Article

The Use of Biofluid Markers to Evaluate the Consequences of Sport-Related Subconcussive Head Impact Exposure: A Scoping Review

Details

Citation

Lember L, Ntikas M, Mondello S, Wilson L, Di Virgilio TG, Hunter AM, Kobeissy F, Mechref Y, Donaldson DI & Ietswaart M (2024) The Use of Biofluid Markers to Evaluate the Consequences of Sport-Related Subconcussive Head Impact Exposure: A Scoping Review. Sports Medicine - Open, 10, Art. No.: 12. https://doi.org/10.1186/s40798-023-00665-6

Abstract
Background Amidst growing concern about the safety of sport-related repetitive subconcussive head impacts (RSHI), biofluid markers may provide sensitive, informative, and practical assessment of the effects of RSHI exposure. Objective This scoping review aimed to systematically examine the extent, nature, and quality of available evidence from studies investigating the effects of RSHI on biofluid markers, to identify gaps and to formulate guidelines to inform future research. Methods PRISMA extension for Scoping Reviews guidelines were adhered to. The protocol was pre-registered through publication. MEDLINE, Scopus, SPORTDiscus, CINAHL, PsycINFO, Cochrane Library, OpenGrey, and two clinical trial registries were searched (until March 30, 2022) using descriptors for subconcussive head impacts, biomarkers, and contact sports. Included studies were assessed for risk of bias and quality. Results Seventy-nine research publications were included in the review. Forty-nine studies assessed the acute effects, 23 semi-acute and 26 long-term effects of RSHI exposure. The most studied sports were American football, boxing, and soccer, and the most investigated markers were (in descending order): S100 calcium-binding protein beta (S100B), tau, neurofilament light (NfL), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), phosphorylated tau (p-tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and hormones. High or moderate bias was found in most studies, and marker-specific conclusions were subject to heterogeneous and limited evidence. Although the evidence is weak, some biofluid markers—such as NfL—appeared to show promise. More markedly, S100B was found to be problematic when evaluating the effects of RSHI in sport. Conclusion Considering the limitations of the evidence base revealed by this first review dedicated to systematically scoping the evidence of biofluid marker levels following RSHI exposure, the field is evidently still in its infancy. As a result, any recommendation and application is premature. Although some markers show promise for the assessment of brain health following RSHI exposure, future large standardized and better-controlled studies are needed to determine biofluid markers’ utility.

Keywords
Traumatic brain injury; Diagnostics; Neurodegenerative disease; Fluid biomarkers; Contact sport; Heading

Journal
Sports Medicine - Open: Volume 10

StatusPublished
FundersUniversity of Stirling, FP7 Ideas: European Research Council, FP7 Ideas: European Research Council and Italian Ministry of Health
Publication date25/01/2024
Publication date online25/01/2024
Date accepted by journal04/12/2023
URLhttp://hdl.handle.net/1893/36362
PublisherSpringer Science and Business Media LLC
ISSN2199-1170
eISSN2198-9761

People (5)

Dr Thomas Di Virgilio

Dr Thomas Di Virgilio

Lecturer, Sport

Professor Angus Hunter

Professor Angus Hunter

Honorary Professor, FHSS Management and Support

Dr Magdalena Ietswaart

Dr Magdalena Ietswaart

Senior Lecturer, Psychology

Miss Liivia-Mari Lember

Miss Liivia-Mari Lember

Technical Specialist (Cognition), Sport

Professor Lindsay Wilson

Professor Lindsay Wilson

Emeritus Professor, Psychology

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