CTE is a devastating brain disease, but there is hope

If you're a sports fan, you've no doubt heard of the acronym CTE. It has made plenty of headlines in recent years.

CTE — chronic traumatic encephalopathy — is a devastating, degenerative brain disease triggered by repetitive head injuries. It often impacts athletes, but also soldiers and victims of intimate partner violence.

At the moment, the condition can only be diagnosed after death. But a team of researchers at the Centre for Addiction and Mental Health (CAMH) is working hard to change that. 

Their goal is to become the first lab in the world to diagnose the condition in life, not death — a breakthrough that could help stop the disease and even reverse it.

Our guest on this week's episode of Village Media's Closer Look podcast is Dr. Neil Vasdev, director of the Brain Health Imaging Centre at CAMH.

Transcript

SPEAKER_01 0:00

There's no biomarker to image CTE in left. So that's what our lab is hoping to be, is the first lab in the world to do that.

SPEAKER_03 0:25

Welcome back to Closer Look Across the Village Media Network. It's Sunday, the 14th day of June. Michael Friscolanti, our editor in chief, is back for another week. I'm Scott Sexmith, Zach Trenzo in the room as well. Have you been watching the uh Stanley Cup final?

SPEAKER_02 0:41

I've caught glimpses of it, yes. Yeah. Fantastic hockey. I was a little heartbroken with the Canadians being eliminated, but but but I have caught, you know, just because Mitch Martner's playing so well, I can't help but watch the videos. Well, Hattrick in one period, right?

SPEAKER_03 0:53

That was almost four goals because he missed on a penalty shot. Yeah. But tell me he's not living his best life right now. It's amazing.

SPEAKER_02 0:58

You know, I'm not a Leafs fan, but if I were a Leafs fan, I would I think I'd feel good for the guy. I mean, I I I don't buy that he didn't give it his best in Toronto, that he probably I'm sure he gave everything he had. That was the team he loved growing up, right? But imagine the difference of going to that high-pressure cooker and then going to Vegas, where the guy could literally walk down the strip in Vegas and no one would recognize him. It's just a whole it's just a huge weight off your shoulders, right? There's the pressure's just way down. And he's had a great I mean he had a great Olympics, right? Yeah, he's played really well. Trevor Burrus, Jr.

SPEAKER_03 1:27

It seems like a lifetime ago when his former coach uh Mike Babcock, who's back in the news, apparently vying for the uh head uh coaching position in Edmonton. Uh but when Babcock made him rank the players in terms of work ethic and then unveiled it to the team in the room, unbelievable.

SPEAKER_02 1:45

I've done I've done that with my team. I don't know why you were on the bottom of the list. You should have been right at the top. Look, I'm on the bottom of every list. You should have been right at the top. But you know what I'll tell you the best thing about the playoffs for me was the torch ceremony with the Montreal Canadians. There was I think at the beginning, they had Jean Bellevue's wife at one point. Did Guy Lafleur come out at one of the with one of those?

SPEAKER_03 2:06

No, because I believe he has passed.

SPEAKER_02 2:08

He passed away, yeah. So yeah, you tell you how well I know locked. Nobody does pump and circumstances. There was an old player that came out. It wasn't just Jean Belleville's wife. That's what I mixed up. Sorry. I must apologize. Apologies to the dead. Um that but it was fascinating, just the the emotions in that room. You get goosebumps watching it on TV. And you know, the tragedy, we're gonna talk about that on the show today, but Claude Lemieux was the last Montreal Canadian to go down with the torch. Um it was the the game that they got eliminated, and the crowd just went crazy. He was a tough guy in the league, you know, took a lot of took a lot of shots to the head for sure. Yeah. And tragically, he died three days later, committed suicide. His family's been opening. It's just a terribly tragic story. And I just now that you know that happened, you think about what the emotions would have been like for him and the triggers of hearing the crowd cheering like that and the struggles he's gone through. His family's actually donated his brain to the Boston University CTE Center because they want him to hopefully contribute to brain research and brain damage from there, they think from which is happens a lot, hockey players, football players, CTE. Uh, we're gonna talk about that condition today. It's something that it's been in the news a lot in the last few years. There's a lot of high-profile athletes and other people who have dealt with who but it can only be diagnosed after death. After death, right. And there's a team of doctors and researchers who are working on trying to diagnose this in life to actually help those patients while they're alive. And we're gonna chat about that today.

