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BU-Led Study: CTE May Occur without Concussions

Progressive brain disease could be caused by repetitive head injuries

  • BU-led study explains CTE in nonconcussed athletes
  • Head injury causes brain vessels to leak protein, inflame tissues
  • 20 percent of athletes with CTE had no diagnosed concussions

A new BU-led study published Thursday in the journal Brain suggests that chronic traumatic encephalopathy (CTE) is caused by head injuries, not by concussions. The research explains why 20 percent of athletes who exhibited the early stages of the progressive brain illness postmortem never had a diagnosed concussion.

“It’s the hits to the head, not concussion, that trigger CTE,” says study coauthor Lee Goldstein, a School of Medicine associate professor of psychiatry, who also has an appointment at the College of Engineering.

The study suggests that head injuries can cause blood vessels to leak proteins into adjacent brain tissues, inflaming them. CTE is a brain disease characterized by accumulation of tau protein around the brain’s blood vessels. It is found in athletes, soldiers, and others who have suffered repeated concussions and other brain trauma and is associated with dementia, mood changes, and aggression. Concussions are injuries that impair a person’s functions, such as memory or balance.

The study’s finding is important because efforts to protect athletes focus on preventing concussions rather than repeated hits to the head, says Christopher Nowinski, cofounder and CEO of the Concussion Legacy Foundation.

“In order to reduce CTE risk” in athletes and military veterans, “there must be a reduction in the number of head impacts,” says Ann McKee, director of the CTE Center and another study coauthor. “The continued focus on concussion and symptomatic recovery does not address the fundamental danger these activities pose to human health.”

McKee and her team first examined the brains of four dead teenage athletes who’d suffered head injuries one, 2, 10, and 128 days before they died. They found a range of post-trauma pathologies, including one case of early CTE (the disease has four stages) and two brains with abnormal tau accumulations. When researchers compared the brains to those of four teenage athletes who had not suffered recent head trauma, they found that those brains did not have the same pathologies.

The researchers speculated that early CTE could result from damaged brain blood vessels that leak blood proteins into nearby tissue, causing inflammation of the brain. They tested the hypothesis by exposing lab mice to two different triggers linked to CTE: repeated head impacts and blast exposures.

They then scanned the mice brains and found leaky blood vessels, as well as persistent changes in electrical functions, possibly explaining cognitive impairment in some people after similar injuries.

“The same brain pathology that we observed in teenagers after head injury was also present in head-injured mice,” says Goldstein. “We were surprised that the brain pathology was unrelated to signs of concussion.”

The findings, he adds, “provide strong causal evidence” linking head impacts to both traumatic brain injury and early CTE, “independent of concussion.”

The researchers focused especially on capillaries, the smallest “and most important blood vessels” in the brain, Goldstein says, through which oxygen, nutrients, and waste removal occur. “Head impact results in focal disruption” of capillaries, resulting in proteins leaking into the brain, he says.

The researchers also used computer simulations from Lawrence Livermore National Laboratory and mechanical models from BU, both of which showed that triggers for concussion and CTE may be distinct.

The study, by a multinational team of universities and government agencies from the United States, Israel, Canada, and the United Kingdom, was funded by the National Institutes of Health, the Department of Veterans Affairs, the US Department of Defense, the US Department of Energy, and the National Football League, among others.

Rich Barlow, Senior Writer, BU Today, Bostonia, Boston University
Rich Barlow

Rich Barlow can be reached at barlowr@bu.edu.

One Comment on BU-Led Study: CTE May Occur without Concussions

  • Patricia Frederick on 01.22.2018 at 7:25 pm

    This article raises two questions in my mind: First, at what point do our American high schools and colleges decide that football is a threat to the health of our young people, and cancel their football programs in favor of promoting sports people can play all their lives, like golf and tennis?

    And second, if bleeding in the brain is so dangerous, what of all the older people whose doctors have them taking blood thinners to prevent stroke? Might not these blood thinners (literally the same as rat poison designed to cause rats to hemorrhage to death) be a danger to the brain? I have seen so many older friends with horrible looking bruises resulting from very minor impacts to their arms or legs in consequence of being on these medications. I would think there must be a danger of brain damage there, especially insidious since it is unseen.

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