{"id":69820,"date":"2019-04-10T17:02:37","date_gmt":"2019-04-10T21:02:37","guid":{"rendered":"http:\/\/www.bumc.bu.edu\/busm\/?p=69820"},"modified":"2019-04-11T08:29:29","modified_gmt":"2019-04-11T12:29:29","slug":"toward-diagnosing-cte-in-living-people","status":"publish","type":"post","link":"https:\/\/www.bumc.bu.edu\/camed\/2019\/04\/10\/toward-diagnosing-cte-in-living-people\/","title":{"rendered":"Toward Diagnosing CTE in Living People"},"content":{"rendered":"

Experimental brain scan reveals abnormal tau protein in former NFL players<\/h4>\n
\"\"
These images show areas of the brain where an experimental brain scan detected higher abnormal tau protein in a group of former NFL football players than compared to a group of control subjects. The former football players in the study have self-reported cognitive, mood, and behavior symptoms that are thought to be associated with CTE. Courtesy of the New England Journal of Medicine<\/em><\/figcaption><\/figure>\n

For the time being, the only way for scientists to detect whether a person has CTE, or chronic traumatic encephalopathy, is to examine their brain tissue after death. But to get any closer to being able to treat or even prevent CTE, researchers must first find a way to diagnose it in the living.<\/p>\n

\"\"That critical goal may finally be within sight, according to a new study published April 10, 2019, in the New England Journal of Medicine<\/em>, by Robert Stern<\/a>, director of clinical research at the Boston University Chronic Traumatic Encephalopathy (CTE) Center<\/a>, and collaborators from Avid Radiopharmaceuticals, Banner Alzheimer\u2019s Institute, Brigham and Women\u2019s Hospital, the Mayo Clinic, and University of Arizona. Their findings reveal that an experimental PET (positron emission tomography) scan on living people is able to detect abnormal brain tissue\u2014called tau protein\u2014in patterns similar to those found in the brains of deceased people diagnosed with CTE after death.<\/p>\n

Tau protein\u2014a hallmark of several neurodegenerative diseases including CTE, Alzheimer\u2019s, and certain kinds of dementias\u2014\u201cbecomes toxic and destroys brain tissue\u201d as it accumulates, says Stern. In their study, the researchers found evidence of abnormal tau proteins in living people by comparing experimental PET scans of 31 control subjects without any history of head trauma or psychological symptoms against 26 former National Football League players who have self-reported cognitive, mood, and behavior symptoms associated with CTE.<\/p>\n

The experimental PET scan detected greater amounts of abnormal tau protein buildup in the group of living former NFL players compared to the control group.<\/p>\n

\u201cIt can\u2019t yet be used for individual diagnosis,\u201d Stern cautions. \u201cWe analyzed group data, not individual findings.\u201d<\/p>\n

Yet, after a decade of doing CTE research himself, he admits it\u2019s a crucial step toward the ultimate goal of diagnosing CTE in living individuals. \u201cFrom day one,\u201d Stern says, \u201cI had hoped for there to be a tau tracer for PET scans in humans. It\u2019s such an important thing\u2026to be able to see and quantify tau.\u201d<\/p>\n

Stern says scientific data suggests that it\u2019s not necessarily concussions that cause the neurodegenerative disease known to have affected hundreds of military veterans and former NFL stars, including Aaron Hernandez, Dave Duerson, Junior Seau, and Andre Waters, among others.<\/p>\n

\u201cCTE is a buzzword these days,\u201d Stern says. But \u201ca lot of people are confused about what it is, what causes it\u2026. There\u2019s a lot of misconception out there that it\u2019s caused by concussions.\u201d<\/p>\n

Instead, repetitive subconcussive hits to the head\u2014like you commonly see in tackle football\u2014appear to be the root of the disease. Studying the brains of deceased NFL players, other athletes, and veterans\u2014BU CTE Center scientists have amassed nearly 700 such brains\u2014has yielded new clues to what drives CTE. But Stern says there are still a lot of unanswered questions, such as how common CTE is, why some people get it and others don\u2019t, and how it can be treated and possibly prevented.<\/p>\n

To find those answers, he says researchers need to be able to diagnose CTE in the living.<\/p>\n

