New research led by teams at Trinity College Dublin (TCD) has identified for the first time what causes some sports injuries to result in poor brain health in retired athletes.
The research has pinpointed "leaky" blood-brain barrier (BBB) as a driver of chronic brain damage in retired combat athletes and collision sport athletes, like rugby players and boxers.
The research published this evening in the international journal Science Translational Medicine, was also led by the FutureNeuro Research Ireland Centre.
It says that the blood-brain barrier acts as a security gate letting in essential nutrients, while keeping harmful toxins and inflammatory cells out.
But when there is a breakdown in the BBB, often after repetitive head injuries, it cannot perform this security job and becomes associated with the cognitive decline and neurological damage seen in some former professional collision and combat sports athletes.
The researchers say that for the first time, the study has shown that in some retired athletes with a history of repetitive head injuries, this gate remains leaky, years after they have left the field.
The study says that certain MRI scans, focused on the blood-brain barrier, could serve as an early warning system, identifying athletes at the highest risk for future brain disease while they are still living and potentially playing.
Matthew Campbell, Professor of Neurovascular Genetics and Head of the TCD Genetics Department led the work with Colin Doherty, Professor of Epileptology and Head of TCD School of Medicine.
They said that even years after retirement, retired athletes showed significant blood-brain barrier disruption, compared to age matched controls.
It suggests that the damage from head impacts is a chronic, ongoing process.
The researchers say the findings have significant potential to herald the beginning of an entirely new chapter in sports medicine.
They say that early intervention trials could now investigate whether sealing the "leaky" barrier through new or existing drugs could slow down or even stop the progression of brain damage in at-risk athletes.
The team says that research should follow current professional players throughout their careers to determine exactly when the barrier starts to fail, information that could help sports organisations refine return-to-play protocols and safety regulations.
Prof Campbell said that brain concussion is not a small problem in Ireland and he does not believe that individual sports codes can solve it.
He pointed out that among recreational sports players alone, Ireland sees around 30,000 concussions a year and that around 11,000 of those people visit an emergency department.
Prof Campbell is advocating for the Government to get involved and to bring agencies together, along with experts, scientists and clinicians.
He said that he and his colleagues would like to assist in this work.
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Risks have increased, says former Irish team doctor
Dr Mick Molloy, the former Chief Medical Officer of World Rugby and former Irish rugby team doctor, said that the physicality of the game now has added to the risks.
He is now an advocate for retired rugby players.
Dr Molloy said that most of the players he had played with have managed well, but that the modern game has added physicality, bigger contact forces and it is easy to see why there are injuries.
He said there is concern about brain injury and that it can be preventable.
Dr Molloy said that the lifespan of rugby players must be looked at very carefully and that while head contact cannot be eliminated, it needs to be minimised.
He said it is important to advocate for players and let them know about the risks and for them to also understand that they also need to take major responsibility themselves.
