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Research by scientists at the BU School of Medicine has raised national awareness about the effects of repetitive head trauma on former football players whose brains were studied after their deaths. Now a $6 million cooperative grant from the National Institutes of Health (NIH)—bolstered by major funding from the National Football League (NFL)—will enable researchers at BU’s Center for the Study of Traumatic Encephalopathy (CSTE) to share their results with scientists around the world through a national tissue bank and database. The grant, to be shared with two other institutions, is one of eight new NIH-funded projects aimed at understanding the long-term effects of repetitive brain injury and improving diagnosis of concussions, according to an NIH announcement released last month. At BU, the funds will also help lay the foundation for developing a diagnosis of chronic traumatic encephalopathy (CTE)—the degenerative disease researchers here discovered in the brains of scores of deceased former NFL players—in individuals during their lifetimes.
The new NIH grants are funded largely by a $30 million donation from the NFL, which in 2012 formed the Sports and Health Research Program, a partnership with the NIH and the Foundation for the National Institutes of Health for research on injuries in athletes, chiefly brain trauma. The cooperative grant, which BU will share with brain imaging teams at Washington University in St. Louis and Boston’s Massachusetts General Hospital, will fund the establishment of a national CTE tissue reference bank accessible to experts around the world, says Ann McKee, a MED professor of neurology and pathology and a codirector of the CSTE, based at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Mass. The CSTE was created in 2008 as a collaborative venture between MED and the Sports Legacy Institute (SLI), which funds concussion research and education. The mission of the CSTE is to conduct research on the neuropathology, pathogenesis, and clinical presentation of CTE, as well as genetic and environmental risk factors and ways to prevent this progressive dementia.
Six years after McKee first identified CTE—at that time believed to occur almost exclusively in “punch-drunk” boxers—in the brain of a former NFL player, the condition still needs to be specifically defined, and clear criteria established to distinguish it from other degenerative brain diseases such as Alzheimer’s, McKee says. The brains of the former NFL players studied all showed severe damage in the frontal cortex, the part of the brain connected with insight, judgment, and intellect. That area was “completely congested and filled up with tau, an abnormal protein that forms tangles that strangle and destroy brain cells,” says McKee.
Diagnosed posthumously, CTE is an insidious degenerative disease with no known cure, so there is widespread and often false hope for experimental tests that might identify the disease in a living person. But before a reliable scan or other test is developed, “we need to validate the criteria” for the disease, says McKee. The new grant will drive this crucial first step. “We’ve been criticized in the past for being too insular,” she says. “Now we’re going to all the experts in the field, asking them to look at the tissue we’ve studied. Eventually there will be a web-based tissue site.”
Traumatic brain injury is a major public health problem and the leading cause of death in young adults, according to the NIH. McKee and her colleagues in the growing field of repetitive brain injury research are not only identifying the long-term brain damage caused by these injuries, they are striving to predict who, among football players and others at risk, is likely to recover and who will go on to suffer the degeneration known as CTE.
The grant provides “the long-awaited chance to fund our brain bank,” says McKee. “We’ve made tremendous progress; now we really need to spread out and study all different aspects of this disease, with researchers from all over the world—a wide net of researchers with different skill sets—addressing issues like genetic susceptibility and the nature of brain degeneration. The broader view is to apply what we know pathologically to clinical complications, to identify this disease in living people.”