Neurofilament light and tau in serum after head-impact exposure in soccer

Introduction: Blood-based biomarkers can provide valuable information on the effects of repetitive head impacts in sports. This study investigated if repetitive headers or accidental head impacts in soccer could cause structural brain injury, detected as an increase in serum neurofilament light (NfL) or tau. Methods: NfL and tau were measured in professional soccer players in pre-season. Then, the effect of three short-term exposures on biomarker levels was assessed: (1) high-intensity exercise, (2) repetitive headers, and (3) head impacts in a match. Results: We analyzed 354 samples and observed no effects on NfL from any of the three short-term exposures. Tau levels rose significantly from baseline to 1 h after (1) high-intensity exercise (Delta 0.50 pg/mL, 95% CI 0.19-0.81, p < .01); the same was observed after (2) repetitive headers (Delta 0.29 pg/mL, 95% CI 0.10-0.48, p < .01), but not after (3) accidental head-impact incidents (Delta 0.36 pg/mL, 95% CI -0.02-0.74, p = .06). The highest absolute values were seen 1 h after high-intensity exercise (mean +/- SD, 1.92 +/- 0.83 pg/mL). Conclusion: NfL and tau in serum were unaffected by head impacts in soccer. Importantly, tau levels seem to rise in response to exercise, emphasizing the need for control groups. Our findings highlight important characteristics and limitations when using these biomarkers in sports.