title: CSF-biomarkers in Olympic boxing: diagnosis and effects of repetitive head trauma.
abstract: BACKGROUND
  Sports-related head trauma is common but still there is no established laboratory test used in the diagnostics of minimal or mild traumatic brain injuries. Further the effects of recurrent head trauma on brain injury markers are unknown. The purpose of this study was to investigate the relationship between Olympic (amateur) boxing and cerebrospinal fluid (CSF) brain injury biomarkers.
  
  
  METHODS
  The study was designed as a prospective cohort study. Thirty Olympic boxers with a minimum of 45 bouts and 25 non-boxing matched controls were included in the study. CSF samples were collected by lumbar puncture 1-6 days after a bout and after a rest period for at least 14 days. The controls were tested once. Biomarkers for acute and chronic brain injury were analysed.
  
  
  RESULTS
  NFL (mean ± SD, 532±553 vs 135±51 ng/L p = 0.001), GFAP (496±238 vs 247±147 ng/L p<0.001), T-tau (58±26 vs 49±21 ng/L p<0.025) and S-100B (0.76±0.29 vs 0.60±0.23 ng/L p = 0.03) concentrations were significantly increased after boxing compared to controls. NFL (402±434 ng/L p = 0.004) and GFAP (369±113 ng/L p = 0.001) concentrations remained elevated after the rest period.
  
  
  CONCLUSIONS
  Increased CSF levels of T-tau, NFL, GFAP, and S-100B in >80% of the boxers demonstrate that both the acute and the cumulative effect of head trauma in Olympic boxing may induce CSF biomarker changes that suggest minor central nervous injuries. The lack of normalization of NFL and GFAP after the rest period in a subgroup of boxers may indicate ongoing degeneration. The recurrent head trauma in boxing may be associated with increased risk of chronic traumatic brain injury.
authors.affiliation: Department. of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden. sanna.neselius@vgregion.se
authors.forename: Sanna
authors.initials: S
authors.lastname: Neselius
authors.forename: Helena
authors.initials: H
authors.lastname: Brisby
authors.forename: Annette
authors.initials: A
authors.lastname: Theodorsson
authors.forename: Kaj
authors.initials: K
authors.lastname: Blennow
authors.forename: Henrik
authors.initials: H
authors.lastname: Zetterberg
authors.forename: Jan
authors.initials: J
authors.lastname: Marcusson
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000134:cerebrospinal fluid*; D001914:Boxing / Q000293:injuries*; D016022:Case-Control Studies; D006259:Craniocerebral Trauma / Q000134:cerebrospinal fluid* / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005904:Glial Fibrillary Acidic Protein / Q000134:cerebrospinal fluid; D006801:Humans; D008297:Male; D009414:Nerve Growth Factors / Q000134:cerebrospinal fluid; D011379:Prognosis; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000134:cerebrospinal fluid; D011795:Surveys and Questionnaires; D014157:Transcription Factors / Q000134:cerebrospinal fluid; D055815:Young Adult; D016875:tau Proteins / Q000134:cerebrospinal fluid
chemical_list: D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; C054369:MAPT protein, human; C411985:NSMF protein, human; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D014157:Transcription Factors; D016875:tau Proteins