Boxing's Most Important Issue: A Look Into Traumatic Brain Injury Research

Sean Mills returns to Bad Left Hook today to look at boxing's most troubling problem, and the research done by a Notre Dame doctor.

The greatest single threat to the sport of boxing is a moving target. For some people, steroid allegations have made Olympic style drug testing the number one concern. Others think it's the need for a new commission, one that could prevent questionable decisions and championship gerrymandering. Jim Lampley, a color commentator for HBO once called the floor decals used as advertisement in the ring itself as the biggest problem in boxing, because they cause boxers to slip an injure themselves. However, all of these choices pale in comparison to this the most basic element of the game: the lasting mental health of boxers.

If you are a sports fan, chances are you watch multiple sports. So, you may have already seen the television commercials for a research program headed by Dr. Mayland Chang at the University of Notre Dame. During this season's Notre Dame versus USC game (which Notre Dame could have won if it didn't fumble in the red zone), we learned that Dr. Chang is the recipient of an NFL grant, which allows her to continue studying ways to prevent damage from traumatic brain injuries.

At Notre Dame where Dr. Chang performs her research, alumnus-boxer Mike Lee recently brought professional boxing to campus. And while the National Football League provides funding because of injuries from hard tackling, the true beneficiary might really prove to be boxers. There are many pathological issues that plague boxing; this is to be expected perhaps from the nature of the game.

Understandably, Chang's work is complex and one struggles to fully understand the technical language written in medical journals. However, from her interviews and public statements an exciting picture develops:

The idea is that after a traumatic brain injury, enzymes in the fluid of the brain eventually begin to kill brain tissue. Chang's research has isolated an inhibitor, which may prevent the "destined brain damage." The hope is to provide a treatment for athletes, which will provide quick-response intravenous solution to the body, essentially saving part of the patient's brain.

It's natural to wonder if such a treatment would be applied to the concussion-prone field of boxing. Would this procedure be administered to boxers immediately after a fight? Could this procedure be administered after every fight?

I contacted Dr.Mayland Chang, at the University of Notre Dame to find the answers to these questions and have her clarify in her own words:

"Following a traumatic brain injury (TBI), there is a primary injury caused by the blow, followed by a cascade of biochemical events that leads to secondary injuries hours to days after the initial injury. Gelatinase B (also referred to as matrix metalloproteinase-9, MMP-9) is at the top of the cascade and is responsible for the events leading to blood-brain barrier damage, death of brain cells, swelling, inflammation, hemorrhage, cognitive and emotional disabilities.

The idea is to protect the brain from the cascade of events that lead to further/permanent damage by inhibiting MMP-9. We hope to be able to help patients who suffer a TBI in the early stages (hours to days). We envision that such a treatment will be given to athletes, including boxers, who suffer a TBI soon after the injury. This therapy is not recommended to be given as a prophylactic since MMP-9 is not present in the uninjured brain.

So while the compound may not be toxic, it will not provide a benefit if the therapy is administered without a TBI. While we have indication that the compound is not toxic, we have not yet conducted toxicology studies in animals at high doses, which are required before advancing the compound to clinical trials in humans."

While Dr. Chang's deserves attention from the public, one wonders what the medical experts familiar with the sport of boxing are making of her progress. I contacted the Association of Boxing Commissions to find out. Dr. Sherry Wulkan, the Chair of the ABC Medical Committee had this to say:

"The work of these researchers should be commended both for the thoroughness in its execution and, because of the long term implications it may have on the treatment and outcome of stroke patients, patients with TBI, spinal injuries, aneurysms and atherosclerosis. Their work may also theoretically impact cancer therapy in that MMP-9 inhibitors are believed to alter the natural history of tumor invasion and metastasis. While clearly exciting, further research still needs to be done regarding the potential toxicities of these newly derived compounds before clinical trials will be approved by the FDA."

So while boxers wait for this treatment to be fully tested, the possible development of a partial antidote to traumatic brain injury cell death is encouraging news for everyone.

According to report by the U. S. Department of Health and Human Services, 1.7 million concussions are reported per year. Most of these occur from falls, next by automobile accidents, then by blows, and finally causes unknown. Unfortunately, it's not possible to catch all cases.

A troubling quote brings to mind the victims among retired boxers that are casually called "punchy."

"TBI is frequently referred to as the 'silent epidemic' because the complications from TBI, such as changes affecting thinking, sensation, language, or emotions, may not be readily apparent. In addition, awareness about TBI among the general public is limited."

For more information on traumatic brain injury you can check the CDC website here.

For more information on Dr. Chang's research you can check her website here.