Concussion and Sports-Related Brain Injury: Prevention Vs Cure?

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Much has been written and debated over recent months about the dangers of concussion incurred playing contact sports such as football, rugby and American Football. Some suggest it will compromise the attraction of the game to future players, while others go so far as to predict financial ruin for some sports but, for most running these games, there is an opportunity to show how far they can adapt the rules to increase safety and player wellbeing.  Having witnessed the level of investment made into stopping the spread of Covid and while there remains such sentiment within the City, can impact investing in Life Sciences be a strong lever for progress in this area?  Conversely, might sentiment turn negative if track records are not good?

One Nucleus’ BioWednesday Webinar discussed what R&D is underway to treat the effects of concussions, how new technologies are enabling better diagnoses and monitoring, and ultimately whether there is a case for investing in new medicines to treat the resultant disorders of which there are many related types including sub-concussive brain injury, concussion and ultimately chronic traumatic encephalopathy (CTE).

Panel

  • Mike Ward, Global Head of Thought Leadership, Clarivate (Moderator)
  • Michael Wyand, CEO, Oxeia Biopharmaceuticals, Inc
  • Hugh Nuthall, Senior Director, Search & Evaluation Neuroscience, Eli Lilly and Company
  • Claire Thompson, CEO, Agility Life Sciences
  • Eva Haas, Director, Optimum Strategic Communications
  • Will Walker-Arnott, Senior Investment Manager, Charles Stanley & Co. Limited

 

Optimum’s Key Takeaways:

  • Evidence associated with the long-term impact of sports-related concussion is still scarce and classification of severity of injury continues to prove difficult. Chronic traumatic encephalopathy can only be diagnosed post-mortem. Treating brain injury is a huge unmet need with concussion alone accounting for between 2 million to 5 million Emergency Room visits in the USA per annum and that’s just for the cases that are diagnosed.
  • The elimination of diagnosis of post-concussion syndrome from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association has affected the appetite of big pharma to invest in the area. The syndrome’s pathology overlaps with other chronic diseases such as dementia, but understanding causes and long-term effects as well as better diagnostic tools and biomarkers will be key to attracting more investment.
  • Currently the highest interest amongst sports associations and professional sports teams is in diagnostic tests and head protection, the latter as equipment, new, on-trial, regulations e.g. reduced tackle height (in rugby), higher age cut-off before children can play contact sport at grass-roots level and monitoring. There is a focus on tests that define an absence of traumatic brain injury with certain blood protein biomarker tests available, sensors in player gum shields delivering real-time data on frequency and size of collisions and so on.
  • Investors are wary of investing in therapeutics targeting concussion. A lot of uncertainty remains around indications such as concussion and depression as pathology is poorly understood and the success of therapeutics and the benefits from readouts are not well defined. It is a hard sell but the landscape is slowly shifting with better diagnostics and readouts of concussion. Additionally, the rise of socially responsible investing, where societal impact is important may provide funding, with first movers being high net worth individuals (including ex-sports professionals), Family Offices and private investors. Initial therapeutic clinical trials will mostly be in non-athletes who do not re-expose themselves to brain injury as readily as sports people, with clearer clinical outcomes/endpoints, before moving on to athletes.
  • Optimum’s Eva Haas highlighted that to secure investment and drive successful outcomes communication strategy is key. More published data, positive trial outcomes and key opinion leader engagement on the topic will boost confidence in concussion therapeutics. Claire Thompson, former Irish international footballer, and football coach commented that engaging with high profile athletes to leverage their influence and have them advocate for these therapies can have a huge impact.
  • Raising awareness of sports-related concussion with children involved in impact sports (e.g. rugby, football etc) and their parents is important. However, we should not discourage children from partaking as the benefits of sport far outweigh the risks (e.g. mental and physical health benefits, socialising etc).
  • There needs to be a shift in focus from prevention to treatments and a willingness of professional sports associations to collaborate with therapeutics companies in the space. Persistent head trauma in professional players (e.g. in rugby and American football) can have a lasting impact on an athlete’s life. Many are currently pursuing class action lawsuits against their sports’ associations. It is important for sports associations to drive change. Prevention can only go so far in contact sports.
  • Things to be optimistic about in this space: renewed interest in the brain with a surge in neuroscience investment, including some big pharma resurrecting neuroscience and neurodegeneration research units and doing strategic early-stage M&A, is bound to extend to the brain injury space as scientific enquiry and renewed understanding of the brain involving the use of AI and other cutting-edge technologies progresses.

Listen to the panel here: One Nucleus BioWednesday Webinar, 14th July 2021