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Research paves way for saliva test for concussion

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The saliva test is particularly promising because concussion can be difficult to diagnose, especially locally, where most of it occurs, but where the baseline medical evaluation is not readily available. © Mike Bain

Distinct chemical “signatures” for concussions have been identified in the pin of elite male rugby players, researchers report.

The results potentially pave the way for a rapid, non-invasive diagnostic test for concussions that could be used on the field and after the game at all levels of participation, suggest the study team.

A patented salivary concussion test is being marketed as an over-the-counter test. However, at this point it will only target elite male athletes.

Meanwhile, the researchers aim to collect further samples of players in two top men’s rugby competitions in order to provide additional data to expand the test and develop its use.

They are also conducting several additional studies to further validate and expand the test for use in different groups that were not included in this study, including female athletes, young athletes, and participants in community-level sports.

The study team, whose results are reported in the British Journal of Sports Medicine, believe their test could be used alongside gold standard head injury protocols used in elite sports.

The saliva test is particularly promising because concussions can be difficult to diagnose, especially at the local level, where most of them occur, but where the baseline medical evaluation by qualified clinicians during and after a match. is not readily available, they add.

As a result, a high percentage of concussions are missed and concerns have emerged regarding the long-term brain health of athletes exposed to repeated concussions.

The short-term consequences of a missed diagnosis range from a prolonged recovery period, often accompanied by prolonged and overwhelming symptoms, to an increased risk of further injury, including catastrophic brain swelling, although this is rare, pointed out. Researchers.

In the absence of objective diagnostic tests for concussion, diagnosis currently relies on a clinician’s interpretation of observed signs and symptoms and the results of formal clinical assessments.

But recent technological advances in gene sequencing have allowed scientists to examine the diagnostic potential of molecules called small non-coding RNAs, or sncRNA for short. They regulate the expression of different cellular proteins linked to various diseases, such as cancer and Alzheimer’s disease.

The researchers therefore obtained saliva samples from more than 1,000 professional male players from the top two levels of England’s top rugby union over two seasons of competition.

Samples were collected before the start of the season from 1,028 players and during standardized head injury assessments “baseline” at three specific times: during the match, immediately after, and 36 to 48 hours later at 156 of these players.

Saliva samples were also collected from a comparison group of 102 uninjured players and 66 who had suffered muscle or joint injuries, and therefore had not been assessed for a head injury.

A combined panel of 14 sncRNA differentiated players with concussion from those suspected of having head trauma, but whose head trauma assessments had excluded concussion, and from the comparison group, both immediately after the game and 36 to 48 hours over. late.

This was an observational study, the study team pointed out, and its design clearly shows that sncRNA biomarkers cannot surpass the benchmark clinical assessment.

But it is believed that saliva can receive cellular signals directly from the cranial nerves in the mouth and throat, and therefore can quickly register traumatic brain injury, making a saliva test particularly suitable for field-level diagnosis, suggest. -they.

“Concussions can be difficult to diagnose and are often missed, especially when a structured assessment by an expert clinician is not possible – for example, at the local level,” they write. “Small non-coding RNAs can provide a diagnostic tool that could reduce the risk of missing this type of injury at all levels of involvement,” they suggest.

“In community sport, [sncRNAs] can provide a non-invasive diagnostic test comparable in accuracy to the level of assessment available in a professional athletic setting, “while the test could be added to current protocols for assessing head trauma at the elite level,” they add. .

And since the biology of concussion is still not fully understood, sncRNAs could help shed light on the response to injury as it evolves over time, they suggest.

“The detection of concussion signatures at early times in saliva (a biofluid collected non-invasively) presents both at the field level, and in primary care and emergency medicine departments, an opportunity to develop a new objective diagnostic tool for this common clinical presentation ”, they conclude.

At the end of last year, at a roundtable published alongside the Journal of Neurotrauma, experts stressed the urgent need for objective markers to diagnose concussion.

The status of blood biomarker development and point-of-care testing were reviewed by the expert panel.

They said that the accurate and timely diagnosis of a concussion in the field is essential to ensure that those who have suffered a concussion are at no risk of sustaining a second injury before recovering from the first.