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In Mexico City, ASU thinks about the future

April 10, 2019

When we think about self-driving cars, we don’t usually think about organ donation. But, as Anne Hobson and Ian Adams argued in a 2016 article published in Slate’s Future Tense— a partnership between the magazine, Arizona State University, and the New America Foundation — we should. 

About 20% of donated organs come as a result of traffic-related deaths, which tragically claimed more than 34,000 lives in the U.S. in 2017. Self-driving cars promise to reduce that number by taking human error off the road. But as we work to ensure that self-driving technology reaches its goal of saving human lives, we also need to think about solutions to the less obvious consequences that technology’s success may leave behind — such as a reduction in donor organs. 

Asking about the less obvious consequences of technology is one of Torie Bosch’s rules for thinking about the future, which she shared with an audience in Mexico City last week. Bosch is the editor of Future Tense and an editor-in-residence and lecturer at ASU’s Walter Cronkite School of Journalism and Mass Communication. She was joined by Pablo Duarte, an editor of the prestigious Mexican magazine Letras Libres, and Alejandro Pisanty, a professor of chemistry at the Universidad Nacional Autónoma de México who is one of the foremost authorities on the Mexican internet. Letras Libres is a partner of Future Tense, publishing its content in translation for its readers in Mexico, Spain and across Latin America.

The event, titled “How to Think About the Future in the Present,” forms part of a series of events hosted by ASU’s Convergence Lab, an initiative that brings together thinkers from ASU and Mexico to explore challenges and opportunities shared across the border. 

“Mexico is a great place to be if you care about the future, the present and the past,” Pisanty said, echoing the Mexican writer Carlos Fuentes’ saying that Mexico is a place where all times co-exist. 

Both Pisanty and Bosch urged the need to strike a balance between optimism and pessimism about emerging technologies — the kind of balance that allows you to ask the right questions. 

Pisanty, who has extensively studied the internet and information security, said that when the internet first started becoming widely used, he and other researchers were “too optimistic about online behavior.” Now, he’s working on creating frameworks to understand that behavior, especially as it moves between online and offline. 

Bosch’s other rules include admonitions against making predictions about specific technologies or believing that technology can fix human problems by itself. 

Bosch has used these rules in over close to eight years of editing Future Tense, since its founding in 2011. In that time, and through the support of ASU, Slate and New America, Future Tense has explored how emerging technologies will change the way we live through published commentary and its own public events. 

The project’s effects have rippled far beyond ASU: About 25% of Future Tense’s readership on Slate (which was founded in early internet days by Bill Gates) comes from outside the U.S. And in addition to Letras Libres, Future Tense is also partnered with publications in Brazil and the United Arab Emirates that translate its articles into Portuguese and Arabic. 

The idea is that if — across borders and languages — we all think about the future together, we’ll be able to construct a better one. 

Although, Bosch said, there is one problem with thinking about the future.

“The truth is that there is no single the future, it’s a limitation in English ... the future isn’t a fixed destination,” Bosch said. “Every day we all make decisions that lead toward the future where we will arrive. And some of our decisions matter more than others, some people’s opinions matter more than others. And that’s the point of Future Tense, is to try to democratize these conversations.” 

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Top photo: ASU hosts an event on technology and the future in Mexico City on Thursday, April 4. The event featured a presentation by Torie Bosch, the editor of Future Tense, a collaboration between ASU, Slate Magazine and the New America Foundation that explores how emerging technologies will change the way we live.

Written by Mia Armstrong

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New techniques may detect CTE in brains of living former NFL players

April 10, 2019

When you search online for “CTE and NFL,” you’ll find a list of 54 professional football players who have died and were diagnosed with the degenerative brain disease chronic traumatic encephalopathy, or CTE — names like Frank Gifford, Ken Stabler, Bubba Smith and Andre Waters. It’s a smart guess that hundreds more are unaccounted for.

Next, you’ll see a list of living ex-NFL players including Brett Favre, Bernie Kosar and Jim McMahon, who have been diagnosed with “likely CTE.” And therein lies the problem: CTE cannot be detected until autopsy, leaving questions about who has it, when they get it, and how it affects their lives. To confirm CTE, scientists must rely on players and families who agree to donate their brains to research.  

But now, Arizona researchers are playing a key role in the search for new ways to identify CTE before death. In a study released online in the New England Journal of Medicine, a cross-national team, including local researchers from Arizona State University, Banner Alzheimer’s Institute, Mayo Clinic Alix School of Medicine and Boston University have brought us a step closer to diagnosing CTE in living former NFL players.

The study demonstrates that an experimental positron emission tomography (PET) scan can detect a hallmark of CTE, the accumulation of abnormal tau protein in brain regions of living former NFL players who have cognitive, mood and behavior symptoms. The researchers also found that the more years of tackle football played (across all levels of play), the higher the tau protein levels detected by the PET scan.

Corresponding author Robert Stern, a professor of neurology, neurosurgery and anatomy and neurobiology at Boston University School of Medicine (BUSM), said that “the results of this study provide initial support for the flortaucipir PET scan to detect abnormal tau from CTE during life. However, we’re not there yet,” he cautioned. “These results do not mean that we can now diagnose CTE during life or that this experimental test is ready for use in the clinic.”

