.
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Selected CSTE Cases
- John Grimsley: 43-year-old NFL player
The first deceased athlete examined by the CSTE researchers was John Grimsley, former Linebacker for the Houston Oilers and Miami Dolphins, who died in February 2008 at the age of 43 from an accidental gun shot wound. Examination of Mr. Grimsley’s brain confirmed extensive CTE. In both sets of photographs, below, the brain tissue has been immunostained for tau protein, which appears as a dark brown color.
Figure 1: Tau immunostained sections of medial temporal lobe from 3 individuals
Top left: Whole brain section from a 65 year old control subject showing no tau protein deposition
Bottom left: Microscopic section from 65 year old control subject also shows no tau protein deposition
Top middle: Whole brain section from John Grimsley showing abundant tau protein deposition in the amygdala and adjacent temporal cortex
Bottom middle: Microscopic section showing numerous tau positive neurofibrillary tangles and neurites in the amygdala
Top right: Whole brain section from a 73 year old world champion boxer with severe dementia showing very severe tau protein deposition in the amygdala and thalamus
Bottom right: Microscopic section from a 73 year old world champion boxer with severe dementia showing extremely dense tau positive neurofibrillary tangles and neurites in the amygdala
Figure 2: Tau immunostained sections of frontal cortex from 3 individuals
Top left: Whole brain section from a 65 year old control subject showing no tau protein deposition
Bottom left: Microscopic section from 65 year old control subject showing no tau protein deposition
Top middle: Whole brain section from John Grimsley showing patchy deposition of tau protein in the frontal cortex
Bottom middle: Microscopic section from John Grimsley showing numerous tau positive neurofibrillary tangles and neurites in the frontal cortex
Top right: Whole brain section from a 73 year old world champion boxer with severe dementia showing very severe, patchy tau protein deposition in the frontal cortex
Bottom right: Microscopic section from a 73 year old world champion boxer with severe dementia showing dense tau positive neurofibrillary tangles and neurites in the frontal cortex
- Thomas McHale: 45-year-old NFL player
The CSTE examined the brain of nine-year NFL veteran, former Tampa Bay Buccaneer Tom McHale. They found that he was suffering from chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by head trauma, when he died in 2008 at the age of 45. McHale, a Cornell University graduate, former restaurateur, husband and father of three boys, is the sixth former NFL player to be diagnosed post-mortem with CTE since 2002.
Figure 3: Thomas McHale brain tissue
Top left: Whole mount section of neocortex immunostained for tau protein showing extensive deposition of tau protein as neurofibrillary tangles throughout the neocortex
Bottom left: High magnification photomicrograph of neocortex showing innumerable tau immunoreactive neurofibrillary tangles and neuropil neurites
Top right: Whole mount section of amygdala immunostained for tau protein showing dense, patchy deposition of tau protein
Bottom right: High magnification photomicrograph showing tau immunoreactive neurofibrillary tangles and neuropil neurites in the amygdale
Figure 4: Thomas McHale brain tissue
Top left: Whole mount section of inferior orbital cortex immunostained for tau protein showing dense, patchy deposition of tau protein
Bottom left: High magnification photomicrograph sof inferior orbital cortex howing numerous tau immunoreactive neurofibrillary tangles and neuropil neurite
Top right: Whole mount section of hippocampus and temporal cortex immunostained for tau protein showing dense, patchy deposition of tau protein
Bottom right: High magnification photomicrograph showing numerous tau immunoreactive neurofibrillary tangles and neuropil neurites in the hippocampus
- 18-year-old high school football player
The CSTE has discovered early evidence of CTE in the youngest case to date, a recently deceased 18-year-old boy who suffered multiple concussions in high school football.
Figure 5: 18 year old brain tissue
Top left: Whole mount section of frontal cortex showing very focal deposition of tau protein around small blood vessels (red box)
Bottom left: High magnification shows dense tau immunoreactive NFTs around small blood vessels (holes) and extensive tau immunoreactive neurites in the neuropil immediately surrounding the area
Top right: Another whole mount section of frontal and insular cortex showing very focal deposition of tau protein around a small blood vessel in insulara cortex (red box)
Bottom right: High magnification shows dense tau immunoreactive NFTs around a small blood vessel (hole) and tau immunoreactive neurites in the neuropil immediately surrounding the area
Figure 6: Control brain tissue
Top left: Whole mount section of medial temporal lobe immunostained for tau protein showing no immunoreactivity
Bottom left: High magnification photomicrograph of amygdala showing only extremely rare tau immunoreactivity
Top right: Whole mount section of frontal cortex immunostained for tau protein showing no immunoreactivity
Bottom right: High magnification photomicrograph of frontal cortex showing only no tau immunoreactivity
- Lou Creekmur: 82-year-old former NFL player, Member of NFL Hall of Fame
Lou Creekmur, former Detroit Lions and eight-time Pro Bowl Player, died in 2009 due to complications with dementia. The CSTE examined his brain and found substantial evidence of CTE and no evidence of Alzheimer’s disease or of any other neurodegenerative disease. Creekmur becomes the tenth former NFL player diagnosed with CTE and the most advanced case of CTE found in a football player to date at the CSTE.
Figure 7: Lou Creekmur brain tissue
Figure 7 shows dense tau deposits (brown) in the insula (1), temporal (2) and frontal (3) cortices, amygdala (4) and hippocampus (5) in the absence of beta amyloid plaques. A normal control brain would not show any brown discoloration.
- Mike Borich: 42-year-old former college football player
Mike Borich, former college football wide-receiver, died of a drug overdose in February 2009. At the age of 42, he was already suffering from Chronic Traumatic Encephalopathy. Borich played for Snow College and Western Illinois University in the 1980s, and was later a division I college coach and a coach for the NFL’s Chicago Bears. This is the first advanced case of CTE discovered in a college football player who did not play professionally. It also represents the first case of CTE diagnosed in a wide receiver.
Figure 8: Normal control brain tissue and Mike Borich brain tissue
Left: Whole mount hemi –section of 61-year-old normal control brain immunostained for tau protein (brown) and counterstained with cresyl violet (purple) showing no tau deposition.
Right: Whole mount hemi –section of 42-year-old Mike Borich immunostained for tau protein (brown) and counterstained with cresyl violet (purple) showing extensive tau deposition throughout the frontal (1) and temporal (2) gray matter.
Figure 9: Normal control brain tissue and Mike Borich brain tissue
Photomicrographs of normal control brain (top panels) and the brain of Mike Borich (bottom panels), immunostained for tau protein (brown) and counterstained with cresyl violet (purple). Virtually no tau deposition is found in the normal control brain whereas numerous tau containing neurofibrillary tangles are found in individual nerve cells of the brain of Mike Borich.
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Contact Us
For additional information about the CSTE or about how to participate in current or future research studies, please contact Megan Wulff at 617-638-6143 or mawulff@bu.edu.
Thank you for helping make sports safer
for future generations!
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