State-of-the-Science Meeting Addresses CTE: Insights from the Contact Sports Community Highlighted

Drawing increasingly more public and media attention every day, chronic traumatic encephalopathy, or CTE, continues to garner substantial public concern for the potential neurodegenerative effects of repeated head trauma. With the at-risk population expanding to include a much wider demographic than originally thought, CTE is taking its toll on not only professional athletes, football players, hockey players and wrestlers, but it may also impact our military veterans as well; especially those who have a history of repeated blast exposure. Because of this parallel with the sports community, a topic of interest at the 5th International State-of-the-Science Meeting Nov. 3-5 in McLean, Virginia, was research connecting CTE to repeated head trauma sustained during play in contact sports; this was addressed repeatedly by subject matter experts in attendance. Indeed, participation by these experts was essential to the mission of the meeting.

"The DOD Executive Agent for the Blast Injury Research Program has a responsibility, based in public law and the governing directive, to reach beyond the DOD for expertise, no matter where it resides, to help solve the DOD's blast injury problems," said Michael Leggieri, director of the DOD Blast Injury Research Program Coordinating Office and planning committee chair. "It makes sense to engage the sports community for help on the topic of trauma-related neurodegeneration and the development of CTE because they are deeply engaged in this issue and have been for some time. We want to leverage the knowledge of this community."

One of these experts from the sports community is Dr. Joseph Maroon, clinical professor at the University of Pittsburgh Medical Center and team physician for the National Football League Pittsburgh Steelers football team, who started off the day 2 morning topic presentations. He began with a video of the Pittsburgh Steelers players; a compilation of the countless hits we see every Sunday, replayed over and over again on sports television networks like ESPN and Sports Center. Maroon then switched gears, showing next a video of deployed Soldiers encountering a car bomb while driving abroad.

"There is something different with blast injuries," said Maroon, addressing the difference in recovery times of athletes versus Service Members. "Most athletes recover quicker than Soldiers and Marines do. Why? I don't know why. But probably, most likely, from the talks yesterday, something happens in the brain that might be a little more disruptive with a blast injury than with a direct traumatic injury."

CTE is not limited to professional athletes; documented cases are also being found and reported anywhere from pee-wee football to the national level. With so many questions still unanswered when it comes to how one acquires CTE, meetings like the state-of-the-science meeting are more important than ever; bringing together the best and brightest in their fields to address those identified knowledge gaps associated with CTE.

"We need conferences like this," emphasized Maroon during the closing remarks of his presentation. "This is phenomenal; I think this is the highest level conference that I have seen on this subject [CTE] and I can't wait for you to distill all of the information presented, because I think it's extremely powerful."

Dr. David Cook from the Veteran's Affairs Puget Sound Health Care System and Dr. Charles Rosen from the Department of Neurosurgery at West Virginia University started off the scientific presentations in scientific session III, honing in on blast-induced neurodegenerative mechanisms. Professor Denes Agoston from the Uniformed Services University of the Health Sciences; Dr. Meghan Robinson from the VA Boston Healthcare System; Dr. Jessica Gill from the National Institutes of Health; Dr. David Okonkwo from the University of Pittsburgh Medical Center; and Dr. Dara Dickstein from the VA Medical Center and Icahn School of Medicine at Mount Sinai; all followed with presentations during scientific session IV, centering on neuroimaging and biomarker research. Dr. Ku Ping Lu from the Beth Israel Deaconess Medical Center at Harvard Medicine School wrapped up the scientific sessions with a presentation during scientific session V on treatment strategies.

This year's meeting also provided attendees the opportunity to meet and engage with 17 poster presenters Nov. 4 and 5, before splitting off into what meeting coordinators refer to as the real "meat" of this meeting.

According to Leggieri, a unique aspect of the International State-of-the-Science meeting format is the use of working groups to elucidate knowledge gaps and to formulate strategies to close the gaps and advance the science. The discussions held during this meeting are a key element, as the dialogue from this meeting is what will be used to shape and guide future medical science, research and technology strategies.

"This year we had six working groups that met on the second and third day of the meeting," explained Leggieri. "Each working group was led by a member of the expert panel. As in previous years, each working group was tasked to answer the same five questions regarding the association between blast-related trauma and the development of CTE."

Each working group was headed by a chosen subject matter expert panel member; who, this year, included: Col. Jamie Grimes, Dr. Stephen Ahlers, Dr. Kelley Brix, Dr. David Brody, Dr. William Stewart and Lt. Col. Avraham Yitzhak.

"As I observed the working group discussions, I was most impressed by the passion, commitment and focus of the participants as they applied their diverse expertise and experience to the task of identifying knowledge gaps and formulating strategies that will close the gaps and advance the science," said Leggieri. "Based on the findings and recommendations generated during the working group discussions, the expert panel members are able to formulate very specific and actionable recommendations for research and other actions that will help to fill the identified knowledge gaps, advance the science and, most importantly, improve the way we protect and care for Service Members."

Overall, the topic of this year's meeting generated a tremendous level of interest among the DOD Blast Injury Research Program stakeholders in light of the many unknowns regarding the association of blast-related trauma, neurodegeneration and the development of CTE. Currently, the PCO is preparing a detailed report of the meeting proceedings, with an anticipated completion date by the end of February 2016. Once completed, the report will be posted to the DOD Blast Injury Research Program website as well submitted for publishing in a peer-reviewed journal.