Dr. Fred Korley is an associate professor of Emergency Medicine at the University of Michigan Medical School and a Michigan Concussion Center faculty member. His research program is focused on improving the diagnosis and treatment of traumatic brain injuries (TBI). He is the co-inventor of a panel of novel biomarkers that can aid in diagnosing acute traumatic brain injury, a co-PI of a multi-center study examining the use of blood-based biomarkers for monitoring patient response to traumatic brain injury treatment, and a co-PI of a clinical trial examining the use of hyperbaric oxygen in treating severe traumatic brain injury.
We sat down to speak with Dr. Korley about his concussion interests, his research, and why he is excited to be a part of the Michigan Concussion Center.
How did you become interested in working with concussions?
It all started a couple of years ago after I finished my PhD training. I was taking care of patients in the emergency department and realized that although we had tools for diagnosing most emergencies, we had very limited tools for diagnosing concussions and that was very frustrating to me. There are also no drugs for treating concussions. So many times patients who came to the emergency department for evaluation after a concussion had questions like, “When should I get back to work? I have finals tomorrow; should I take my finals? Is there any medication for this? Do I really have a concussion or not?” And I realized that the scientific literature did not have enough data to answer these questions. I decided to study concussions to help contribute to this knowledge gap so that we can, at least from the emergency department standpoint, be able to provide data-driven answers to these important questions that patients have.
Can you talk about the areas of concussion you have worked on?
I have done work in a number of different areas of concussion. One is with quantifying how often patients are evaluated in the emergency department for concussion.
According to the Centers for Disease Control and Prevention (CDC), 2.5 million people are diagnosed with concussions or TBI every year. But as an emergency department physician, I knew that number was much lower than the number of patients who are evaluated for suspected concussion or TBI in the emergency department each year. So we did a study using a national database of emergency department visits and we found that at least twice, nearly 5 million people each year are evaluated at emergency departments across the country for concussion or TBI. So the problem is much bigger than we initially thought.
Which areas of diagnosis you are working on?
I have been working on developing and validating new blood-based tests for diagnosing a concussion. In working with some basic scientists, we discovered a number of blood-based biomarkers that could be useful for diagnosing both concussion and even more severe traumatic brain injuries. The bulk of my work over the last couple of years has been validating these biomarkers.
What is a blood biomarker test and how does it work?
Blood biomarker tests are typically substances that are found in the blood after brain cells are injured or die. Typically, following a concussion, some brain cells are injured and some die. When these cells die, certain proteins that are normally inside the cells are released and they find their way into the bloodstream. The blood biomarker tests we have been examining measure levels of these proteins.
When could we reasonably see blood biomarker tests on the sidelines of a sporting event for diagnosis of a concussion?
If I had to put concussion on a scale, the blood tests are currently best at identifying people who are on the more severe spectrum of concussions because they’re the people who are likely to have had brain cell death. Blood tests will not be used in isolation for diagnosing concussion. They will be used in conjunction with a clinical exam to aid in the diagnosis of concussion. Currently, the Food and Drug Administration (FDA) has approved two of these blood tests to be used in helping clinicians decide which concussed patients need further evaluation with a head CT scan and which do not. We also need additional studies to better understand how soon after a concussion event these biomarkers reach abnormal levels in the blood.
We are currently doing a study here at the University of Michigan with student-athletes
participating in men’s and women’s lacrosse, and men’s and women’s soccer. The main objective of this study is to determine whether the blood-based biomarkers we are studying are useful for diagnosing concussion and predicting when concussed athletes can be deemed as safe to return to play. There is a point of care device that can generate biomarker test results within 15 minutes. We will examine how accurate this device is in identifying concussed players with significant brain injury. Prior to using this test at the sidelines, we need to understand how soon after injury these biomarkers appear in the blood. This will take time and continued research.
Are there any other areas of research, in addition to diagnosis, that you would like to share?
I’ve also been working with identifying novel treatments for traumatic brain injury. I am part of a clinical trials network called the SIREN Network (Strategies to Innovate Emergency Care Clinical Trials Network), which is funded by the NIH to do clinical trials in neurologic and cardiovascular emergencies. This is where my work in biomarkers shifts from diagnosis concussion and TBI to monitoring the efficacy of novel treatments.
I am doing a pilot study involving emergency department patients who have been diagnosed with mild TBI or a concussion. The goal of the study is to determine whether high dose fish oil can help improve recovery from concussion. We randomly assign persons who have been concussed to treatment with either high dose fish oil or placebo (olive oil). We then monitor these patients for three months to determine the effect of the treatment they received on blood levels of biomarkers of brain injury. We also examine these patients to see whether there is evidence to suggest that high dose fish oil may help improve recovery from concussion. Prior animal model studies have shown that fish oil can help improve recovery from concussion. Fish oil can help with decreasing brain inflammation, decreasing the oxidative damage from traumatic brain injury, and helping with brain cells heal and repair. If this pilot study is promising, we will do a larger study to fully understand the role of high dose fish oil in treating concussion.
What do you see as the key barriers towards the next level understanding of concussions?
I think a critical gap is a clear understanding of what is actually happening to the brain physiologically following concussions. This is very challenging to do. MRIs are decent, but they don’t tell it all, and CT scans have a limited role, especially for concussions. And that’s why I’m very excited about things like blood-based tests, but they have their limitations as well. I think if we have better ways of non-invasive monitoring of what’s going on with the brain after a concussion, then we can have a better understanding of how to treat it.
I think that another major limitation to progress in the field today is that we have no good methods for sub-classifying traumatic brain injury. For this reason, even if there are promising treatments, sometimes they don’t demonstrate benefit in clinical trials because we’re not, necessarily, treating the right people. And so when we get to the point where we can better sub-classify and say this is the specific kind of traumatic brain injury you have, then targeted therapies may be able to work better.
What excites you about working with the Michigan Concussion Center?
I think that the great thing is that we all sort of know each other and know of each other’s work and have always talked about working together, but it’s been just lip service. And so the nice thing is that the Concussion Center brings a unified platform to allow people to work together.
Amongst all other research on campus, why do you think now is the right time and the University of Michigan is the right place for the Concussion Center?
I think this is a great time to study concussion because some time ago there was less awareness about the burden of concussions, but now there’s a lot of awareness. There is also renewed interest from funding agencies.
And why here? I think the University of Michigan just has a whole bunch of really talented people who are all individually doing pretty amazing stuff. Bringing them all together will only catalyze what each person is doing and put us in a position where we can have a huge impact on the field.