Boston University CTE Center and Brain Bank

Boston University's CTE Center was formed as a part of the school's Alzheimer's Disease Center (BU ADC) which was established in 1996. As the prominence of long-term brain injuries continued to grow in the early 2000s, the CTE Center collaborated with the United States Department of Veteran Affairs and the Concussion Legacy Foundation to form the VA-BU-CLF Brain Bank. This Brain Bank was officially formed in 2008, and acts as a subset of the Boston University School of Medicine. A brain bank is designed to act as a central resource for the collection and distribution of brain and brain tissue samples. Brain donors may donate their brains after death to aid in the understanding of neural diseases. Brain banks differ from other organ banks in that donated brains will only be used for research purposes, and will not be given to other individuals. Ann McKee acts is the Director for the VA-BU-CLF Brain Bank and Boston University CTE Center, leading her team of researchers during group and individual case studies. McKee is aided in directing the Brain Bank by Christopher Nowinski, CEO of the Concussion Legacy Foundation, and Lisa McHale, who acts as the Bank's director for family relations. When the VA-BU-CLF Brain Bank formally opened in 2008, it became the first tissue repository in the world fully dedicated to the study of CTE. The Brain Bank continues to lead the field of CTE study, as it remains the largest brain tissue repository in the world that focuses on traumatic brain injuries and CTE. In partnership with the VA-BU-CLF Brain Bank, the Boston University CTE Center continues to be the most accomplished CTE research facility in the world, as the Center houses 70% of global CTE cases. == Mission and Practices ==

The goal of the Boston University CTE Center is to collect and study post-mortem brains to better understand the long-term diseases associated with head trauma. Specifically, the CTE Center focuses its research on the formation of neurodegenerative diseases, including Post-Concussion Syndrome and CTE. During case studies, researchers at the CTE Center perform high-impact tests and in-depth autopsies on post-mortem brains to further understand the neuropathology and clinical presentation of CTE. These tests examine the effects of concussions and sub-concussive blows on the brain, specifically as they relate to the development of CTE. The Center's ultimate goal is to develop a test that would definitively diagnose CTE in a living subject. In order to accomplish this, researchers at Boston University made it a priority to study as many post-mortem brains as possible, which led to the formation of the VA-BU-CLF Brain Bank. Currently, the Brain Bank contains over 600 brains, including 325 brains that have been diagnosed with CTE since the formation of the bank. The directors of the VA-BU-CLF Brain Bank work with families of former athletes and veterans to create a well-rounded database that researchers can utilize during large CTE case studies. Employees of the Brain Bank collect tissue samples from the central nervous system (brain, eyes, and spinal cord) of deceased athletes, most notably American football professionals, and military veterans. The Bank then stores these samples optimally to ensure proper care and treatment before, during, and after research testing. The Brain Bank directors will also share findings with family members and caregivers of the deceased. Although the Brain Bank contains a variety of brains belonging to many different types of athletes and military personnel, Boston University has made it a priority to study the brains of former American football players. These brains come from players involved in every different level of football and have been at the forefront of some of the most important CTE case studies over the past decade. == Notable people ==

Ann McKee Dr. Ann McKee is the Director of the Boston University CTE Center and a professor of neurology and pathology at the Boston University School of Medicine. Her research focuses on CTE and the late effects of neurodegeneration. Along with her colleagues, McKee has conducted several research studies involving traumatic brain injuries in sports and military situations, and the long-term effects of these injuries. While her largest project has been the formation and expansion of the VA-BU-CLF Brain Bank, McKee is also the director of several other brain banks, all of which are located in Massachusetts. Chris Nowinski Dr. Chris Nowinski is the co-founder and current CEO of the Concussion Legacy Foundation, an organization dedicated to the awareness and prevention of concussions in every level of sport. Concussions in American football is particularly important to Nowinski as he himself experienced a significant brain injury while playing football at Harvard University. Nowinski partnered with researchers from Boston University to create the VA-BU-CLF Brain Bank. Lisa McHale Lisa McHale currently acts as the director of family relations for the VA-BU-CLF Brain Bank, working with families of former athletes to help them understand CTE and the mission of the Boston University CTE Center. McHale joined the Concussion Legacy Foundation in 2010, first acting as the Volunteer and Family Coordinator. McHale has personal experience with families dealing with the effects of CTE, as her husband Tom McHale, a former American football player, died in 2008 due to complications from the disease. == Notable Case Studies ==

2009 Case Study In 2009, Dr. McKee and her team of researchers from Boston University published their first CTE study. This publication discussed 47 instances of neuropathological deterioration determined to be CTE. The study involved former athletes from a wide range of sports. Through in-depth autopsies, the researchers observed the formation of proteins in the brain that caused initial brain cell decay, ultimately leading to CTE in the brain. This tau protein was present in each brain that was diagnosed with CTE, demonstrating its role in the development of the disease. In the study, researchers noted that microscopic signs of p-tau pathology were primarily observed in subjects with Stage III and IV CTE. Each of the 202 deceased players had a history of brain trauma and experienced behavioral, mood, and cognitive symptoms during their lives. In addition, the most common cause of death among participants was neurodegeneration or suicide. Each brain was evaluated and CTE p-tau pathology for the brains were classified into a stage of CTE. Aaron Hernandez autopsy In April 2017, former New England Patriots tight end Aaron Hernandez committed suicide in a jail cell at the age of 27. Hernandez's suicide occurred two years after he was convicted of first-degree murder and sentenced to life in prison without the possibility of parole, and just five days after he was acquitted of a separate 2012 double murder. After his death, Hernandez's brain was donated to the VA-BU-CLF Brain Bank, where Boston University researchers, led by Ann McKee, immediately performed an autopsy on the post-mortem brain. The posthumous examination of the brain showed that Hernandez suffered from stage III CTE, which had previously only been diagnosed in former American football players who were well into their 60s before their deaths. According to McKee, Hernandez's brain presented a classic case of CTE, as multiple groupings of the tau protein could be seen in frontal lobes. These p-tau deposits developed in close proximity to small blood vessels in the brain and spread to areas that control perception, memory, and emotion. The discovery from Hernandez's autopsy began to shed new light on the impact of CTE in American football players, as well as other athletes. The degree of the CTE present in Hernandez's brain was unprecedented for someone so young. In the autopsy report from Boston University, McKee explains that Hernandez's brain was one of the most intact specimens her team had ever examined. McKee also notes that the damage to Hernandez's brain took years to develop, and was not the symptom of one incident. == Potential Applications of CTE Research ==

Current CTE research has primarily focused on how the disease could potentially impact the world of sports. Most notably, CTE has been linked with American football at all levels, though the most concerning findings have dealt with retired players from the National Football League. By analyzing how and where this protein forms within the brain, researchers can potentially map the protein in living individuals, and predict the development of the disease. As research into the disease continues, leaders of the VA-BU-CLF Brain Bank hope to utilize their findings to develop methods for treating and preventing the disease. == See also ==