\u201cMost importantly,\u201d to best learn about how and why the disease develops, \u201cit would be great to detect it early before it progresses to the point where there\u2019s too much destruction of brain tissue,\u201d says Stern, who is also director of the clinical core of the BU Alzheimer\u2019s Disease Center and a BU School of Medicine professor of neurology, neurosurgery, and anatomy and neurobiology.<\/p>\n

The experimental PET scans in the new study were done using two different tracers\u2014radioactive compounds designed to be injected into the bloodstream, after which they travel into the brain and glom onto specific proteins. The two types of tracers used by Stern\u2019s team, one an experimental tracer designed to detect tau and the other an FDA-approved tracer for detecting amyloid proteins, have been used over the past several years by researchers looking for signs of Alzheimer\u2019s disease. Delivered one at a time during two different PET scans, once these tracers reach the brain and get stuck to any existing tau and amyloid proteins, the PET scans can pick up their radioactive glow, illuminating their exact location and pattern inside the brain structure.<\/p>\n

The FDA-approved amyloid tracer is intended \u201cto be used in people in their 60s and above who have cognitive difficulties, but their doctor isn\u2019t sure if it\u2019s Alzheimer\u2019s,\u201d Stern says. \u201cIf they have the PET scan and it comes back negative [without any elevated amyloid], the doctor can\u2019t assume the person has Alzheimer\u2019s.\u201d<\/p>\n

Because of tau\u2019s role in Alzheimer\u2019s\u2014which affects more than 5.5 million Americans and is now the sixth leading cause of death in the United States, according to the National Institute on Aging\u2014researchers raced to develop tau tracers for use with PET scans. Stern says the combination of the two scans, amyloid and tau, may help detect the specific brain tissue patterns that make CTE unique from other neurodegenerative diseases.<\/p>\n

\u201cAt the beginning of CTE, tau is found in patchy areas around small blood vessels located deep in the valleys of the cortex,\u201d he says. From there it can spread throughout other areas of the brain, until the whole brain can become \u201cdevastated.\u201d<\/p>\n

In contrast, Alzheimer\u2019s disease starts off \u201calmost backward from CTE development,\u201d Stern says. Deep in the brain, \u201camyloid buildup seems to kick off first and then tau becomes abnormal,\u201d forming protein tangles along the spreading amyloid network.<\/p>\n

In CTE, then, you would expect to find a smattering of tau protein without the presence of elevated amyloid.<\/p>\n

The results from the experimental PET scans in the study seem consistent with those facts. Although both tau and amyloid tracers were used in the study, only abnormal tau was detected in the group of former NFL players. As would be expected with CTE, there were no abnormal signs of amyloid buildup.<\/p>\n

Looking at the group results as a whole, Stern says there\u2019s no way to interpret whether any individual person in the study has CTE, but he says, \u201cit\u2019s likely that there are people in the group who have CTE.\u201d<\/p>\n

Ultimately, these early results are a step\u2014albeit a significant one\u2014in the journey toward one day being able to diagnose individuals with CTE while they are still alive.<\/p>\n

\u201cWe need to study larger numbers of people with greater variability in their history of being hit [in the head] repeatedly and in their history of CTE-related symptoms,\u201d he says. By the end of 2019, Stern and collaborators expect to complete tau and amyloid scans of up to 240 additional people. \u201cIn the next five years or so, we will be able to diagnose and detect [CTE] during life.\u201d<\/p>\n

But whether or not the experimental PET scans on this group detected signs of CTE, or some other abnormality, won\u2019t become clear unless the study participants\u2019 brains are examined after death. To make that possible someday, Stern says, \u201cmost of them have agreed to donate their brains.\u201d<\/p>\n

This study was supported by Avid Radiopharmaceuticals, the National Institutes of Health, and the Department of Defense.<\/p>\n

 <\/p>\n

This BU Research<\/a> story was written by\u00a0Kat J. McAlpine<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

A New England Journal of Medicine<\/i> study found elevated amounts of abnormal tau protein in brain regions affected by CTE in a small group of living former NFL players with cognitive, mood and behavior symptoms.<\/p>\n","protected":false},"author":12772,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[91,90],"tags":[],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/69820"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/users\/12772"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/comments?post=69820"}],"version-history":[{"count":4,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/69820\/revisions"}],"predecessor-version":[{"id":69828,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/69820\/revisions\/69828"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/media?parent=69820"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/categories?post=69820"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/tags?post=69820"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}