#C4CT @ Super Bowl XLVIII – A day that will change the course of concussion management

“Be the change you want to see in the world” – Gandhi

Rare is the opportunity to be a part of history, to be a part of changing the lives of millions. However after a long and extraordinary day at the United Nations last week with many of the leading minds in scientific research, clinical care, public policy, emerging technologies, legal implications, journalism and advocacy, as well as some professional athletes, I believe that #C4CT has begun the process of coordinating the key stakeholders in this quickly emerging field of concussion management. Certainly, we believe the folks at One Mind for Research are on the right track with their perspective and we are proud to assist their organization in their efforts to help organize the field. For those who heard Gen. Chiarelli’s opening remarks at the #C4CT Summit, it is clear that the military has more work to do than anyone else when it comes to dealing with concussions, TBI and other mental health issues as they relate to caring for America’s veterans.

I come at this topic from a unique perspective. My father is a scientific researcher focused on brain diseases who previously led research groups at the National Institute of Neurological Disorders and Stroke. I played both contact football and hockey in my early adolescence, continuing through high school before being awarded a football scholarship to Stanford University where I completed a degree in Management Science & Engineering with a focus on financial decisions. I then played football professionally in the Canadian Football League, where I was able to use my contacts to raise the capital necessary to start Amarantus. I strongly believe that without football, it is unlikely I would have had the opportunity to attend Stanford or start Amarantus. I am a believer in contact sports, not only because they helped me personally and have helped countless friends and colleagues of mine; I am also a huge fan of contact sports as is a large constituency of the United States and the world generally because I know from experience the dedication and will it takes to battle through physical and mental adversity.

Going forward, we intend to build upon this foundational moment by providing a safe, open forum to share information and pool resources via collaborations so that we can advance the field forward and most importantly improve outcomes for participants. I use the word ‘participants’ and not patients because the vast majority of those affected by contact sports and the military are not ill or injured. Rather, we know that participants are at a higher risk of becoming ill or injured, and so we have an opportunity to conduct meaningful scientific research before it is too late and potentially provide new solutions to not only those who have participated in the past or are participating today, but also those who will be participants in the future because there will always be participants.

When I first began discussing #C4CT with Jack Brewer and how we could put something meaningful together in the area of concussions, the magnitude of the problem had not really dawned on us – we were narrowly focused on the NFL and its ex-players. Yet, as we began interacting with key stakeholders while preparing for our inaugural #C4CT Summit in Minneapolis over the summer, it became clear there was a clear vacuum of leadership that somehow the public at large felt was the NFL’s job to fill. By no means will this blog serve to indict or acquit the NFL’s role in the concussion discussion, because without the litigation and ensuing public relations tsunami, there likely would be no concerted effort to push this issue forward publicly.  I intend to take a position rooted in common sense, that with an increased understanding of brain function and how we react to concussions, as a society we are now charged with updating our policies to properly protect our athletes and soldiers. Through our efforts, we also have the possibility of helping millions of people around the world who suffer traumatic brain injury from other causes, such as road traffic accidents and falls.  As the world population ages, brain injury from falls is set to increase, so solutions found now for contact sports participants and military personnel will serve a growing number of the elderly in future.

However, as the CEO of a company developing treatments and diagnostics for diseases of the brain, it is impossible to ignore certain facts: 4x increased incidence of Alzheimer’s among ex-NFL players and 3x increased incidence of neurodegenerative disease. What’s worse is that these numbers are almost certainly inaccurate because of a propensity among former players to deny illness or injury, and our ability to properly evaluate these diseases is limited; it is very possible the incidence may be higher. Therefore I have summarized what I believe are the salient points coming out of the January 29th, 2014 #C4CT Concussion Awareness Summit at the United Nations so that we may begin the process of planning for the next summit we expect to host over the summer.