SPEAKER_03 3:32

For decades, CTE has remained one of medicine's biggest mysteries. It's been linked to athletes, military veterans, and others exposed to repeated head trauma. But there's been one major obstacle. Doctors have only been able to definitively diagnose it after death. Our guest today is Dr. Neil Vastev, director of the Brain Health Imaging Center at CamH in Toronto. His team is developing groundbreaking imaging technology that could allow scientists to detect signs of CTE in living patients for the first time. If successful, it could change how we diagnose, study, and eventually treat this devastating brain disease. Dr. Vastev, uh, welcome to the show. We appreciate your time today.

SPEAKER_01 4:13

Thank you for having me. I'm honored to be here.

SPEAKER_03 4:15

Uh, a lot of people have heard about uh CTE because of some of the high profile people who have been diagnosed with the uh condition. But just as a refresher, uh Doctor, can you talk about what it is and who it typically affects?

SPEAKER_01 4:28

That's a great comment about uh the high profile in media bringing CTE to the attention of people today. I think um the way this was really started is interesting. It was um Professor Bannet Amalu, who's um in University of California, uh I believe Davis at the time. And before that, he was at Pittsburgh. He started looking at post-mortem human brain tissues of former uh contact sports athletes, primarily NFL football players from the US and also boxers, and found upregulation of a protein called Tau. And uh that's where this whole field of um understanding this disease as CTE came about. Originally, it was originally called punch drunk, and then um other terms from that point on. It was something that they knew boxers used to get, but it was never really understood to affect the masses, like you mentioned. So it stands for chronic traumatic encephalopathy, and now we can start seeing this in not only contact force athletes, but also military veterans and victims of intimate partner violence and interpersonal violence, as well as um uh military veterans are another very big area that we're studying right now, too. And even people who've been in car accidents and uh anyone who's suffered a head injury.

SPEAKER_02 5:56

And how long ago was that initial research done?

SPEAKER_01 5:59

That was um about 20, 25 years ago, uh, that I became known as CTE. But uh people have been studying this since the 40s, since the 1940s. It's just um, I think actually you hit the nail on the head there with how you described it as these uh high-profile athletes that have been uh diagnosed, and that's been making getting a lot of media attention. Because when, for example, an NFL player dies or donates their brain or is confirmed to have CTE, that makes big news. But for example, military veterans, which is in a crisis situation right now, there's two deaths um by suicide in the US alone from military veterans, and one of those is a confirmed suicide, and this is from non-natural causes. So it's a crisis. It's almost one death an hour of confirmed suicide by US military veterans, and that applies to anywhere with the military. In terms of some of the high-profile athletes that we've seen, we've had um, for example, um the original one from Benedomalu that got a lot of media attention was Iron Mike Webster. He was a player for the uh Steelers at the time, and um also had major changes to his behavior. So it's not just the head injuries, these other mental health consequences that you have to be very concerned about, including high risk of suicide, for example, that has to be managed, um, high risks or things like anxiety disorders and mood disorders, depression, and then addictions, often to manage things like pain that come with it. So that can be opiates, it can be alcohol, it could be marijuana products, it could be with legalization of a lot of these substances. That's also something that gets um abused on some level, and um anger issues, sleep disorders, so many things that go on with the head injury. Yeah, after that, there was also the um person, for example, um Aaron Hernandez, and there's actually Netflix documentaries on both of them.

unknown 8:08

Yeah.

SPEAKER_03 8:09

Uh Neil, we mentioned sorry, go ahead.

