case_images: PMC5906531_01
case_images: Concussion case 1: transient symptoms. X axis is days before and after concussion, with day 0 being the day of concussion. (A): clinical assessment of balance error scoring system (BESS) ( ) and near point of convergence (NPC) (Delta). (B): [CD81]SNAP25+ (U/mL), (C): [CD81]EAAT1+ (U/mL), (D): [CD81]OMG+ (U/mL), (E): [NF-L]SNAP25+/[CD81]SNAP25+ ratio, (F): [Tau]SNAP25+/[CD81]SNAP25+ ratio, (G): [TNFalpha]SNAP25+/[CD81]SNAP25+ ratio, (H): [IL8]SNAP25+/[CD81]SNAP25+ ratio, (I): [GFAP]EAAT1+/[CD81]EAAT1+ ratio, (J): [MBP]OMG+/[CD81]OMG+ ratio, and (K): [SYP]CD11b+/[CD81]CD11b+.+-50% from pre- and post-season average values was shown in shaded blanket as referential values. SNAP25, synaptosome-associated protein 25, NF-L, neurofilament light polypeptide; TNFalpha, tumor necrosis factor-alpha; IL8, interleukin-8; EAAT1, excitatory amino acid transporter 1; GFAP, glial fibrillary acidic protein; OMG, oligodendrocyte myelin glycoprotein; MBP, myelin basic protein; SYP, synaptophysin.
case_images: fneur-09-00239-g001.jpg
case_images: PMC5906531_01_fneur-09-00239-g001.jpg
case_images: F1
case_images: His symptoms dissipated by day 7, but increased errors in BESS and worsening in NPC were observed through days 3-9 after concussion and normalized to the baseline level by day 17 (Figure 1A). The levels of [NF-L]SNAP25+/[CD81]SNAP25+, [TNFalpha]SNAP25+/[CD81]SNAP25+, and [IL8]SNAP25+/[CD81]SNAP25+ (Figures 1E,G,H) slowly increased up to day 17 after concussion. The level of [SYP]CD11b+/[CD81]CD11b+ (Figure 1K) showed a 422% increase at day 17 after concussion compared to the baseline. All the other markers showed an unremarkable pattern (Figures 1B-D, F, I, J).
case_images: PMC5906531_02
case_images: Concussion case 2: persisted symptoms. X axis is days before and after concussion, with day 0 being the day of concussion. (A): clinical assessment of near point of convergence (NPC) (Delta).(B): [CD81]SNAP25+ (U/mL), (C): [CD81]EAAT1+ (U/mL), (D): [CD81]OMG+ (U/mL), (E): [NF-L]SNAP25+/[CD81]SNAP25+ ratio, (F): [Tau]SNAP25+/[CD81]SNAP25+ ratio, (G): [TNFalpha]SNAP25+/[CD81]SNAP25+ ratio, (H): [IL8]SNAP25+/[CD81]SNAP25+ ratio, (I): [GFAP]EAAT1+/[CD81]EAAT1+ ratio, (J): [MBP]OMG+/[CD81]OMG+ ratio, and (K): [SYP]CD11b+/[CD81]CD11b+. +50% from pre- and post-season average values was shown in shaded blanket as referential values. SNAP25, synaptosome-associated protein 25, NF-L, neurofilament light polypeptide; TNFalpha, tumor necrosis factor-alpha; IL8, interleukin-8; EAAT1, excitatory amino acid transporter 1; GFAP, glial fibrillary acidic protein; OMG, oligodendrocyte myelin glycoprotein; MBP, myelin basic protein; SYP, synaptophysin.
case_images: fneur-09-00239-g002.jpg
case_images: PMC5906531_02_fneur-09-00239-g002.jpg
case_images: F2
case_images: NPC slowly increased and peaked at day 36 after concussion (Figure 2A) and returned to the baseline levels by day 57. Substantial biphasic increases, peaked at day 50, were observed in [NF-L]SNAP25+/[CD81]SNAP25+, [Tau]SNAP25+/[CD81]SNAP25+, [TNFalpha]SNAP25+/[CD81]SNAP25+, and [IL8]SNAP25+/[CD81]SNAP25+ (Figures 2E-K).
case_images: Serum levels of conventional protein biomarkers. Case 1: (A) Tau, (B) NF-L, (C) GFAP, (D) TNFalpha, and (E) IL8. Case 2: (F) Tau, (G) NF-L, (H) GFAP, (I) TNFalpha, and (J) IL8. NF-L, neurofilament light polypeptide; TNFalpha, tumor necrosis factor-alpha; IL8, interleukin-8; GFAP, glial fibrillary acidic protein.
case_images: fneur-09-00239-g003.jpg
case_images: PMC5906531_02_fneur-09-00239-g003.jpg
case_images: F3
case_images: TNFalpha, and IL8 were assessed in the two concussion cases. There was no remarkable trend for all biomarkers, with the expression levels being widely fluctuated across recovery time points (Figure 3).