Concussion can be hard to diagnose and track. It doesn’t show up on routine brain scans, and there is no definitive diagnostic test. New research could lead to urine ‘biomarkers’ that could be used to diagnose concussion and monitor recovery. Using proteomics, researchers compared urine samples from college athletes with and without concussion. Two proteins thought to be involved in brain injury repair emerged as reliable concussion predictors.

«Athletes usually want to go back to their sport, so lots of times they say, ‘I feel great, doc,’ putting themselves at risk should they sustain a second brain injury,» says William Meehan, MD, a physician in the Division of Sports Medicine at Boston Children’s Hospital and director of The Micheli Center for Sports Injury Prevention. «But we’ve also had a lot of kids coming in worried, saying, ‘I’m not doing so well in school and I play soccer. Could it be a concussion?’ It would be great if a test could just tell us yes or no.»

Rebekah Mannix, MD, MPH, in Boston Children’s Division of Emergency Medicine, says 40 to 60 percent of concussions are missed in the acute setting, where more visible injuries tend to get the attention. «Concussion can be very subtle. But there are lots of reasons to want to diagnose concussion acutely — it can facilitate recovery, prevent kids from going back to sports too quickly, and avoid second-impact syndrome. We are always looking for objective markers of injury.»

New research in the January 11 issue of Neurology could lead to just that: protein «biomarkers» in urine that could be used to diagnose concussion and monitor recovery.

A chance encounter

In 2015, David Howell, PhD, a postdoctoral fellow with Meehan, gave a talk at Boston Children’s describing a study of concussion they were just beginning in collegiate athletes. Marsha Moses, PhD, director of the Vascular Biology Program at Boston Children’s approached Howell afterward. «My lab works in the urinary biomarker space,» she said. «We should talk.»

Moses’s work, going back more than 20 years, began as a way to detect and monitor a variety of cancers. Several of her team’s non-invasive urine tests are now in clinical trials. Over time, the team has also validated urinary biomarkers for chronic pelvic pain, benign prostatic hyperplasia, endometriosis, and more. Moses’s renowned urine biorepository contains thousands of samples.

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Materials provided by Boston Children’s Hospital. Original written by Nancy Fliesler. Note: Content may be edited for style and length.