A multi-institution team including the University of North Carolina at Chapel Hill has received a $14.7 million grant from the National Football League to study potential long-term neurologic health consequences of concussions and sub-concussive injuries sustained by former NFL players. It will be the largest cohort of former NFL players ever studied.

Concern has been growing in the medical and sports communities that repetitive concussions sustained during play may lead to chronic neurologic health problems later in life. Chronic traumatic encephalopathy (CTE) — a pathological condition defined as abnormal tau proteins in the brain — has been reported in post-mortem studies of former NFL football players.

Boston Children’s Orthopedics and Sports Medicine Center and Beth Israel Deaconess Medical Center at Harvard University, the Medical College of Wisconsin and the University Orthopedic Center-State College, Pa., join UNC in the study. UNC will receive $4.7 million from the grant.

The grant extends the work of Carolina’s Center for the Study of Retired Athletes, directed by Dr. Kevin Guskiewicz, IPRC affiliate faculty. The Center began a study in 2001 to understand the later-life consequences of former athletes.

The study will track up to 2,500 former NFL players previously surveyed in 2001 with annual follow-up health assessments. Two hundred of those former players who exhibit impairment will undergo repeated, detailed in-person evaluations. The researchers will assess for associations between clinical outcomes and abnormal tau buildup, as well as examine other risk factors for neurologic health outcomes.

Seminal research by Guskiewicz and Dr. Stephen Marshall, director of the the Injury Prevention Research Center (IPRC) were among the first studies to reveal a link between concussion, depression, and degenerative brain disease. Marshall and Dr. Zachary Kerr, IPRC core faculty member, will play important roles in the new project. Kerr currently oversees the Center for the Study of Retired Athletes’ questionnaire-based monitoring of the health of former NFL players. In collaboration with Marshall, he will oversee data collection and statistical analysis on major portions of the new data collection.

“We are excited about the new projects,” said Kerr.  “It is rewarding to be moving beyond documenting associations to actually intervening and testing therapies.”

Marshall points out that the Center’s work, although focused on an elite population (the NFL), has proven to be applicable to the general population as well. “There is a strong link between the knowledge gained from researching the highly-exposed NFL population and recent advances in the prevention and management of concussion in general population,” said Marshall. “This new work will accelerate that process and will ultimately improve concussion management for all.”

The project will conduct preclinical laboratory studies to investigate several potential therapies for preventing neurologic health problems, including CTE, after injury and for slowing their progression. Through sophisticated neuroimaging, the project will identify former NFL players who may be developing neurodegenerative diseases such as CTE. The most effective therapies will then be translated into clinical intervention studies for former football players identified as being at risk.

Carolina partners involved in the study include the Center for the Study of the Retired Athletes and the departments of Exercise and Sport Science, and Psychology and Neuroscience in the College of Arts & Sciences; the departments of Neurology and Radiology in the UNC School of Medicine; and the department of Epidemiology in the Gillings School of Global Public Health.