Vic researchers close in on world-first concussion blood test
A blood test that can track brain recovery after concussion is close to being approved for use in Australia, thanks to the groundbreaking work of Melbourne researchers.
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Melbourne researchers have revealed they are close to having a unique concussion blood test approved for use in Australia.
It means a simple blood test could now complement sports-related concussion protocols following world-first research on Victorian footballers.
Developed by a Monash University-led team, they published the results of their study that confirmed the blood test accurately tracked brain recovery after concussion.
Bringing a reliable blood test to market has been the Holy Grail for researchers and sporting codes, in particular for football where on average a concussion occurs every second match.
Clubs now need to rely on a mandated four-step protocol guided by concussion symptoms – often self-reported – because there is no biological (blood test) method available to show the extent of injury to help guide recovery.
At community level players can return to play 21 days after a concussion, for the AFL this period is 12 days.
Experts say this protocol, often treated as one-size-fits-all, will benefit from this new blood test as it can accurately and quickly confirm those players who have suffered a brain injury and how long their recovery is likely to be.
Importantly, in the major clinical trial it also identified that recovery was likely to take longer in concussed players who lost consciousness.
The test measures two brain-specific proteins in the blood that researchers found had changed in footballers who had suffered concussion.
Called glial fibrillary acidic protein (GFAP) and neurofilament light (NfL), the proteins are always present in the brain but released into the blood following brain trauma.
The aim of this study was to show how their levels changed over time in concussed players.
The most striking finding, said study lead Dr Stuart McDonald, was the variability in biomarker changes among individuals.
“Over 20 per cent of concussion cases showed substantial and persistent increases in both GFAP and NfL that remained elevated compared to non-concussed footballers for over four weeks,” he said.
This blood biomarker information is important, Dr McDonald says, as it confirms which players may require a longer recovery and also those fit to return to play.
The results of the study involving 137 Victorian footballers was published in the journal JAMA Network Open.
The test measured the proteins in the blood of 81 Victorian Amateur Football Association (VAFA) players who had suffered concussion. The results were then compared with 56 players from the same league who did not have the brain injury.
Dr McDonald, from the Monash Trauma Group and Monash University School of Translational Medicine said in the unique study blood biomarkers were tracked in the players over six months with each player tested eight times. He said this provided the team with invaluable data from around one thousand tests.
He said VAFA footballers were part of the focus of the study because they wanted to ensure the results were relevant to community sports athletes.
“Ultimately, we see these blood tests having the greatest utility in assisting grassroots concussion management,” Dr McDonald said.
The Monash team has published previous studies on these brain-specific proteins and their connection to concussion injury and recovery with smaller groups that included Victorian jockeys.
“The big point of difference with this study is that we wanted to look beyond that first couple of weeks and really hone in on the trajectories of these blood proteins over time,” Dr McDonald said.
“We knew we were on the right path when we saw that the profiles of these biomarkers differed substantially between cases, reflecting variation in the severity and recovery of brain injuries.”
VAFA player and study participant Rob Bambery described it as extremely important work.
The 32-year-old played for the Old Peninsula Football Club and suffered a concussion.
He said he took part in the study to better understand its ongoing impact.
“It can be easy to disregard a concussion as unlike other injuries, you are not always aware of the ongoing impact,” Mr Bambery said.
“This blood test will be really helpful for managing the unknown recovery period.
“Hopefully it can provide more definitive advice about when it is safe to return to play opposed to when you may need another week off.”
Dr McDonald says it is a misconception that concussion is a transient, rapidly recovering injury for all people as the team was able to show that for around 20 per cent of people it is not.
He said that this study adds to previous work highlighting that symptom recovery can often happen before biological recovery, meaning that it may physically appear a player has recovered when they have not.
“There are individual athletes that will have a more substantial and more enduring brain injury than others, and we need tests to help identify them,” Dr McDonald said.
The study also confirmed that testing a player 24 hours after a concussion injury was predictive of how the trajectories would evolve over time.
Lead author Monash’s Dr William O’Brien said the results highlighted that current mandated stand down periods may not be adequate for all cases of concussion.
“This is of particular concern in community sport, where medical guidance can be limited,” he said.
“Sport-related concussion symptoms are subjective, difficult to identify, and players may feel incentivised to not raise them. Furthermore, the brain continues to recover even after symptoms subside, and this ongoing recovery may make athletes more vulnerable to another concussion.”
The team now is now working to have the blood tests approved for use, saying it is feasible for them to be delivered as rapid tests and available on the market within three years.
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