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    The quest to identify a biomarker that can help discriminate between those with and without a mild TBI includes a landmark project, the REpetitive COncussion in Sport RECOS study, designed to look at the effects of repetitive concussion in athletes.

    The team have recruited non-professional rugby players who have suffered a concussion since and collected a range of data; biofluids urine, blood, saliva , results from a battery of neurocognitive tests and neuroimaging files fMRI, MRI, DTI. The key biomarkers in those biofluids — microRNAs, proteins and metabolites — will be analysed alongside the neurocognitive test results and neuroimages at the Biomedical Imaging Center at the Beckman Institute.

    By integrating and comparing biomarkers, neuroimaging and neuropsychology we can refine their individual diagnostic, prognostic and clinical utility. We can then evaluate their effectiveness to detect neural and cognitive recovery. Being able to lean on expertise from both institutions is key. At the outset of , a further key partnership was secured, when Premier League footballers signed up to the study.

    Saliva and urine samples are being taken from both players with head injuries and uninjured 'control' players by club doctors after matches. In February , headlines were made as the FDA announced the first-ever approval for a biomarker for concussion, based on measurements of proteins released from the brain post-event. It has been welcomed by the research community as an important step, but does not solve the problem of diagnosing mild TBI.

    It will tell you if a CT scan is needed for incidents that are more severe than concussion. It can exclude the more severe types of TBI which is useful to clinicians.

    But it is that line between mild TBI and non-concussion events that might prove most useful for point of care and reducing the chance of putting someone back into an environment where they risk more lasting damage — and there is no approved biomarker for this. It does, however, provide a boost for the field who are looking to develop a suite of biomarkers that can accurately diagnose mild TBI.

    But it is an outlier. If you look at biomarkers for any other pathology they are much more complex. It is likely, therefore, that the team look to develop a scoring system based on a combination of biomarkers that can provide a single clinically useful reading. At the point of care it could assess whether a mild TBI had been received, and over the ensuing weeks could be used to track recovery. Once such a suite is developed, it will be tailored over time to accommodate more specific groups — such as children.

    The outlook is promising. The RECOS project has already led to the publication of a paper , jointly published with the Beckman Institute, that identified a potential biomarker for concussion in saliva samples.

    The initial finding will be built upon as more data is brought into the fold through the RECOS study, which has been the subject of quite a significant amount of media attention as it expanded to collaborate with the Rugby Football Union in Over 2, saliva and urine samples are now being analysed. For Dr Di Pietro, there is further work to be done via Mirna Diagnostics, an entrepreneurial spinout that compliments the efforts of the academic community.

    Through the collaboration of experts and the drive to improve diagnosis and management of a severely damaging problem, there is a sense that researchers are on the cusp of a significant breakthrough. With almost 20 years of research experience with particular interest in the molecular mechanisms of TBI, she is an expert of in vitro and in vivo animal models of TBI.

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