In this section
- Impact of genomic advances in concussion education and return to play
- Gene Variation and head injury
- How the APOE gene works
- Clinical Information about APOE types in humans
- Validated Suite of neurocognitive testing tools
- Promises and challenges for improving concussion management
- Become a member of the Athleticode Network and gain access to technologies to support personalized return to play process
Impact of genomic advances in concussion education and return to play
Recent evidence from genetic association studies point to genetic factors that play an important role in the outcome of concussion.
Members of the Athleticode Network including physicians and certified trainers will gain access to a genomic test for APOE and corresponding educational tools to assist in the return to play process. Members will also receive updated information of the latest clinical trials in the rapidly expanding field of genomics and concussion.
To date, one gene called APOE has been studied extensively in the field of head trauma response, and physicians can gain access to an APOE test and associated educational information to provide to athletes and their parents in the return to play process.
Gene variation and head trauma
Apolipoprotein E is a protein that is important in the repair and recovery of brain cells that have been damaged due to concussion.
The Apolipoprotein E protein is the result of the APOE gene.
APOE is a genetic factor that may have an effect on the outcome of patients who have suffered head injuries such as sport concussion and other forms of traumatic brain injury.
How the APOE Gene Works
The APOE gene is turned into the APOE protein whose role it is to protect neurons in the brain and help heal neurons when they are damaged.
APOE occurs in 3 forms: APOE2, APOE3 and APOE4.
APOE3 ('good' APOE) is the most common form, occurring in 65-70% of people and providing beneficial effects. APOE3 is considered the normal form of APOE. Up to 25% of the population have APOE4 (‘bad’ APOE), an abnormal form that is associated with multiple long-term health problems after concussion and other forms of TBI.
How might APOE4 contribute to concussion response
Studies looking at cell cultures, animal studies and human studies show that APOE3 is effective at protecting nerves and nerve cells against these stresses and repairing any damage that occurs. On the other hand, APOE4 is ineffective at protecting and repairing, resulting in outcomes to after nerve injury from head trauma that are poorer than in those with APOE3.
Clinical information about APOE types in humans
Studies on professional boxers dating back to the 1990s have shown that when standardized for technical knockouts, boxers who suffer chronic cognition problems are more likely to possess APOE4 than the frequency of APOE4 in the general population would predict.
The effects of APOE4 on the clinical outcome of military TBI have been examined in 14 studies with 736 people who have APOE4 and 1791 people who have not. APOE4 had no effect on the severity of the initial injury, but it was strongly associated with poor long-term outcomes.
TBI and APOE4 have been shown to have synergistic effects that increase the risk of long-term health issues.
Other studies have shown that patients with APOE4 have overall poorer clinical outcomes at 6 months after severe TBIs.
Additional information about clinical studies investigating the role of APOE in TBI is provided in the References Section.
Promises and challenges for improving concussion management
The recent recognition that concussion is associated with long-term cognitive consequences in former NFL players has raised awareness on the need for further studies of the mechanism and consequences of concussion. However, it will be many years before these studies fully uncover the environmental and genetic influences on concussion with sequellae.
Until then, and without any approved medical therapy for concussion, physicians and certified trainers with training in concussion management will use their clinical acumen to examine athletes and counsel parents during the return to play process.
Athleticode’s technologies are designed to assist the physician in this process. Athleticode’s mission is to assist members of the Athleticode Network in developing data-driven, robust and invidualized strategies for athletes that could include the following:
- Athletes with an APOE4 allele may benefit from a safety buffer into their own path back to the field (e.g., an extra week off and other ‘safety buffers’ in return to play strategy
- Increased ImPact testing frequency
- Scheduled ‘well patient’ visits to monitor baseline
- Strict adherence to ‘healthy brain’ protocols such as supplemental omega3, etc.
- Upon multiple concussions and APOE4 alleles, consideration of change of sport
As more information is gathered by the scientific community, return to play after sport concussion will change to reflect current best practices. Athleticode’s mission is to assist physicians and certified trainers; and athletes and their parents, during these important times.