SPEAKER_01 8:12

Oh, I was gonna say now most recently, Claude Lemieux, his brain was just donated to the Boston University CT Center, and those are our colleagues and collaborators, and also through Concussion Legacy Foundation of Canada, which is out there actively contacting these people and getting them to donate their brains.

SPEAKER_03 8:29

Uh Neil, we mentioned it off the top that CTE can only be diagnosed after death. Why is that?

SPEAKER_01 8:36

Uh so right now, CTE can only be confirmed post-mortem because we're really have to look at the protein, for example, tau protein in the brain. There's other things that you can look at in the brain, but that's a biomarker. So tau is a protein. You see it in Alzheimer's disease and other uh disorders, but CTE is a known biomarker in CTE. So it's typically stained for afterlife. And pretty much everything we know about CTE is from these American football players who've donated their brains. It's pretty much all men and American football players. But um, there's no biomarker to image CTE in life. So that's what our lab is hoping to be, is the first lab in the world to do that. And we're trying to do that with a medical imaging technology called PET or positron imaging tomography, where we use a radioactive imaging agent injected in the body, and as it accumulates in the brain, uh we're trying to image CTE Tau, which is different than, for example, Alzheimer's disease Tau. And that's something that's quite established.

SPEAKER_02 9:46

And how's it coming, Neil? Are you making progress on that?

SPEAKER_01 9:50

I believe we are. We're very excited with our work. Uh, we just shared the uh case studies from the first three subjects that were scanned, the three contact sports athletes, um, with suspected CTE. And we do see an upregulation of the tracer in in the brain, which in regions which we would expect and are consistent with post-mortem analysis of uh people with confirmed CTE compared to healthy controls. So everything is trending in the right direction for us. And we've also looked at it in other non-Alzheimer's disease telopathies, like uh one is called PSP or progressive supernuclear policy. We're starting to see a trend exactly the same, very similar, meaning it's upregulated in regions um that were previously only confirmed post-mortem.

SPEAKER_02 10:36

It's fascinating work. Obviously, we have nothing to we don't understand what the kind of work you're doing, but it's fascinating. And are you literally like doing hundreds of exams? Like, are you looking for volunteers? Like how how do how does the research work?

SPEAKER_01 10:46

So we are definitely looking for volunteers. We're gonna have to do hundreds and if not thousands of exams. For example, with the Alzheimer's uh tracers, that's something I was involved with when I was at Harvard Medical School in Massachusetts General Hospital about 15 years ago. We started uh working very heavily on imaging tau protein in Alzheimer's patients. And then two of the radio pharmaceuticals we've worked on now, one of them is FDA approved, and the other one is um optimized for Alzheimer's disease Tau. And they've been used in well over 20,000 subjects worldwide. They've been used for patient selection, for drug discovery, for Alzheimer's therapeutics, and also for um confirming target engagement of new drugs. So it's very central to drug development, and uh we will need to get into those tens of thousands of subjects. Right now, our we're in early stages. We've uh scanned somewhere around 40 subjects today, but everything had to very be done very systematically and um to get to this point that we can now sprint.

SPEAKER_03 11:49

Neil, is it possible to reverse uh the disease if it's caught early enough?

SPEAKER_01 11:54

This we don't know for sure, but that's what we're hoping. We're hoping to eventually there are things like tau clearing drugs, for example. There's uh ways to manage things so we can hopefully slow it, stop the disease in its tracks, and ultimately reverse it. That is the ultimate goal for us.

SPEAKER_02 12:13

Is it been nice to see uh all these high-profile cases we talked about, I assume, have helped get rid of some of the stigma around this disease and around the things that people who suffer this struggle with. Have you seen that trend as well, Doctor?

SPEAKER_01 12:26

Definitely for contact sports athletes and for military veterans. Uh I'm gonna say less so for people who've um suffered intimate partner violence or interpersonal violence, because there's a lot of stigma tied to those. Um and these are things that tend to affect women more than men and tend to be very heavily underreported. Again, you see similar trends, for example, in the prison system and the homeless population. So there's certain vulnerable sectors that are not gonna get the same profile of exposure.

