Study Identifies New Method to Diagnose Concussion Using Saliva: Salivary Concussion Test Being Commercialized
A University of Birmingham-led study of top-flight UK rugby playerscarried out in collaboration with the Rugby Football Union (RFU), Premiership Rugby, and Marker Diagnosticshas identified a method of accurately diagnosing concussion using saliva, paving the way for the first non-invasive clinical test for concussion for use in sport and other settings.
Following the team’s previous research, which identified that the concentration of specific molecules in saliva changes rapidly after a traumatic brain injury, the researchers embarked on a three-year study in elite rugby to establish if these ‘biomarkers’ could be used as a diagnostic test for sport-related concussion.
Using DNA sequencing technology in the laboratory at the University of Birmingham, the research team tested these biomarkers in saliva samples from 1,028 professional men’s rugby players competing in English rugby’s top two leaguesthe Premiership and Championship.
The results of SCRUM (Study of Concussion in Rugby Union through MicroRNAs), published today (March 23) in the British Journal of Sports Medicine, has for the first time shown that specific salivary biomarkers can be used to indicate if a player has been concussed. Additionally, the research has found these biomarkers provide further insights into the body’s response to injury as it evolves from immediately after trauma, to several hours and even days later.
The scientific breakthrough provides a new laboratory-based non-invasive salivary biological concussion test, which could have wide-reaching use and potential to reduce the risk of missing concussions not only in sportfrom grassroots to professional levelsbut also in wider settings such as military and healthcare.
In community sport, these biomarkers may provide a diagnostic test that is comparable in accuracy to the level of assessment available in a professional sport setting. While, at an elite level of rugby, the concussion test may be used in addition to the existing World Rugby Head Injury Assessment (HIA) protocol.
Marker Diagnostics, a subsidiary of Swiss biotechnology company Marker AG, is in the process of commercialising the patented salivary concussion test as an over-the-counter test for elite male athletes. It has also obtained a CE Mark for test, which has been named MDx.100.
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Distinct chemical signatures for concussion have been identified in the spit of elite male rugby players, reveals research published online in the British Journal of Sports Medicine.
This potentially paves the way for a non-invasive and rapid diagnostic test for the condition that could be used pitch side and after the game at all levels of participation, suggest the researchers.
This is especially important because concussion can be hard to diagnose, particularly at grass-roots level, where most of it occurs, but where gold standard medical assessment by trained clinicians during and after a game isn’t readily available, they add.
As a result, a high percentage of concussions are missed, and concerns have emerged about the long-term brain health of athletes exposed to repeated concussions.
The short term consequences of a missed diagnosis range from a prolonged recovery period, often with protracted and pervasive symptoms, to a heightened risk of further injuries, including catastrophic brain swelling, although this is rare, emphasize the researchers.
In the absence of objective diagnostic tests for concussion, diagnosis currently relies on a clinician’s interpretation of the observed signs and symptoms, and the results of formal clinical assessments.
But recent technological advancements in gene sequencing have allowed scientists to look into the diagnostic potential of molecules called small non-coding RNAs, or sncRNAs for short. sncRNAs regulate the expression of different cellular proteins that are linked to various diseases, such as cancer and Alzheimer’s disease.
So the researchers obtained saliva samples from more than 1000 male professional players in the top two tiers of England’s elite rugby union across two seasons (201719) of competition.
Samples were collected before the season began from 1,028 players, and during standardized ‘gold standard’ head injury assessments at three time pointsduring the game, immediately afterwards, and 3648 hours later in 156 of these players.
Saliva samples were also collected from a comparison group of 102 uninjured players and 66 who had sustained muscle or joint injuries, and so had not been assessed for head injury.
A combined panel of 14 sncRNAs differentiated concussed players from those with suspected traumatic brain injury, but whose head injury assessments had ruled out concussion, and from the comparison group, both immediately after the game and 3648 hours later.
This is an observational study, and the study design makes it clear that the sncRNA biomarkers can’t outperform the gold standard clinical assessment, caution the researchers.
But it is thought that saliva can receive cellular signals directly from cranial nerves in the mouth and throat, and so can rapidly register traumatic brain injury, making a saliva test particularly suitable for a pitch side diagnosis, they suggest.
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More information: Valentina Di Pietro et al. Unique diagnostic signatures of concussion in the saliva of male athletes: the Study of Concussion in Rugby Union through MicroRNAs (SCRUM), British Journal of Sports Medicine (2021). DOI: 10.1136/bjsports-2020-103274 – Journal information: British Journal of Sports Medicine