  • There is no way to take the risk out of life, sports or the military. We are operating in an environment in which to live is to risk. However, we can manage the risk and we can attempt to treat the negative outcomes;
  • Children should not be exposed to contact sports until their brains have reached a certain level of maturity, typically achieved between 12 and 14 years of age. The brain’s ability to protect itself until that point in time is limited due to inadequate myelination of neuronal axons and the body, particularly the neck, not being strong enough to protect a child’s relatively heavy head from damage. As a result, we have to update our policies to minimize exposure of our young children and find alternative ways to protect them from peer, parental, and coach pressure until such a time when they can make informed decisions on whether to risk these types of impacts;
  • We need to monitor not only significant blows to the head, but also monitor sub-concussive impacts. The science in this area has reached a level of maturity where there are few experts in the field who will deny that sub-concussive impacts contribute to the risk of overall deterioration in brain function, and that by reducing the exposure to these we have an opportunity to improve outcomes for participants;
  • We do not currently have marketed objective diagnostic tools to both diagnose and assess the severity of a concussion, nor do objective tools exist to track the course of an injury over time. There is a major need in the field to be able to standardize best patient care, predict those who are most at risk of further injury or disease, and monitor recovery to ensure that we are providing the best opportunity for participants to safely continue engaging in activity;
  • We do not yet have the tools to understand what exactly triggers a neurodegenerative process (Alzheimer’s, Parkinson’s, ALS, CTE, etc.) , however we have strong evidence to suggest cumulative traumatic brain injuries increase the risk of neurodegenerative diseases;
  • The notion that hits to the head early on in a career or life could not somehow be involved in the initiation of a neurodegenerative process is clearly inaccurate. By definition according to every single key opinion leader on the planet, a neurodegenerative process is initiated years, and often decades before symptoms appear. Therefore, those who are suffering now and claiming that it is the result of earlier injuries appear to be within the scope of accepted scientific dogma;
  • There is no objective way to distinguish which hits are responsible for which injuries. The brain remains an extremely complex organ, with our understanding skimming only the surface of its layers of complexity;
  • New treatments are sorely needed at every step in the concussion management paradigm. There are certain treatments, such as rest, that need to be better implemented to reduce potential damage. Emerging treatments involving new molecular pathways are also a top priority, and they are most likely to be developed on the heels of diagnostic products;
  • Caregivers will remain at the center of the concussion management paradigm for years to come. We must provide the proper education to both participants and caregivers in order to allow for informed consent of the risks of participating in various activities.

At #C4CT, Amarantus announced a research collaboration with Boston University to evaluate LymPro in former NFL players. We are particularly interested in this area of research because we have long believed that LymPro may diagnose Alzheimer’s at its earliest stages, potentially before symptoms appear, and believe certain molecular mechanisms are shared between Alzheimer’s and CTE. We believe there is a unique opportunity at hand to work with current and former NFL players to evaluate new diagnostics and treatments in development for neurodegenerative diseases because of the increased incidence found among former players. We believe this research could extend not only to NFL players, but to the broader public. If this holds true, studies such as the ones we will be embarking on with Dr. Stern’s group at Boston University may serve as a harbinger for a much larger and global perspective on neurodegenerative diseases.

While the original goal of #C4CT was to promote awareness of the long-term effects of concussions, our success has now charged us with much more. We have a responsibility to engage the various stakeholders and work to build consensus and establish standards that can be implemented through proper education and disciplined oversight. We would like to thank everyone who participated in this summit in person and via webcast, as well as through social media. While we certainly planned for the day to occur as it did, we could not have predicted the impact that the venue’s significance would have on the reception of the messages delivered, and we believe the work in this area has only begun.

I thank you for taking the time to read this blog and look forward to communicating in the future.

Warmest Regards,

Gerald E. Commissiong

President & CEO of Amarantus Bioscience Holdings, Inc.

 

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Mr. Commissiong was appointed President and CEO of Amarantus BioScience in October 2011.

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