“We want to know whose brains are healing and why”

BALTIMORE – Jonathan Martin believes he does most things right.

A former offensive match against the Miami Dolphins and the San Francisco 49ers, he ended at the age of 26 before the shock shocks characteristic of his position could do more damage. He lost 50 pounds, began yoga and meditation, and entered the MBA program at the University of Pennsylvania after jumping from work to work.

But now 32-year-old Martin thinks he has had dozens of shocks while playing football and has had seizures of anxiety and depression, all of which are linked to chronic traumatic encephalopathy, a degenerative brain disease that has plagued footballers.

Martin’s concern prompted him to conduct a study at Johns Hopkins University in 2019 that could help researchers develop a treatment for the symptoms and diseases associated with brain injury and CTE.

“I wanted to be at the forefront of finding a solution,” said Martin, who was the target of bullying a teammate who made headlines in 2013. “More attention should be paid to head injuries. I want to know how I can get my mind dirty.

The study, which is now nearing completion of the second round, examines why the brains of former footballers continue to work overtime for years after athletes have stopped playing. Using PET scans, researchers monitor the brain cells known as microglia, which remove and repair damaged neurons. These cells are usually active after trauma, including concussions, and shrink as the brain heals.

“The microglia and the molecule they work with are basically sanitary workers in the brain,” said Jonathan Lifshitz, director of translational neurotrauma research at Phoenix Children’s Hospital, who is not participating in the Johns Hopkins study. “They are like FEMA: they are vigilant and when they are needed, they come in and act.”

Active microglia are usually welcome as they help the brain to recover, but staying active long after the trauma has ended can lead to other problems.

Although their microglial activity has been found in others who have suffered a brain injury, such as those involved in car accidents, these groups may be difficult to find and monitor during a time-consuming study. However, NFL players are a discreet group that is easy to identify and, like Martin, can be eager to participate.

Dr. Jennifer Coughlin, an associate professor and lead researcher at Johns Hopkins University School of Medicine, observed the overtime of reparative brain cells for the first time in a pilot project that began in 2015. Four NFL active players and 10 players were tested. Former professionals whose careers ended in 12 years found the Coughlin team to have higher levels of the biomarker, which increases with microglia activity.

He said chronic activity could be a sign that players were at risk of other brain injury problems, such as memory loss, mood disorders or Alzheimer’s disease.

“We want to know whose brains are healing and why,” Coughlin said. “It can inform about new treatments.”

For greater clarity, Coughlin and the researchers in the second phase of the study focused on younger former players who were less likely to have vascular disease or other indications that could interfere with interpretation on their own.

Martin, who had fought depression after the bullying scandal worsened after leaving the NFL, wondered if football had a part to play. He contacted the Concussion Legacy Foundation for more information on possible connections, and the group drew his attention to a study by Johns Hopkins.

“Based on some of my behaviors, the question arose: Is there anything wrong with me other than normal depression?” said Martin. “Everyone who plays football knows that breaking your head isn’t good for you.”

He was examined for the first time in late 2019, and after being delayed due to a coronavirus pandemic, he returned to Baltimore for two-day follow-up tests in March.

On the first day, Martin answered questions about changes in his cognitive abilities and mental health after the first visit. The next morning, he returned to a PET scan, an image test that monitors his brain activity by watching a chemical injected into his arm.

During the 90-minute scan, Martin meditated to overcome the claustrophobia that was in his head in a metal cylinder that had been fitting for so long. Karen Edmonds, a nuclear medicine technician, fitted him with a wet mold that holds Martin’s head in place after hardening.

“Once molded, it fits like a glove,” he said.

The anesthesiologist then placed a catheter in Martin’s left for about 35 blood samples to be collected during the scan.

In the PET scanning room, Martin lay on his back on the table, the blanket covered, and slid upside down until his head was inside the scanning tube. The tracking agent was then injected into his right arm and Edmonds monitored its progress on the monitor.

“The goal is to see how much of the radio tracking device is lit in the brain,” Edmonds said. “There’s only one dose at first, and then we’ll see how quickly it gets worse.”

After the test, Edmonds pulled the table with Martin out of the tube. “I have claustrophobia, but I just breathed through it,” Martin said. “You’re definitely bored, but it’s limited.”

Coughlin arrived to remove the arterial catheter, which took about 15 minutes.

He has so far tested 22 former NFL players and 25 other athletes, and hopes to test a total of 70 participants to better isolate the possible factors that cause brain activity. Coughlin said genetics, other medical conditions, the player’s position on the court and starting football can all contribute to that.

“It allows us to analyze what factors exist for people with permanent brain damage,” he said.

Even with Martin and other players involved, Johns Hopkins’ study is still relatively small and is still beginning to under
stand how traumatized brains behave. However, it can help identify head injury-related illnesses and symptoms, not only in footballers, but also in people who have been involved in bicycle accidents, car accidents and other collisions in the past.

“There is currently no good way to diagnose Alzheimer’s or Parkinson’s disease early,” said Jay Alberts, a neuroscientist at the Cleveland Clinic’s Center for Neurological Recovery. “It’s so important that we can raise a yellow or red flag.”

The study is blind, which means that Martin and the other participants will not be told the results of their individual tests. But Martin said participating means helping others as much as helping himself.

“It’s all part of the research I’m passionate about to make the game better,” he said.