Myelin Imaging in Concussed High School Football Players

A Prospective Study of Myelin Imaging Changes in Concussed High School Football Players

Investigate myelin alterations in high school football players with mTBI

Study Overview

• Status: Terminated
• Conditions: Traumatic Brain Injury
• Intervention / Treatment: Device: McDESPOT

Detailed Description

The lack of highly sensitive clinical neuroimaging and neuropsychiatric markers of subtle changes due to mTBI makes it difficult to characterize injury severity and to predict outcomes. White matter tracts in the brain, both myelinated and non-myelinated, are susceptible to damage from impact-acceleration forces experienced during a TBI,5-7 and there is evidence that significant white matter injury and myelin loss occurs in mTBI. In addition, this damage may be chronic and can negatively affect neural processing speed and cognitive function. Traditional anatomical and function MRI imaging sequences include clinical sequences such as traditional T1 and T2 sequences, fluid-attenuated inversion recovery (FLAIR), three-dimensional (3D) magnetization-prepared rapid gradient echo (MP-RAGE), diffusion-weighted imaging (DWI) and gradient MRI. While a number of advanced imaging techniques, notably magnetization transfer, diffusion tensor and quantitative T1 and T2 imaging (MTI, DTI, qT1 and qT2, respectively), have been used previously to study white matter in neurosurgical diseases, these methods provide only indirect, non-specific information related to myelin content. For example, these modalities can tell when there is swelling that is affecting the movement of water, which may be indicative of a process that would affect myelin, but they cannot give specific information about the amount of myelin surrounding a nerve. An emerging multicomponent relaxometry technique, termed multicomponent driven equilibrium single pulse observation of T1 and T2 (mcDESPOT), provides a voxel-wise estimation ranging from 0 to 1 for myelin content, with higher values providing an indirect marker of greater myelin integrity. Two studies have shown increased myelin after injury in football and ice hockey players.8 DTI, which primarily gives information about the myelin-axon bundle interactions, has shown decreased fractional anisotropy after mTBI,myelin-axon bundle interactions, has shown decreased fractional anisotropy after mTBI, indicating that the myelin that is present is less organized.8 Combining mcDESPOT and DTI findings, it is possible to see a more nuanced picture of the remyelination process after mTBI. In the present program, the investigators propose adding the mcDESPOT sequence to the MRI scanner in accordance with the MRI manufacturer's technical requirements. Although the sequences obtained for mcDESPOT are nearly identical sequences used in clinical practice, the flip-angles are changed so that they cannot be read like a traditional image.

Rather, the data have to be post-processed by a computer in order to be able to derive myelin information. The mcDESPOT sequences are FDA approved, and present no additional risk over traditional clinical MRI sequences. Apolipoprotein E (ApoE) is a class of proteins involved in the metabolism of fats in the body, and is important in Alzheimer's disease and cardiovascular disease. How the body makes this protein is genetically coded in the APoE gene. One form of this gene, APoE allele 4 (APoE4) is found in about 25% of the population, but in 60% of patients with Alzheimer's dementia. Infants with this allele also show decreased myelination at a young age. It is postulated that this defect affects the brain's ability to myelinate and remyelinate, leading to decreased or disorganized myelination, which then leads to an increased risk for development of dementia. This study aims to build upon preliminary data collected by the principal investigator (PI) showing increased but disorganized myelin in collegiate football players, by confirming and reproducing these results in a larger population. This study will also add the component of genetic testing for the APoE4 allele to see if there is a sub-segment of the study population that may be at increased risk for brain injury after mTBI and subsequent findings in the research scans. The mcDESPOT and genetic testing findings will also be correlated with routine neuropsychology concussion assessment results.

• Study Type: Observational
• Enrollment (Actual): 13

Contacts and Locations

Study Locations

• United States
  • Florida
    • Hollywood, Florida, United States, 33021
      • Memorial Healthcare System

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 9 years to 14 years (Child, Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: Male

• Sampling Method: Non-Probability Sample

Study Population

High school age (9th-12th grade), male, right-handed Diagnosed with concussion or mild traumatic brain injury

Description

Inclusion Criteria:

• Experimental Group

  • Patient age range: 9th through 12th grade (high school)
  • Male
  • Right-handed
  • Diagnosis of mTBI or concussion during a football game or training
  • No significant co-morbidities
  • Able to get an MRI

  • Potential subject must be capable of giving informed consent or assent when applicable

    • Control Group

  • Patient age range: 9th through 12th grade (high school)
  • Male Right-handed
  • Does not play contact sports (football, soccer, lacrosse)
  • No significant co-morbidities
  • Able to get an MRI
  • Potential subject must be capable of giving informed consent or assent when applicable

Exclusion Criteria:

• Unable to tolerate MRI scan

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Control
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
mTBI Study Group with McDESPOT sequence; Study group (30 subjects) of football players diagnosed with mTBI (scan at diagnosis, 3-month follow-up scan, genetic screening, concussion assessment at both interaction)	Device: McDESPOT; myelin specific MRI sequence (mcDESPOT) added to standard MRI sequence
Control Group; Control group (30 subjects) of age match non-contact sport players (scan, genetic testing, concussion assessment)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Myelin Disruption on MRI brain scan	Determine whether mTBI in football players leads to increased, but disorganized, myelin compared to non-contact sports players.	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
APoE4 allele genetic mutation on blood test	Explore whether a genetic mutation in the APoE4 allele predisposes football players to decreased or disorganized myelination after mTBI.	3 months
Neuropsychiatric concussion correlation	Correlate any changes in myelination or of genetics with neuropsychiatric concussion assessment.	3 months

Collaborators and Investigators

• Sponsor: Memorial Healthcare System

Study record dates

Study Major Dates

• Study Start (Actual): September 4, 2018
• Primary Completion (Actual): August 12, 2020
• Study Completion (Actual): August 12, 2020

Study Registration Dates

• First Submitted: October 4, 2018
• First Submitted That Met QC Criteria: October 4, 2018
• First Posted (Actual): October 9, 2018

Study Record Updates

• Last Update Posted (Actual): September 25, 2020
• Last Update Submitted That Met QC Criteria: September 23, 2020
• Last Verified: September 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Wounds and Injuries; Craniocerebral Trauma; Trauma, Nervous System; Brain Injuries; Brain Injuries, Traumatic
• Other Study ID Numbers: mTBI

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No