Sports Medicine Research: In the Lab & In the Field: Concussion Risk is Hiding in Your Genes (Sports Med Res)


Monday, October 23, 2017

Concussion Risk is Hiding in Your Genes

Genetic Polymorphisms Associated With the Risk of Concussion in 1056 College Athletes: A Multicenter Prospective Cohort Study

Terrell TR, Abramson R, Barth JT, Bennett E, Cantu RC, Sloane R, Laskowitz DT, Erlanger DM, McKeag D, Nichols G, Valentine V, Galloway L. Br J Sports Med. 2017. Ahead of print

Take Home Message: A college athlete with a specific genetic variation at IL-6R has almost 3.5 times greater risk of concussion and an athlete with a genetic variation at APOE4 had a 40% lower risk.

Several of the concussion sport guidelines highlight the need to identify athletes at risk for poor outcomes, and suggests one way to do so is through genetic testing; however, these statements also point out that there are significant biases and a need for more studies in this area. Therefore, the authors evaluated the association between the risk of concussion in college sports and 8 genetic variations from 4 genes that are related to structural neuronal integrity (APOE, MAPT) and release of pro inflammatory signals (IL-6R). The authors included 1056 college athletes (~20 years of age; 80% male; 65% football, 20% soccer) from 23 sites that had genotyping for one or more of these variations. Overall,133 athletes sustained a concussion during an average of 3-year surveillance per athlete. The authors found that an athlete with a specific variation in IL-6R was at almost 3.5 times greater risk for a concussion. Additionally, an athlete with a specific variation in APOE4 had almost a 40% lower risk for a concussion.

This analysis was the largest cohort to investigate the association between genetic association and sport concussion. However, there were still large differences between groups, and the number of athletes with a concussion was low, which prevented the authors from verifying these results in another study sample. Nevertheless, it is still interesting to note that even after controlling for confounding factors (sex and years of experience) that IL-6R was associated with a 3 times greater risk of concussion. It was surprising to see APOE4 was associated with a decreased risk of concussion, since previous researchers found it to be associated with an increased risk of suffering from Alzheimer’s. Genetic testing could allow medical professionals to determine if an athlete may be at risk for poorer outcomes following a concussion. While this study had many strengths it would be helpful if everyone was tested for the same genes/variations and if they could verify these results in another cohort. Genetic testing in athletes at risk for concussion should remain as part of research protocol, and not for clinical decision making or guidance. In the meantime, clinicians can use studies like this to educate patients about why some people may be more susceptible to concussions.

Questions for Discussion: Would you consider the use of genotypes to provide athletes with information about his/her risk of injury or potential outcomes following an injury?  If an athlete disclosed that he/she had a genotype that made them more susceptible to an injury, what clinical course of action might you take?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

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