University of Birmingham

The University of Birmingham and University Hospitals Birmingham NHS Foundation Trust have launched a new study funded by The Drake Foundation to review and potentially enhance concussion diagnosis in football.

This new study, supported by the Premier League Doctors Group which is allowing access to players, is running throughout the 2018/19 football season. It involves saliva and urine samples being collected from injured Premier League players, as well as uninjured “control” players, by club doctors immediately post-match and at further time points over the course of a players’ recovery.

These samples are then being tested in the laboratory at the University of Birmingham using a new ground-breaking test, called the ‘Birmingham Concussion Test’, which has been developed following a decade of research led by academic neurosurgeon Professor Tony Belli.

The test looks for molecules in the blood, saliva or urine known as microRNAs, which can act as biomarkers to indicate whether the brain has suffered injury*. The patented technology from the University of Birmingham is being commercially developed in partnership with Mirna Diagnostics Limited which owns the global patent licence of these biomarkers.

This expands research also being carried out by the University of Birmingham and UHB, which began in 2017 and is currently ongoing, testing the urine and saliva of concussed Rugby Football Union players.

This research is part of the ongoing REpetitive COncussion in Sport (RECOS) study, being led by the University of Birmingham’s College of Medical and Dental Sciences and UHB through The National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR SRMRC).

In the future, it is hoped that the Birmingham Concussion Test could be used pitch-side and would have the potential to assist in return-to-play decisions or concussion diagnosis across sports, from grassroots to professional, in addition to military and other frontline settings.

Professor Tony Belli, Academic Neurosurgeon at the University of Birmingham and UHB and Director of NIHR SRMRC, said: “Early and accurate diagnosis of concussion is one of the biggest challenges we face clinically and is particularly a major concern in the sporting world.

“This exciting new study is an important addition to the breadth of research we are undertaking into concussion and player welfare in sport more broadly.”

Dr Valentina Di Pietro, molecular neuroscientist at the University of Birmingham’s Institute of Inflammation and Ageing,  said: “Sports around the world want a more reliable and objective assessment for concussion than currently exists and the test we have developed in the laboratory is the first step in the development of a pitch-side test to enhance assessment.”

Dr Patrick O’Halloran, Sports Concussion Research Fellow at the University of Birmingham, Sport and Exercise Medicine Registrar at UHB, and Academy Doctor at Wolverhampton Wanderers FC, said: “This research has the potential to benefit professional, grassroots and youth level footballers alike, making the process for diagnosing concussion as effective as possible. Similarly, this may be valuable in other sports or for patients in NHS Accident and Emergency departments.”

James Drake, Founder of The Drake Foundation, a not-for-profit organisation committed to improving evidence-based measures for the management of concussion injuries in contact sport, said: “We are delighted to fund this essential study in Premier League football. The conversation around concussion has come a long way in the last five years and scientific research such as this is essential in keeping our players safe.”

Gordon Taylor OBE, Chief Executive of the Professional Footballers’ Association, said: “We are pleased to support all our Premier League members who are taking part in this innovative study which will hopefully bring a health and safety benefit to players at all levels of our game.”

This latest study will also look to evaluate the effectiveness of the current Premier League Doctors Group Standard Operating Procedure for diagnosis of concussion. When a team doctor suspects a player has been concussed, the following data will be sought to accelerate and more accurately diagnose any potential concussion:

• Pitch-side assessment
• Video review of the incident at the pitch-side
• Subsequent clinical reviews of the player after the match and in the days following the game
• The time course and trajectory of recovery post injury

For more information please contact Emma McKinney, Communications Manager (Health Sciences), University of Birmingham, tel: +44 (0) 121 414 6681, or contact the press office out of hours on +44 (0) 7789 921 165.

