MICRO-RNAS AND THE DIAGNOSIS OF CONCUSSION

A concussion is not only something which I myself have experienced as well as seen firsthand on the Rugby field, it is also an issue that is prevalent in most sports across the world.By NHS definition a concussion is a temporary head injury to the brain caused by bump, blow or jolt to the head.A concussion can vary in severity, which affects the subsequent intensity of symptoms and duration of symptoms. Concussions are most commonly associated with contact sports such as Rugby, the rate of concussion within Rugby actually rose for the seventh year running to 20.9 concussions per 1,000 hours of match play.

Within Sports and Exercise Medicine it is crucial  to diagnose concussions as quickly as possible to assess whether someone is fit to carry on playing and determine the severity of symptoms.This, in turn, will help prevent the occurence of a catastrophic head injury if the player returns to playing prematurely and also allow for adequate rehabilitation for patients suffering prolonged concussive  symptoms. Whilst there are indicators of a concussion (which are used within the standard Head Injury Assessment)  these aren’t conclusive and are often subjective, however the University of Birmingham may have developed an alternative more effective way of diagnosing concussion.

The ‘Birmingham Concussion Test’ involves the testing of saliva and urine for the presence of specific microRNAs  (which act as biomarkers) after suspected concussions.The levels of these microRNAs will then be compared to baseline levels collected at the start of the match .Within minutes of a head injury, the body responds by producing specific microRNA, which if detected when samples are analysed, indicate the player has a concussion.

MicroRNA (miRNA) is a small non-coding mRNA strand which is involved in gene silencing and the RNA interference pathway, where miRNA controls post-transcriptional regulation of gene expression, allowing it to affect the  expression of specific genes.However, what makes it a good biomarker is the fact that it is more stable than mRNA and additionally miRNA is less susceptible to degradation than mRNA.MicroRNA is transported in exosomes which are vesicles present in most, if not all eukaryotic fluids.

The research commenced in 2017 where the study was conducted in Aviva Premiership Rugby for the 2017/18 season and the results are currently being analysed.Currently, further research is being undertaken within the Premier League for the 2018/19 season to provide even more evidence for the reliability of these biomarkers in diagnosing concussions.

If this research is proven to be successful, then the University of Birmingham will work with their industrial partners to implement a handheld device which will be able to instantly diagnose concussion pitch-side rather than the samples being sent to a laboratory.

In conclusion, this fascinating research being conducted by the University of Birmingham has the potential to significantly impact the diagnosis of concussion and management of players in sports across all skill levels.However, this piece of technology wouldn’t be limited to just sports, it would prove a useful tool for the military as well as Accident and Emergency within the NHS, to improve treatment and diagnosis in the first critical hour after brain trauma.Furthermore ,microRNA,which has been proven to be an effective biomarker, could potentially be used in the detection and identification of cancers and neurodegenerative diseases in the future.

Fozy Ahmed

Photo Credits due to: GETTY IMAGES

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254405/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844919/

https://www.birmingham.ac.uk/news/latest/2017/08/rugby-concussion-major-study.aspx