A new blood test for concussion demonstrates how multiple metabolomic biomarkers have the potential to be used by medical laboratories for diagnostic testing purposes

Medical laboratories and pathology groups will soon see new blood tests that measure hundreds of biomarkers. One such test is being developed by Children’s Health Research Institute, a Lawson Health Research Institute program, and Western University in Ontario, Canada. This test, based on metabolomics, has been shown to be 90% accurate for diagnosing concussion in preliminary studies.

In an article published on Brainline.org, an organization dedicated to the prevention and treatment of traumatic brain injuries (TBIs), Melissa Duff, PhD, Assistant Professor in the Department of Communication Sciences and Disorders and the Department of Neurology at the University of Iowa, wrote, “The risk of concussion is highest in the 15- to 19-year-old age group. In addition, males are at higher risk than females.” Thus, the Lawson team focused on developing a test for the group that is most at-risk for concussion—adolescent males.

Mark Daley, PhD, Associate Vice-President (Research) at Western University, and Douglas Fraser, MD, PhD, Scientific Director, Translational Research Centre; Professor and Clinician Scientist, Western University; and, Consultant, Pediatric Critical Care/Trauma Medicine Children’s Hospital, London Health Sciences Centre, led the investigation into metabolomics and concussion at Children’s Health Research Institute. The test requires blood to be drawn within 72 hours of when the concussion may have been sustained. The team began by measuring a full spectrum of 174 metabolites.

Distinguishing Concussed from Non-Concussed Patients

Their study, titled, “Metabolomics Profiling of Concussion in Adolescent Male Hockey Players: A Novel Diagnostic Method,” published in the December 2016 issue of the journal Metabolomics, had 12 concussed and 17 non-concussed participants. The researcher’s stated objective was “To determine if concussions in adolescent male hockey players could be diagnosed using plasma metabolomics profiling.”

Mark Daley, PhD, Associate Vice-President (Research) at Western University, in the Lawson Research press release, states, “With fine tuning we can now look at sets of as few as 20-40 specific metabolites and maintain the diagnostic accuracy level of the test over 90 percent.” (Photo copyright: Podium.)

Mark Daley, PhD, Associate Vice-President (Research) at Western University, in the Lawson Research press release, states, “With fine tuning we can now look at sets of as few as 20-40 specific metabolites and maintain the diagnostic accuracy level of the test over 90 percent.” (Photo copyright: Podium.)

“We looked at all of these metabolites in concussed male adolescent patients and in non-concussed male adolescent patients and it turns out that the spectrum is really different,” said Daly in the Lawson Research press release. “There is no one metabolite that we can put a finger on, but when we looked at all of them, those profiles are different enough that we could easily distinguish concussed patients from non-concussed,” he added.

The researchers immediately realized there was a difference in the metabolomic profiles of the two groups. Fraser said, “We looked at a host of patterns and it appears that those who suffered a concussion have a very different pattern than those who have not had a concussion.”

After realizing that there was a clear difference in the metabolomic profiles of patients with concussion and those without, the researchers began narrowing down the spectrum of metabolites they looked at. “With fine tuning we can now look at sets of as few as 20-40 specific metabolites and maintain the diagnostic accuracy level of the test,” said Daly in the Lawson press release.

Fraser is optimistic about the future of the research. “With further research, we anticipate that our blood test will also aid clinicians in predicting concussion outcome, as well as aid rehabilitation after concussion,” he stated in the Lawson press release.

Metabolomics and Time for Healing

Complicating the issue of recovery is the fact that the time it takes to heal varies from patient to patient. In the Brainline.org article, Duff said that although most children will make a full recovery, “it is important to remember that recovery can take days, weeks, and even months and that a number of cognitive and physical symptoms are possible.”

And according to a study published in the journal Neurosurgery Clinics of North America, “Heterogeneity of disease and progressive nature mean that applying metabolomics to predicting secondary events and/or long-term risks could be highly impactful.” In other words, the more studies into metabolomics and brain injuries such as concussion there are, the more likely it will be that researchers will be able to identify long-term effects or the likelihood of secondary events.

This new multi-analyte test, which incorporates more than 100 biomarkers, is an instance of researchers creating a diagnostic test that can be used for athletes who are otherwise healthy, but have suffered blows to the head with the potential to be concussive. Thus, it creates a new channel of diagnostic testing—but one that has demonstrated value to both the patient and
the healthcare system.

As the understanding of metabolomics and biomarkers continues to expand, clinical pathologists will see more demand for the processing of such tests. In fact, tests that are designed for otherwise healthy individuals, such as student athletes who may have concussions, could create a new channel of diagnostic testing.

—Dava Stewart

Related Information:

Patient Information: Concussion 

Management of Sports-Related Concussion in Children and Adolescents

Western and Lawson Scientists Develop Game-Changing Blood Test for Concussions

Identification of Candidate Biomarkers of Brain Damage in a Mouse Model of Closed Head Injury: A Metabolomic Pilot Study

Metabolomics Profiling of Concussion in Adolescent Male Hockey Players: A Novel Diagnostic Method

Concussion Treatment: Acute Concussion

Role of Metabolomics in Traumatic Brain Injury Research