Neurofilament light and tau as blood biomarkers for sports-related concussion

Pashtun Shahim, Yelverton Tegner, Niklas Marklund, Kaj Blennow, Henrik Zetterberg, Pashtun Shahim, Yelverton Tegner, Niklas Marklund, Kaj Blennow, Henrik Zetterberg

Abstract

Objective: To compare neurofilament light (NfL) and tau as blood-based biomarkers for acute sports-related concussion (SRC) and determine whether their concentrations at different time points after the injury are associated with prolonged time to return to play (RTP).

Methods: A total of 288 professional hockey players were followed longitudinally from September 1, 2012, to April 30, 2015. Data collection and biomarker analyses were conducted between 2015 and 2017. Associations were tested between blood concentrations of NfL and tau, and RTP time. Serum concentrations of S100B and neuron-specific enolase (NSE) were also measured for comparison.

Results: Of 288 players, 105 sustained an SRC. Of these, 87 underwent blood sampling 1, 12, 36, and 144 hours after SRC and at the RTP time point. Serum NfL concentrations 1, 12, 36, and 144 hours after SRC were related to prolonged RTP time, and could separate players with RTP >10 days from those with RTP ≤10 days (area under the receiver operating characteristic curve [AUROC] 0.82). Also, serum NfL 144 hours after SRC discriminated players who resigned from the game due to persistent postconcussion symptoms (PCS) from those who returned to play (AUROC 0.89). Plasma tau 1 hour after SRC was related to RTP but less strongly than NfL, while S100B and NSE showed no such associations.

Conclusion: Serum NfL outperformed tau, S100B, and NSE as a biomarker for SRC. From a clinical standpoint, serum NfL may be useful to identify individuals at risk of prolonged PCS, and may aid in biomarker-informed decisions with regard to when RTP should be considered.

Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Figures

Figure 1. Screening and enrollment of study…
Figure 1. Screening and enrollment of study participants
RTP = return to play.
Figure 2. Effect of age on the…
Figure 2. Effect of age on the blood-based biomarkers
(A–C) Correlation between age and blood-based biomarkers in concussed athletes and preseason sample controls (both healthy controls and gymnasts). The ρ and p value are from the Spearman rank correlation. NfL = neurofilament light; NSE = neuron-specific enolase; S100B = S100 calcium-binding protein.
Figure 3. Temporal profile of the blood…
Figure 3. Temporal profile of the blood biomarkers in concussed professional hockey players
(A–D) Dynamic of blood neurofilament light (NfL), tau, S100 calcium-binding protein B (S100B), and neuron-specific enolase (NSE) in concussed professional hockey players measured at 1, 12, 36, and 144 hours, and when the players returned to play. The black dotted lines in each plot show the median of the preseason samples.
Figure 4. Prognostic utility of the biomarkers…
Figure 4. Prognostic utility of the biomarkers at selected time points after sports-related concussion (SRC)
(A) Area under the receiver operating characteristic curve (AUROC) for the biomarkers at 1 hour after SRC in players with return to play (RTP) >10 days vs RTP ≤10 days. (B) AUROC for the biomarkers at 144 hours after SRC in players with persistent postconcussion symptoms who eventually resigned vs players who could RTP. NfL = neurofilament light; NSE = neuron-specific enolase; S100B = S100 calcium-binding protein B.

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Source: PubMed

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