Human Practices
Here at the University of Oregon, athletics is one of our prominent disciplines of excellence. Given the spotlight that we have on athletics, the University of Oregon is also well-known for being the center of ground-breaking sports medicine and human performance research. With many athletic groups and teams on campus and in the surrounding community, we wanted to work on solving an issue that was a real-time problem that we could solve in real-time.
With athletes and sports, the risk of injury is always high. Among the most common types of injuries that athletes may incur are mild traumatic brain injuries (mTBIs)–– specifically concussions. With a few iGEM UOregon team members describing first-hand experience that current concussion diagnostic methods are severely underdeveloped and inaccurate, our project was aligned to work with our local communities to address this issue using synthetic biology.
Our initial idea was to develop a rapid, point-of-care test to detect concussions using biomarkers known to be associated with mild traumatic brain injuries. The first biomarker we looked into was S100-β, which seemed promising at first. However, upon reaching out to a fellow researcher and faculty member here at the University of Oregon, Mike Harms, we realized that S100-β may not be the most viable biomarker for us to use.
In the following weeks, as we researched other potential biomarkers for our project, we also sent out a survey to a wider audience to see their thoughts on the viability and potential impact of our project. This form asked respondents about their experience with concussions, the diagnostic tests that were performed on them, and how useful they felt a rapid-test for concussions would be. The survey also asked respondents to rate their satisfaction with the medical care they received, if they received any. Many of our respondents were high school and college students who had previous experience of being on athletic teams. Many of them described feeling as if they had received inadequate medical care and how they wished there had been a quantitative way to assess the damage done to their brains immediately after the incident.
When I did my test, I was allowed to go back onto the field and continue playing. Later, I was told I had a concussion, only after I developed physical symptoms (headache, fatigue). I played 3 games of rugby with a concussion before I was removed from play.
I had been hospitalized after passing out and hitting my head due to pneumonia but I had to return to the emergency room two days later because the medical personnel failed to test for a concussion.
This shaped our project, and we decided to make a quick-acting, blood-based system in response to expert consultations and the literature. Our sensor needed to be fast as even 30 minutes on the sidelines is unacceptably long compared to the concussion tests we use now. We scrapped our plans for a saliva-based solution for this reason as all the techniques we found to detect saliva-based biomarkers would take far too long to be useful in the real world.
We realized that there is a need for rapid, quantitative tests for detecting a concussion in a patient. While the responses provided some insight into the current diagnostic methods, we wanted to hear from current medical providers from various institutions and fields to tell us about the way they diagnose concussions. As of now, we are in the process of contacting several departments within the University of Oregon, including the athletic medicine department and the HEDCO clinic on campus (a multi-disciplinary team of educators, psychologists, therapists, and scientists providing medical and behavioral health services). We also reached out to medical providers outside of the University of Oregon, and many of them have expressed an interest in our project idea.
Interview with Dr. Linda Lynch
On September 15th, 2022, we had an online interview with Dr. Linda Lynch, a senior emergency medicine physician practicing in New Mexico. With over 20 years of experience both in the clinic and on the ski slopes in the western United States, Dr. Lynch had plenty of insights to share about current concussion diagnostic methods and the demand for a quantitative measure of mild traumatic brain injuries like concussions.
Dr. Lynch shared that current diagnostic methods are often neurocognitive tests that be described as falling into two camps: immediate and comparative. Immediate concussion diagnostic methods might include some basic questions like asking for the name, the date, reciting the months backwards, and other cognitive tests. However, Dr. Lynch shared that athletes most commonly use comparative neurocognitive tests to determine if they have a concussion or not. All athletes complete a rigorous neurocognitive test prior to the season starting to get a good baseline. If there is suspicion of a concussion, the athlete must be pulled from the field for several hours to days and will complete the same neurocognitive test. The results from the test are compared to the baseline reading to determine if a concussion has occurred.
However, Dr. Lynch pointed out that many athletes may show no symptoms, either neurologically or physically (head hurting, “seeing stars”, etc.). Thus, she emphasized that a quantitative test based on blood biomarkers would be a great way to determine whether a concussion has occurred in ambiguous cases.
Dr. Lynch emphasized that our project should focus on sensitivity and specificity versus speed. Since most states already implement guidelines for pulling athletes out of the game upon suspicion of impact/concussion, it isn’t worthwhile to focus on a rapid test such as what we had previously thought. Thus, in response to this feedback, we have decided to focus on researching the complementation and binder systems for our biomarkers with more depth and modeling various combinations and assessing their efficacy and compatibility with much higher standards than before.
Interview with UO Health Services
On September 29th, we also had an online interview with health professionals at our university. We had the pleasure of talking with Dr. Anna Hejinian, medical director, Dr. Aaron Vaughan, sports medicine specialist, and Debra Beck, executive director of the UO University Health Services. Our hope is to provide clinicians with an effective tool to assess concussions, so we wanted to understand what the ideal detection tool looks like to them. Through our interview, Dr. Hejinian shared that clinicians are very utilitarian and are driven to provide the best care for their patient. So, it is important to inform healthcare professionals of the specificity and sensitivity of our biosensor. That way, they have a better understanding of how much to trust the tool and, ultimately, inform the decision making after a suspected concussion. Debra Beck shared that, looking to sports medicine, we will need to market the tool to coaches and on-site medical support. They are the ones on the field making decisions in the heat of a game, so getting them comfortable and trusting of our new tool is crucial. Dr. Vaughan also discussed the utility of our biosensor in the Student Recreation Center and for intramural sports. Anyone participating in an active lifestyle is at risk for head injuries and concussions, so the ease of delivery is important moving forward when designing the actual tool.
Overall, in response to this feedback, we will continue conversations as we progress with our biosensor and in later stages of development, keep health professionals informed of our work, and fit the tool to their needs and protocols.