New technology that could pave the way for an objective test to diagnose a concussion at the side of the field has been hailed as a “game changer” by researchers. The test, performed on saliva samples, has the potential to be used in high impact sports such as elite rugby and football where head injuries are common, as well as locally and in other areas of life.
The research team, led by the University of Birmingham and funded in part by the Rugby Football Union, published the study in the British Journal of Sports Medicine. Identifying biomarkers in saliva creates the possibility of a non-invasive clinical test for concussion.
According to the report’s first author, Dr Valentina Di Pietro, the technology to make the test available at the field edge could be developed within three to five years. RFU chief medical officer Dr Simon Kemp says the samples, which currently require lab analysis, could return results for practical use in the elite men’s game as early as next season.
“For the first time, we have successfully identified that these specific salivary biomarkers can be used to indicate whether a player has suffered a concussion,” said Professor Antonio Belli, lead author of the report. “We now have a non-invasive, laboratory diagnostic test using saliva, which is a real game changer, and provides an invaluable tool to help clinicians diagnose concussions more consistently and accurately.
“The test could be used not only in sport, from local to professional level, but also in healthcare and military settings. In community sports, these biomarkers can provide a diagnostic test that is comparable in accuracy to the level of assessment available in a professional sports environment. “
The breakthrough of the study is the identification of these biomarkers in saliva, but the practical use of the technology in real life will depend on further testing and ratification by player unions and governing bodies. Kemp said: “The best of times is we could see some real-time results sent back next season in the elite men’s game.”
However, the study has nothing to say about the levels of damage to a player’s brain incurred in a given event, let alone participation in a given game, let alone a season or career. Definitive answers to these questions are still available decades from now, but if the kind of science revealed by the Birmingham study can begin to give objectivity to timely brain damage detection, the benefits could resonate throughout. sport and beyond.
The issue of brain damage in rugby has been brought to the fore by a group of former players who are suing gaming authorities after being diagnosed with dementia premature, which they claim was caused during their career in rugby.
The identified biomarkers are called microRNAs, discovered in 1993. They are interesting because the changes observed following injury are precursors to the production of the type of protein molecules usually tested as biomarkers. They are also much smaller. This makes it a more sensitive gauge of neurotrauma.
“They work differently from protein biomarkers,” Belli said. “MicroRNAs are messages that cells transmit in response to an event, such as a brain injury. These are codes that cells send to each other to say, “You don’t need these genes” or, “You need these other genes,” in response. And the place where you find the most microRNAs is saliva. The salivary glands are connected directly to the brain by nerves. We see this response a few minutes after the injury. “
The study will now expand into other areas, examining the role of these biomarkers in women’s sport, among young people and in the community.
There are also plans to collect further samples from two as yet unidentified elite men’s competitions, subject to ratification at the upcoming World Rugby Wellness Symposium at the end of this month and by relevant player unions. .
The main authors of the report, Belli and Di Pietro, are the founding members of a company called Marker Diagnostics, which is in the process of trying to develop an over-the-counter test. This would revolutionize the safety of sport at the community level, but significant obstacles remain.
Many other factors contribute to the challenge of making the test available at the pitch. Saliva samples are analyzed by the polymerase chain reaction method, such as in tests for Covid-19, which means they must be sent to a lab. Di Pietro notes how quickly the lateral flow test has been developed for Covid-19. This was achieved in a national emergency, but she maintains that the prospects for similar development of a field-side test are realistic. “I think the technology will be there in the next three to five years.”
Meanwhile, the definition of when a player suffered a brain injury remains inaccurate. The parameters of the Birmingham study mean that the “correct answer” for whether or not a player has suffered a brain injury is provided by the HIA, a test that relies solely on the symptoms presented by a player. These can vary from individual to individual and there is no way to assess how they might be related to the broader crisis of some sports regarding neurodegenerative conditions later in life. The current study, for now, is based on that old-fashioned symptom survey. The hope is that one day these roles will be reversed.