SPEAKER_02 13:07

Can I ask you even the when you talked about Claude Claude Lemieux? That story really impacted a lot of people in the country, a lot of hockey fans, because they knew him. He was a tough player, somebody that very recognizable uh multiple four times Stanley Chancellor, right? And then to watch him, I I watched that game where he had the torch and he came in, you know, the with the torch bearing, and yeah, it gives you goosebumps watching this, right? My son's a huge Montreal Canadians fan, so he's and then to hear that he committed suicide, it's just it's heartbreaking, right? And I I think that it's very brave of the family to do to don't doing. How do those stories impact you when you see that, Doctor?

SPEAKER_01 13:42

It's absolutely heartbreaking to see exactly too. I mean, um, that's something I still play hockey just recreationally once a week, and uh had a lot of friends who played higher level, um, not just hockey, but other sports, including soccer and other things. And you see, um it's really sad uh growing up watching hockey and hearing of these players um suffering all these other mental health consequences and seeing them, you know, with addiction and pain and suffering and changing their entire personalities. And uh it's the same thing in um veterans' mental health. It's very difficult. Uh is something personally and professionally I'm interested in because my mother served in the Canadian Armed Forces for over 30 years. So this is something where um having seen a lot of military veterans who've uh you know trained, and most of these act most of these injuries actually with the vets happens from training exercises. Like, for example, military breachers and special ops forces, they're practicing breaking into buildings and handling explosives and subjected to shockwaves and repetitive head impacts. So yeah, and and to see the same uh increased risk for suicide in military populations as uh contact force athletes, it's it's really heartbreaking. And I'm hoping some of this awareness can either change the training regimens, it can also hopefully offer treatment options and start treating this as an actual disease, knowing that it's real.

SPEAKER_03 15:19

So, what's the most realistic timeline for this technology becoming something that a patient will be able to access uh through the healthcare system?

SPEAKER_01 15:28

Um we're still in very early days, but I'm hoping within a couple of years that we will be sprinting because now we found ways to shorten the scan time and to simplify the imaging protocol. So um it's much easier and faster to get a scan in. So this is why I think we can now start getting at these multi-center clinical trials. We've shared the tracer already with a group in California, and it will be also shared across the world with a few other labs. And if all of us can collectively work together and start imaging Alzheimer's disease and other non-Alzheimer's disease tyopathies, including people with suspected CTE, we can get into those tens and 20 thousands of subjects very, very quickly. Just like the Alzheimer's tracers have been.

SPEAKER_02 16:18

Yeah, that's amazing. This might sound like a silly question, Doctor, but how rewarding is this work? It must be extremely rewarding.

SPEAKER_01 16:24

I think it's very rewarding at times like this because there's so many ways a radio tracer can fail. Just like most drugs fail, most radio tracers fail. And this is something, this has been a huge collective team effort that I'd like to mention. I mean, we've been working on this now. I've been working on TALPET for almost 15 years now. And uh the last five years, we've been really working tightly with a team out of Sweden called the Oxygen Discovery and the University of Pittsburgh, and had several other international collaborations with pharma companies and academic labs worldwide. And almost everything we make does fail, right? So most of the tracers we make fail. And there's so many points where we actually just triage them and say, okay, well, this is not going to advance to human for the following reasons. And um to have a tracer that's already gone all the way and keeps checking the boxes to justify us doing more scanning is extremely exciting because this doesn't happen that often in our careers.

SPEAKER_02 17:31

That's amazing. Is there before we let you go, is there a story you can share about a patient you've worked with or someone who is just so grateful that this work is happening?