CTE is a neurodegenerative disease associated with repeated blows to the head. Symptoms of CTE can begin in a patient’s late 20s or early 30s. Common behaviors are anger, lack of impulse control, depression, suicidal thinking and paranoia. This is a brain disease for which there is no treatment.

In CTE, a protein called tau forms clumps that slowly spread through the brain, killing brain cells, and patients typically show a relative lack of the amyloid plaques which are associated with Alzheimer’s disease.

Diego Mastroeni, a researcher with the ASU-Banner Neurological Disease Research Center at the Biodesign Institute, first got an “up-close-and-personal” look when a member of Mastroeni’s family shared his concerns about memory issues and how his NFL career may have affected his brain. Mastroeni was recruited to speak at a meeting of Arizona’s NFL Alumni Association.

ASU researcher

Diego Mastroeni

“This was 2015. The NFL concussion settlement was in full form, but players needed to be diagnosed with dementia or mild cognitive impairment in order to qualify,” said Mastroeni. “By this time I was having personal communication with well over 50 retired NFL players. They were calling and emailing me daily, pleading for help, asking what to do.”

Methods for diagnosing CTE in living patients were undependable and expensive. A single brain scan cost about $10,000 at the time.

“When I say this is a vulnerable population, I mean it,” said Mastroeni. “It got to the point that I needed to find a way to help these guys at no cost to them.”

From his work with Alzheimer’s, Mastroeni knew that chances were good that CTE was brewing in the brain before symptoms began appearing.  

“Unfortunately, efforts to develop a diagnostic tool during life have largely been unsuccessful,” said Mastroeni. But Mastroeni also knew that advances in brain imaging techniques like PET scans were revolutionizing the field, providing a means to reliably detect and track brain changes in living subjects before the onset of memory loss in neurological conditions like Alzheimer’s disease. 

Mastroeni reached out to Marwan Sabbagh, a neuroscientist, formerly with Banner Alzheimer’s Institute and now with the Cleveland Clinic, and asked if he’d be willing to meet with Mastroeni’s relative and others who had expressed interest.

Next, Mastroeni connected with Eric Reiman, a leader in neuro-imaging, University Professor of Neurology at Arizona State University and executive director of Banner Alzheimer’s Institute, who knew just the right people with whom to partner.

“A couple weeks later, Bob Stern flew out from Boston and we hashed out a plan to image all the guys we could; some at BUSM, some at Banner and some at Mayo, at no cost to them,” said Mastroeni. Stern leads a CTE Center at BUSM where he is working to develop accurate methods to detect and diagnose CTE while the player is still alive, gaining a better understanding of risk factors for the disease — and understanding why some players get it and some do not.

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In 2014, Mastroeni sent a letter to NFL players who lived in Arizona, offering them the opportunity to be part of a study. After several appearances at the local NFL alumni chapter, some 60 players were eager to participate. Some of the patients were included in the study, and others did not meet the inclusion criteria. The state of Arizona provided enough funding to launch the study in Arizona, while researchers in Boston also recruited participants and secured their own funding.

The Arizona force was strong, involving not only Mastroeni and Reiman’s team in Arizona, but also neurologists David Dodick and Charles Adler at Mayo Clinic Alix School of Medicine in Phoenix. The multidisciplinary group of researchers also included Brigham and Women’s Hospital and Avid Radiopharmaceuticals.

In the study, experimental flortaucipir PET scans (flortaucipir is the chemical used to measure tau in the PET scans) were used to assess tau deposition, and FDA-approved florbetapir PET scans were used to assess amyloid plaque deposition in the brains of 26 living former NFL players with cognitive, mood and behavioral symptoms (ages 40-69). There was also a control group of 31 same-aged men without symptoms or history of traumatic brain injury.

Results showed that the tau PET levels were significantly higher in the former NFL group than in the controls, and tau was seen in the specific areas of the brain that have been shown to be affected in post-mortem cases of neuropathologically diagnosed CTE.

Interestingly, the former player and control groups did not differ in their amyloid PET measurements. Indeed, only one former player had amyloid PET measurements comparable to those seen in Alzheimer’s disease (AD).

“Our findings suggest that mild cognitive, emotional and behavioral symptoms observed in athletes with a history of repetitive impacts are not attributable to AD, and they provide a foundation for additional research studies to advance the scientific understanding, diagnosis, treatment and prevention of CTE in living persons,” said co-author Reiman. “More research is needed to draw firm conclusions, and contact sports athletes, their families and other stakeholders are waiting."

With support from NIH, the authors are working with additional researchers to conduct a longitudinal study called the DIAGNOSE CTE Research Project in former NFL players, former college football players and persons without a history of contact sports play to help address these and other important questions. Initial results of that study are expected in early 2020.

Funding for this study was provided by grants from Avid Radiopharmaceuticals (a wholly owned subsidiary of Eli Lilly and Company), the National Institutes of Health (grant numbers R01NS078337, U19AG024904, 1UL1TR001430); the state of Arizona; and the U.S. Department of Defense (grant numbers W81XWH-13-2-0063, W81XWH-13-2-0064, W81XWH-14-1-0462). All flortaucipir and florbetapir PET radiotracers were provided by Avid Radiopharmaceuticals.

Top image: CTE is a neurodegenerative disease associated with repeated blows to the head for which there is no treatment. Common behaviors include anger, lack of impulse control, depression, suicidal thinking and paranoia.