However, this changed dramatically with the recent death of 26-year-old Chris Henry, a former NFL wide receiver who participated in 55 NFL games with no history of concussion, but who possessed a particular variant of a brain protein responsible for protecting neurons called APOE4. An autopsy requested by Chris’ family revealed severe neurodegenerative damage in this young player who had never suffered an on-field concussion.
Athletes and the rest of society quickly grasped the implications – concussions are not a prerequisite for cognitive or neuropathological problems that athletes with head trauma may develop. Nor is the syndrome of chronic traumatic encephalopathy (CTE) – a condition that can currently only be diagnosed at autopsy – restricted to older, battle-scarred athletes. In fact, logic suggests strongly that someday soon we will be reading the first report of an even younger athlete than Chris with evidence of CTE.
Chris’ death sheds light on just how little is known about the biology of what happens over long periods of time when the brain experiences high impact forces and – importantly – about the role that genetic variation among athletes might play in the response to repeated head trauma.
Like 25% of the population, Chris is reported to have had one copy of the APOE4 gene variant. Previous reports of athletes experiencing multiple head injuries showed that the APOE4 Code is present in higher frequencies in athletes experiencing cognitive and/or behavioral difficulties than in members of the general public.
While additional research is needed, there is now strong suggestive evidence that at least some athletes with multiple concussive or even sub-concussive head injuries are at a higher risk of cognitive and/or behavioral problems later in life. For example, in studies involving former NFL players, it has been shown that about half of the players developing cognitive problems possess at least one copy of APOE4.
Think about this. If NFL players possess APOE4 at the same frequency as the general public, this would mean that 400 NFL players have the same APOE4 variant as Chris did. This fact alone calls for comprehensive longitudinal studies that track outcome based on genetic status of APOE4, and for research to search for possible additional gene variations associated with head trauma, concussion or their sequelae. Yet, to date, this call to action has not resonated among the teams, the league, or even players.
And let us not restrict our thinking to the NFL or even football – think about college and yes, even think about high school athletes participating in soccer, ice hockey, lacrosse and any sport in which an athlete could hit their head. The fact is that genetic testing, baseline cognitive testing, and rigorous longitudinal assessment are the primary research tools we have. And of these, genetic testing may well prove to be crucial for arming athletes and those around them with information about possible risks associated with playing. But if athletes are not tested, then by definition this important information will never be available.
Genetic testing of athletes must be deployed in many studies of various cohorts of athletes in a variety of sports. Responsible studies must start now, around the country and around the world.
Athleticode was founded on the premise that genetic information can be used as one of many important tools to help athletes reduce injury. Of the key members of Athleticode management, four of us are former NFL players. Like other former and current NFL players, we suffered many concussions among us. We endured weeks of double sessions characterized by day after day of splitting headaches, yet played on. We played through the dizziness of big hits, doing everything possible to minimize our symptoms of head trauma to stay on the field of competition.
We talked about these times at a recent all-hands meeting, and we decided to do our part to set the stage for a better day for all athletes who might experience head trauma.
Today we call on both the NFL and NFLPA to join us in advocating for genetic research on not only APOE but other as yet undiscovered genes that may be implicated in susceptibility to and response to not only concussion, but also repeated sub-concussive blows.
Immediate action is required, and we will act. Effective immediately:
- Athleticode’s Athlete Report will now provide customers who sign up for APOE testing with information regarding their APOE Code and actionable advice to reduce the incidence of sport-associated head trauma and its possible consequences.
- Athleticode is developing comprehensive plans to offer research testing, at a discounted price, of APOE and other gene codes previously implicated in response to concussion, in order to create a database of NFL Players – past and present – to serve as a resource to all academic institutions seeking to conduct longitudinal studies of the role of genetics in influencing player health and outcomes.
- Athleticode will establish a network of interdisciplinary academic and business collaborators to enhance the understanding of the basic mechanisms of head injury and injury response, and to speed the development of new technologies and approaches to identifying, preventing and treating the consequences of repetitive head injuries.
- Athleticode will make a donation from the proceeds of every Athlete Report sold to the general public to support neurologists and other professionals conducting systematic cognitive testing on athletes in order to help these athletes establish a cognitive ‘baseline’ that can be measured over time.
- Athleticode will publish information on ‘actionable’ steps athletes can take to improve brain health, including those related to pre-habilitation exercises, diet and other decisions controlled by the athlete.
Athleticode is committed to working with you, the athletes, to provide you with the latest information in an area of sports science that is moving fast, but that is of critical importance for identifying – and protecting – athletes at greatest risk of injury.
As former players, our motivation is to assist young athletes by serving as a resource of the most valuable asset that can be currently offered – Knowledge. In sport concussion, knowledge is an actionable end – truly in these times, knowledge is power.
Join the team – contact Athleticode today to lend your voice to this effort.
Athleticode Inc. Co-Founders
Jim Kovach | Pete Koch | Hoby Brenner