A CTE test in life may be closer than ever

SHICKLEY, Neb. – Chris Eitzmann seemed to excel at everything until he didn’t.

He turned a football captaincy at Harvard into a 2000 invite to Patriots training camp. After bouncing back in the NFL, Eitzmann retired from professional football in 2002, earned an MBA from Dartmouth, and worked at several major financial firms in Boston, where he and his wife, Mikaela, had four children.

In 2015, however, Chris began a descent that has become familiar to former football players with CTE, or chronic traumatic encephalopathy, the degenerative brain disease associated with repeated blows to the head.

Chris loved mountain biking, running and lifting weights, but he quit exercising and drank to excess. After a move to Mikaela’s family farm in their home state of Nebraska two years later, Chris’ behavior became more alarming. He disappeared for long periods of the day and neglected his work. His drinking got worse and she said he sometimes drove drunk.

In December 2021, Chris Eitzmann was found dead in his Boston apartment from alcohol poisoning at age 44. Nearly a year later, doctors at Boston University discovered he had CTE, a condition that can still only be diagnosed posthumously. Mikaela said knowing if her husband had the disease while he was alive would have changed the last years of his life significantly.

“If he had known it was really something, and not just this endless void of not knowing, if he had had an idea he could have held on to, that clarity and understanding would have been so valuable,” she said.

Without treatment options, a diagnosis of CTE could only provide clarity to former players such as Eitzmann who have reason to believe they might be affected. But it could eventually help current players assess the risks for when to quit football and help former players get treatment.

The researchers hope that a series of recent breakthroughs will help accelerate the development of a test for CTE in the living.

Currently, the only way to accurately diagnose CTE is to stain brain samples and examine them under a microscope to look for the presence of the specific tau proteins associated with CTE.

But if ongoing studies are successful, there could be testing for CTE in the living in as little as two years, according to a leading researcher. The future of CTE testing lies in developing ways to identify the protein without requiring brain samples. Thus, scientists from several research institutes around the world are working to identify biomarkers of the disease that can be observed in blood, saliva or cerebrospinal fluid samples or by using brain imaging scans.

Additionally, diagnostics for Alzheimer’s disease have advanced to the point where blood tests are now on the market, and the companies that developed these tests are now looking to create a similar blood test for CTE.

The most comprehensive effort to develop a test for CTE in the living began in 2015, when the US National Institutes of Health awarded a seven-year, $17 million grant to the DIAGNOSE CTE research project.

As part of the large-scale project, NIH doctors are following 120 former NFL players, 60 former college players and 60 people with no history of repetitive impacts to the head to see if they have symptoms of CTE. 2016, participants underwent a three day exam that included neuropsychological and neurological assessments and were asked to detail their history of traumatic brain injury, lifestyle and other health factors such as genetics in a comprehensive look at their health.

Participants are now undergoing remote follow-up exams to see if they have symptoms of CTE or if those symptoms have progressed, and researchers hope that changes to their tests – which include lumbar punctures, blood tests and neuroimaging scans – will help them identify biomarkers. for CTE The multidisciplinary group of 50 researchers from nearly a dozen institutions around the world is already releasing some of the results from the three-day exams.

“I now think we are much closer to having fluid biomarkers, and especially blood biomarkers, that will play an important role in the diagnosis of CTE in life,” said Robert Stern of Boston University. , principal investigator of the project.

The long search to identify CTE biomarkers reached a watershed moment in 2019, when a group identified that CTE-specific tau proteins were distinct from those in Alzheimer’s disease and other tau-based neurodegenerative diseases.

Led by Michel Goedert, program leader at the Medical Research Council’s Molecular Biology Laboratory in Cambridge, England, the group published the results of their study, which showed that the abnormal filaments, or threads inside cells, were observable, giving hope that their presence could be tested via PET scans.

Positron emission tomography, or PET, is a test that uses a radioactive compound, or radiotracer, that is injected into patients to create images of biochemical processes in the brain and other parts of the body.

The researchers developed radiotracers to use in studies of football players and others with traumatic brain injury to see if these tracers bind to the tau protein associated with CTE and brain inflammation.

“We are on the verge of advancing new radiotracers in humans to image tau which is more prevalent in CTE,” said Neil Vasdev, radiochemist at the University of Toronto and director of the CAMH Brain Health Imaging Center. , which is developing several promising radiotracers that focus on identifying tau CTE. “I like to think we’re in two to five years, not 10 years” from developing a test for CTE in the living.

Doctors leading CTE research have said for years that a diagnostic test for the living is five to 10 years away. The expectation for the finish line to move up marks a significant shift in research predictions that is complicated by a relatively small sample size of study participants and the need for long-term studies. But identifying the tracers visible on PET scans could lead to the diagnosis of CTE before its symptoms are apparent.

“In principle, this should make it possible to seek to diagnose these deposits at an early stage,” Goedert said. “You need to be able to identify people who have some of these deposits in their brain before they show symptoms.”

Still, doctors like Gil Rabinovici at the University of California, San Francisco have encountered barriers to using tracer technology. Rabinovici’s work examines how a tracer, MK-6240, attaches to tau CTE in the brains of dozens of former NFL players. The signal from these radio tracers so far has been weak.

“It’s quite difficult because you don’t know if they have CTE in life, and if you use the scan, you can’t immediately say ‘aha’ and have a level of truth in the scan,” said he declared.

The good news, Rabinovici said, is that tau proteins in Alzheimer’s disease and CTE have more similarities than differences, so researchers can use some of the same techniques for testing.

“I don’t think we have to start from scratch,” he said. “This is where I’m cautiously optimistic that we’ll find a tracer that works.”

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