January 13, 2018
Carolina Panthers quarterback Cam Newton’s injury and return to play during the team’s NFC Wild Card playoff game against the New Orleans Saints on Sunday, Jan. 7 was another reminder of the weakness of the National Football League’s current concussion protocol. In a January 11 rant on Players Tribune, Seattle Seahawks cornerback Richard Sherman called the league’s concussion protocols “a joke.”
It’s that exact procedure that could be aided by a medical technology company, Phlogistix. Even with the advancements in medicine, however, the degree of benefit will still be dependent on personnel involved in sports making the right decisions, however.
American football is just one potential application of the diagnostic and therapeutic products that Phlogistix is working on. People engaged in all contact sports and military personnel could also take advantage of the neurodiagnostic and therapeutic technologies. Phlogistix CEO and President Barry W. Festoff, M.D. explains the basic premise behind the products to Advocacy for Fairness in Sports.
“Injury, mechanical injury, is dealt with by the body as a whole and the brain specifically in essentially the same way as an invasion by pathogenic organisms, bacteria, viruses,” Festoff explained. “We have developmentally, it begins at birth but isn’t complete until maybe two years of age, the establishment of a barrier, a vascular barrier, the blood brain barrier. The blood brain barrier….these endothelial cells sort of butt each other like bricks [and] have very tight cement between them. In fact the area is called a tight junction. They have a number of proteins and on the surface of the endothelial cell in contact with the blood there are a variety of receptors. Now on the other side if you will of these endothelial cells that are facing the blood, imagine a garden hose. The inside of the hose is the endothelial cells. The outside of the hose would be in contact with the brain. It’s called the abluminal side. The luminal side is in contact with the blood. With an infection, even the flu, the blood brain barrier either pulls apart or there is some kind of biochemical signal that interacts with receptors and that in turn makes this barrier leak, permeable. In the normal situation 98-99 of what’s in the bloodstream can’t get into our brains. You get hit on the head, you get the flu, now that increases. You know that when you get the flu you get a little dizzy, you get a little disoriented, a little uncoordinated. You want to sleep. You don’t want to eat much, the same kind of symptoms that happens when you get a concussion….The barrier opens and now substances which are normally excluded can now gain access and the opposite is also true, even more true with mechanical injuries. Our premise for detecting substances that are from the brain now circulating in the blood stream is based on this two-way dysfunction.”
Phlogistix is currently using that premise to produce products that could revolutionize how medical science diagnoses and treats head trauma in two different ways. The first is diagnosis of head trauma. Festoff envisions the product being a 3D-printed cassette which could be placed inside of a cell phone. After receiving a potential head injury, some of the patient’s blood would be deposited into the cassette and within 15 minutes a reading would be given in a “stoplight” form, depending on the prevalence of mitochondria from brain cells in the blood.
Festoff thinks that the diagnostic end of the company’s work could end years of robust searching for solutions.
“It’s the holy grail. That’s what we’re doing,” Festoff commented. “We’re not the only ones. Everybody who is in this game believes that the holy grail is to be able to do it at the venue. This is an area of biomedical research that is more pervasive than just brain injury. It’s in cancer, it’s in infectious disease, it’s in cardiovascular disease and it’s called point of care diagnosis. Which means you can hold something in your hand. It implies mobile medical apps to and fro, transmission that is secure, that kind of stuff. What we’re talking about is a subset of that, it’s point of injury, at the venue, sporting events, you know, could be contact sports, a motor vehicle accident, could be warfare, could be how much brain damage did I suffer when I hit my head getting into the car yesterday, those are the kinds of things where point of injury point of care diagnosis is important. It also applies now to preclinical diagnosis of diseases that repetitive concussion can lead to like CTE.”
Festoff’s company is also involved in the therapeutic side of brain trauma treatment. The full extension of the technology would be a desktop platform available to attending physicians. The platform would be replete with all the information captured during the diagnostic and advise physicians on how best to proceed with patients. Phlogistix’s approach involves a theranostic drug.
“What we want to do is build on the brain’s own natural process of repairing things,” Festoff stated. “You get banged, it swells, it’s painful. Red cells come in and digest a lot of things and that sets the stage for repair and regeneration. There isn’t a lot of that going on in the brain but there is some. The more we can harness that in the brain, we can repair and regenerate. The strategy is harnessing neural inflammation.
For sport applications, the huge potential benefit of the diagnostic is that it could reduce the frequency of athletes lying about symptoms to remain in/return to games. Additionally, it could eliminate teams’ needs to rely on current brain trauma testing methods which are weak in comparison. Comments made by San José Sharks defenseman Marc-Edouard Vlasic highlight those issues:
“It’s just a written test,” Vlasic said of the written exam that took him about 45 minutes to complete. “In order for me to fail that, I’d have to be in a coma. … The baseline cannot show how I’m feeling.” Vlasic’s comments and Newton’s situation represent an area where the even most objective tests that didn’t depend on athletes’ cooperation could still fall short of producing the results in athletes’ health outcomes that are desired.
Even with a completely objective test, the responsibility would still fall on the personnel present to accurately report the outcome of that test. Furthermore, it would be on the rest of the personnel responsible for ensuring the proper protocol was followed after the test results were reported. Those personnel are often on the payroll of leagues and teams putting on games and paying athletes’ salaries, creating an immediate conflict of interest.
Personnel could feel pressure to change their reporting of the test in order to keep their superiors happy. Teams could also see the fine resulting from a breach of the protocol following a “red light” test as an acceptable cost of rushing an athlete back into play.
Barring those circumstances, however, Phlogistix could be on the verge of providing the “holy grail” to an industry which is in desperate need of it. Like at the end of the movie, “Indiana Jones and the Last Crusade,” the efficacy of this “holy grail” depends on the people involved choosing wisely.
Edited by Sheilla Dingus