SPEAKER_01 17:39

Um I'm not a physician, so for full disclosure, I but um I would love to give a shout out to, for example, Brandon Hines. I'm not sure if you saw the CBC piece that came out. But Brandon is a military veteran who's um extremely um supportive of the research, wants to be the first person. He says if he's the first person diagnosed, he will be the first to beat it. He's very optimistic, but he's suffered, you know, thousands of uh blasts being a special operations um uh forces um vet, and has had so many other mental health consequences as a result. So he's a huge advocate for us in the field and Canada and the military and everything. And um, another person too, I just want to give a massive shout out to is uh Tim Fleiser. He's the executive director of the Concussion Legacy Foundation of Canada. He used to play Harvard football. And um then uh I think 10 years in the CFL. I think he's the only person in the world who's won four Great Cups with great team, four teams, something like that. So he's had 10 years, and he's a part he's formed a partnership with our lab. I used to work with the Concussion Legacy Foundation when I was in Boston, and then they connected me with Tim when I moved back to Toronto about uh eight, nine years ago. And we have a great partnership with him. They've been amazing at helping us recruit contact sports athletes. He's personally volunteered for three scans with three tracers. Brendan's already come back for two. I think they're competing to see who's gonna get the most. But they've been huge advocates for us and CamH and just Canada in general for Contact Sports military and everything beyond. I think um we need more people like that who can do that, and also getting people to enlist in something project enlist to dedicate to donate their brains uh to medical science so we can study them in autopsy because we also need to look at different ages, different conditions, men, women, um everything's a f different. And uh, we really need the community to sort of pull together to do this as a as a team.

SPEAKER_03 19:56

Uh before we let you go, uh Neil, anything that uh we didn't ask you uh that maybe we should have?

SPEAKER_01 20:03

Um, thinking of uh maybe I think you covered pretty much everything uh we could do other than maybe we could think about uh hoping that this will start leading to some CTE specific and tau clearing drugs by having an imaging biomarker from and using PET. We can definitely accelerate this and de-risk the process. So I'm hoping that that's gonna be the one of the biggest applications of this tracer, similar to the way the Alzheimer's drugs have uh now come to approval by the FDA and in Canada.

SPEAKER_03 20:40

I'm hoping we'll start to see this for CTE as well. All right, there's Dr. Neil Vazdev, the director of the Brain Health Imaging Center at CamH uh in Toronto. It's incredibly important work that you're doing, uh doctor. So thank you for that and thank you for uh for this today.

SPEAKER_01 20:56

Thanks again for having me. It's been an honor.

SPEAKER_03 21:01

Uh that is tremendously uh important work uh that uh Neil and his team uh is doing. So I I can't wait to kind of follow that progress and see.

SPEAKER_02 21:08

It's fascinating. You know, uh we do we do talk about medical issues and and different breakthroughs on this show. But I I always every time I'm done in a conversation like that, I realize just how I still don't grasp that kind of brain power to be doing that kind of work, right? It's amazing research and the the different groups of people that come together. And for an issue that is, you know, like Neil said, he realizes how much of a high-profile issue it is that there's lots of you know, athletes that were well known that after death were diagnosed with CTE and it and they some of them suspected they had it based on the struggles that they had. Yeah. Um so it's definitely an issue that if if if Canada can lead the way in helping to find breakthroughs on this, it would be an amazing accomplishment.

SPEAKER_03 21:48

All right. Uh good stuff. I think that's uh a wrap for this week here on Closer Look. Uh you can follow us, by the way, uh all over uh our social channels Instagram, TikTok, Facebook, X, YouTube, uh, and of course right across the Village Media Network. If you've yet to sign up for our newsletter, uh please do so. You can do that at uh closerlookpodcast.ca. Every episode we do, sent straight to your inbox uh inbox, absolutely uh free of charge. We're uh happy to do that. Uh comments, always welcome. Uh inbox, open twenty-four-seven, closerlook at villagemedia.ca. We'd love to get some feedback. Uh good or bad. Uh we take it all uh and happy to do so. Okay, uh, that's it for us. Uh for Zach Trunzo, executive producer of the program, of course, uh Michael Friscolanti, our editor-in-chief here at Village Media. I'm Scott Sexmith. Thanks for your time uh today. Enjoy what's left of your weekend. We will see you next Sunday at eight, right here on Closer Look.

SPEAKER_00 22:43

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