* Research by the University of Birmingham, published in July 2017 in the Journal of Scientific Reports, identified biomarkers, known as microRNAs, as novel early biomarkers of traumatic brain injury. (Di Pietro et al. 2017. ‘MicroRNAs as Novel Biomarkers for the Diagnosis and Prognosis of Mild and Severe Traumatic Brain Injury’. Scientific Reports. DOI: 10.1038/s41598-018-22951-0).

• The Investigators of this study are:

1. Professor Tony Belli is an academic neurosurgeon at the University of Birmingham and Queen Elizabeth Hospital Birmingham, which is part of UHB. He is the director of the National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR SRMRC), one of the largest trauma research centres in the world. The NIHR SRMRC is jointly funded by the UK Department of Health and Ministry of Defence. Professor Belli leads numerous multicentre trials and observational studies in traumatic brain injury and is the Chief Investigator of NIHR SRMRC’s ongoing REpetitive COncussion in Sport (RECOS) study - one of the largest research programmes on concussion in Europe. He is an independent advisor on concussion to the Rugby Football Union and Football Association, and has co-authored the concussion management guidelines for England rugby and football, GB basketball and other sports.
2. Dr Valentina Di Pietro is a Birmingham-Illinois BRIGE fellow at the University of Birmingham and head of the research at Mirna Diagnostics. Dr Di Pietro is a molecular neuroscientist with experience in genetics, biochemistry and molecular biology. During her PhD at the Catholic University of Rome, she specialised in the identification of biomarkers for the diagnosis of mild, repeated and severe traumatic brain injury with a focus on the molecular mechanisms of trauma. In 2012, Dr Di Pietro joined the Institute of Inflammation and Ageing at the University of Birmingham where she started studying MicroRNAs as biomarkers of traumatic brain injury. In 2017 she was awarded the prestigious BRIDGE fellowship to undertake research in collaboration with the University of Urbana-Champaign Illinois, USA.   
3. Dr Patrick O’Halloran is a Clinical Research Fellow at the University of Birmingham in the field of concussion. He is a General Practitioner and Sport and Exercise Medicine Registrar at UHB. He has previously undertaken research roles at the Centre for Sport and Exercise Medicine, Queen Mary’s University London and with the UK School Games. He is currently the Academy Doctor at Wolverhampton Wanderers FC.

• The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 5,000 international students from over 150 countries.
• The Drake Foundation is a not-for-profit organisation committed to improving understanding of concussion injuries in sport, based on scientific research and insight. Through collaboration we aim to ensure that progress continues towards a better understanding of sports-related concussion and safety is improved for years to come. 
• University Hospitals Birmingham NHS Foundation Trust (UHB) runs the Queen Elizabeth Hospital Birmingham, Birmingham Chest Clinic, Heartlands Hospital, Good Hope Hospital, Solihull Hospital and various community services across the region. The Trust has regional centres for trauma, burns, plastics, neurosciences, dermatology and cancer. It also has centres of excellence for vascular, bariatric and pathology services, as well as the treatment of MRSA and other infectious diseases. We also have expertise in HIV/AIDS, premature baby care, bone marrow transplants and thoracic surgery. UHB has the largest solid organ transplantation programme in Europe and runs Umbrella, the sexual health service for Birmingham and Solihull. It is also home to the West Midlands Adult Cystic Fibrosis Centre and a nationally-renowned weight management clinic and research centre. The Queen Elizabeth Hospital Birmingham is a Major Trauma Centre treating the most severely injured casualties from across the region. The hospital’s single site 100-bed critical care unit is the largest in Europe. The Trust hosts the Institute of Translational Medicine (ITM) and leads the West Midlands Genomics Medicine Centre as part of the national 100,000 Genomes Project. UHB is also proud to host the Royal Centre for Defence Medicine (RCDM) at the Queen Elizabeth Hospital Birmingham. The RCDM provides dedicated training for defence personnel and is a focus for medical research.
• The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

1. Funds, supports and delivers high quality research that benefits the NHS, public health and social care
2. Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
3. Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
4. Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
5. Partners with other public funders, charities and industry to maximise the value of research to patients and the economy.

• The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.