Christian Franck, PhD, Professor of Mechanical Engineering at Granger Institute for Engineering, at University of Wisconsin, Madison, talks about a simple way to treat concussions and traumatic brain injuries.
Tell me about your research on cooling concussions. What was it that you and your colleagues were looking at?
FRANCK: We had spent a good amount of time looking into the literature, particularly on the efficacy of brain cooling, and using hypothermia to prevent the generative effects of concussions and traumatic brain injuries. We found very conflicting accounts in some cases where it wasn’t working. We wanted to dig deeper and understand why so we could be more definitive. Could we establish that it is working or it’s not working? So, in partnership with the Office of Naval Research, we started this project which lasted over several years. We wanted to go deep behind the scenes to understand molecularly whether the cooling could prevent some of those detrimental effects that we see in concussions and traumatic brain injury. Most of our work focused on the cellular, molecular scale. Trying to uncover mechanisms of an injury and then treatment and injury prevention. What we did is we started with a larger parameter space than some of the previous studies, then looked for classical molecular targets of injury that you would typically see in concussions. A stunning revelation to us was that we found cooling at the right temperature for the right duration was very effective at preventing neurodegeneration.
What exactly happens to the body when somebody gets a concussion?
FRANCK: A concussion is a neurological term for an underlying physical condition of a brain injury that occurred in a traumatic event. What happens is you have a physical injury that changes the structure, anatomy, and functioning of the brain tissue. It can be very local, or wider spread and depends on the incident or the accident. It’s a change in the biochemical composition of our cells in the brain. Because that process takes time to unfold, it gives us a chance to therapeutically intervene. So, a big part of our study was to understand what the window of opportunity was that we could do something? And, again, we were particularly interested in using temperature or cooling to see if we could therapeutically intervene.
With your findings, what was the window of opportunity that was most effective?
FRANCK: What we found in our study was that cooling just a few degrees, to about 33 degrees Celsius, within the first four hours was most beneficial in preventing those very detrimental sequelae from occurring that usually unfold during a concussion or traumatic brain injury event. The significant thing was to establish that time window because sometimes it’s just not possible to get someone treated within four hours. Once you pass four to six hours, we don’t see any more effect of cooling or not cooling on the outcome of that initial injury. So, getting the timing right was crucial along with the correct temperature.
Would this be more for someone who had multiple concussions or their first concussion? Who would get the most impact from this?
FRANCK: We looked primarily at brain cell health and some other biochemical indicators. What we found is that it’s beneficial for everyone. There’s no condition on whether that’s your first concussion. It’s just in general whenever there is an impact that could cause a concussion, cooling will help. Right now, one of the biggest struggles that we have is on the spot diagnosis and detection. A concussion is a clinical diagnosis that’s done neurologically through symptoms. Some people develop symptoms, and some people don’t. But in both cases, it’s possible that you can have physical trauma that can lead to a significant change in the health of the brain.
Is it always guaranteed that if someone gets a concussion at the cellular level, it will change in their brain?
FRANCK: There are always changes, but they don’t always have to be bad. The brain has a very good self-defense healing strategy. It really depends on the individual. Some individuals do better with that, and some do worse. There are protective mechanisms the brain will try to employ. But I think from a research side, and from a clinical perspective, if we can help support the brain and its defenses that’s something that we should explore.
Is there a particular group of people that will likely experience those negative consequences?
FRANCK: We still don’t know the real answer because it depends on the individual and the biochemistry in the brain. So, there’s a lot of factors that come together, which is why in many ways we haven’t made as much progress as we really hoped for.
How would you imagine this being implemented in a clinical setting?
FRANCK: We’ve been working with a larger team through the Office of Naval Research, and there’s a couple other researchers that had some successful testing in animal models. They’ve seen similar and beneficial outcomes as we have. The next step would be to go to the FDA and have a device that can cool the brain. There are still a few technical challenges for implementation. What we have learned through the research is that we know what the parameters are now, and we know the temperature, the cooling duration, and when to cool. From our technology side, there are still a couple hurdles. There was a device on the market a few years ago, and at the time, people did not have the parameter space. So, it was sort of shooting in the dark. But the next step is to go to the FDA and start running trials. Then, if that goes well, we could start rolling it out to the consumer.
What impact do you think this would have for someone who is in an activity or participates in sports that are likely to suffer from concussions?
FRANCK: One of our big goals when we started this was to get to a translational point where we could have an end consumer product and envisioned it almost like a little inhaler that has a coolant in it. One would have to work up carefully to deliver that safely. But the idea was that if there was reason to believe that someone had a significant enough fall or impact to the brain that could lead to a concussion, they could self-administer or at least there would be a medical team on site in the sports world. What we have learned through our work and work from others is that cooling seems to be one of the very promising treatments with very little to none side effects.
What are the side effects, if any?
FRANCK: We work with laboratory models, so we don’t have all the complexity of a real human brain. But this is why you have the FDA and why there are human trials. So, I think time will tell. I think we were encouraged and ran everything in triplicates to make sure that our science was sound.
Is there anything that you feel is important for people to know we didn’t cover?
FRANCK: I think in general, detection of concussions continues to be a challenge. As we’re moving into a space where we will have treatments available for cooling, the challenge of our rapid detection remains and there’s a lot of people working on that. But it’s something we’re going to have to solve because you want to know whether something detrimental might have happened. Then, once you know that, you can start the treatment. Hopefully we’ll have something soon to help people and prevent their brains from being injured.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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