Executive Summary: Sports & Health Research Program Stakeholders Meeting

 

March 31, 2015
Marriot Marquis, Washington, DC

The Sports and Health Research Program (SHRP) is a public-private partnership of the National Institutes of Health (NIH), the Foundation for the NIH (FNIH) and the National Football League (NFL), aimed at addressing major public health issues related to sports participation. Launched in 2012, SHRP was made possible by a $30 million commitment from the NFL with an initial focus on traumatic brain injury (TBI). To date, SHRP has supported three Requests for Applications (RFAs), and in December 2013 announced the selection of eight projects to address fundamental problems related to TBI, including understanding the long-term effects of repeated head injuries and improving diagnosis for concussions.

On March 31, 2015, 39 scientists and clinicians reviewed current SHRP projects, received an update on a longitudinal clinical study and discussed pilot projects on sports-related brain injury. Organized by Patrick Bellgowan, Ph.D., from the National Institute of Neurological Disorders and Stroke (NINDS), and Stephanie James, Ph.D., Director of Science for the FNIH, the meeting brought together experts in concussion, TBI and chronic traumatic encephalopathy (CTE) as well as stakeholders from sports and military interests and representatives from several NIH Institutes and the FNIH.

NIH Investment in TBI Research

TBI research at NIH encompasses the full range of TBI severity, from mild (concussion) through severe TBI (car crash or serious fall). NIH funded $87 million in research projects on TBI in FY 2014 with NINDS contributing approximately 60 percent of these funds. As part of an international initiative for TBI research (InTBIR) aimed at lessening the global burden of TBI by 2020, NIH is currently funding two large TBI clinical research programs (ADAPT and TRACK-TBI) to collect data to determine what treatments work best for which patients. NINDS also supports the FITBIR Informatics System, a $10 million project funded by the Department of Defense (DOD) as a central inter-agency repository for sharing TBI data. Together with the DOD and the Uniformed Services University of the Health Sciences (USUHS), NINDS founded the Center for Neuroscience and Regenerative Medicine (CNRM ), a collaborative Federal intramural TBI research program that brings together clinicians and scientists across disciplines.

Concussion: The Scope of the Issue

Although concussions are the most common type of TBI, little is known about what happens in the brain at the time of concussion. Key open questions surrounding concussions revolve around:

  • Pathophysiological targets for acute diagnosis and treatment
  • Effects of TBI on brain development in pediatric and adolescent populations
  • Mechanisms of post-concussive syndrome (PCS)
  • Increased vulnerability to prolonged PCS with repeated concussion
  • Characteristics of TBI associated with tau deposits
  • Predicting an individual’s risk for chronic traumatic encephalopathy (CTE), a neurodegenerative disorder associated with repeated concussion.

Collaborative Agreements (U01 grants) on CTE and Delayed Effects of TBI:
Neuropathology and Neuroimaging Correlation

In March 2013, NIH released a Request for Applications and selected two four-year projects, each funded at $6 million, aimed at studying the neuropathology associated with CTE and the delayed effects of TBI for the development of in vivo diagnostic tools.

Pilot Projects on Sports-related Brain Injury

SHRP is currently funding six pilot projects focused on developing new ways to diagnose and treat athletes who suffer concussions. These are up to 2 year projects, collectively funded at approximately $2 million. The themes for these projects are:

Future Directions for SHRP

The stakeholders meeting stimulated a great deal of discussion about the high quality science being done by the SHRP. Pressing unanswered questions include:

  • How common is the CTE pathology?
  • What are the relationships between TBI and CTE?  
  • Should a next step include enlisting medical examiners to collect brain tissue from individuals who die with a history suggestive of exposure to repeated concussion?
  • Can the techniques now in use to follow outcomes in college athletes with concussion be modified for use in children?
  • Does concussion adversely affect neurodevelopment in children?
  • What neural substrates underlie adverse late outcomes in TBI?
  • Can educational models be designed to inform the broad spectrum of caregivers—from trainers to parents to physicians?

View the full summary of the SHRP meeting.