WEBVTT
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There's no biomarker to image CTE in left.
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So that's what our lab is hoping to be, is the first lab in the world to do that.
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Welcome back to Closer Look Across the Village Media Network.
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It's Sunday, the 14th day of June.
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Michael Friscolanti, our editor in chief, is back for another week.
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I'm Scott Sexmith, Zach Trenzo in the room as well.
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Have you been watching the uh Stanley Cup final?
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I've caught glimpses of it, yes.
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Yeah.
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Fantastic hockey.
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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.
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Well, Hattrick in one period, right?
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That was almost four goals because he missed on a penalty shot.
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Yeah.
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But tell me he's not living his best life right now.
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It's amazing.
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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.
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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.
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That was the team he loved growing up, right?
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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.
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It's just a whole it's just a huge weight off your shoulders, right?
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There's the pressure's just way down.
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And he's had a great I mean he had a great Olympics, right?
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Yeah, he's played really well.
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Trevor Burrus, Jr.
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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.
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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.
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I've done I've done that with my team.
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I don't know why you were on the bottom of the list.
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You should have been right at the top.
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Look, I'm on the bottom of every list.
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You should have been right at the top.
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But you know what I'll tell you the best thing about the playoffs for me was the torch ceremony with the Montreal Canadians.
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There was I think at the beginning, they had Jean Bellevue's wife at one point.
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Did Guy Lafleur come out at one of the with one of those?
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No, because I believe he has passed.
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He passed away, yeah.
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So yeah, you tell you how well I know locked.
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Nobody does pump and circumstances.
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There was an old player that came out.
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It wasn't just Jean Belleville's wife.
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That's what I mixed up.
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Sorry.
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I must apologize.
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Apologies to the dead.
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Um that but it was fascinating, just the the emotions in that room.
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You get goosebumps watching it on TV.
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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.
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Um it was the the game that they got eliminated, and the crowd just went crazy.
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He was a tough guy in the league, you know, took a lot of took a lot of shots to the head for sure.
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Yeah.
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And tragically, he died three days later, committed suicide.
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His family's been opening.
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It's just a terribly tragic story.
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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.
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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.
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Uh, we're gonna talk about that condition today.
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It's something that it's been in the news a lot in the last few years.
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There's a lot of high-profile athletes and other people who have dealt with who but it can only be diagnosed after death.
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After death, right.
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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.
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And we're gonna chat about that today.
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For decades, CTE has remained one of medicine's biggest mysteries.
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It's been linked to athletes, military veterans, and others exposed to repeated head trauma.
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But there's been one major obstacle.
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Doctors have only been able to definitively diagnose it after death.
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Our guest today is Dr.
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Neil Vastev, director of the Brain Health Imaging Center at CamH in Toronto.
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His team is developing groundbreaking imaging technology that could allow scientists to detect signs of CTE in living patients for the first time.
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If successful, it could change how we diagnose, study, and eventually treat this devastating brain disease.
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Dr.
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Vastev, uh, welcome to the show.
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We appreciate your time today.
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Thank you for having me.
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I'm honored to be here.
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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.
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But just as a refresher, uh Doctor, can you talk about what it is and who it typically affects?
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That's a great comment about uh the high profile in media bringing CTE to the attention of people today.
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I think um the way this was really started is interesting.
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It was um Professor Bannet Amalu, who's um in University of California, uh I believe Davis at the time.
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And before that, he was at Pittsburgh.
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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.
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And uh that's where this whole field of um understanding this disease as CTE came about.
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Originally, it was originally called punch drunk, and then um other terms from that point on.
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It was something that they knew boxers used to get, but it was never really understood to affect the masses, like you mentioned.
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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.
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And even people who've been in car accidents and uh anyone who's suffered a head injury.
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And how long ago was that initial research done?
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That was um about 20, 25 years ago, uh, that I became known as CTE.
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But uh people have been studying this since the 40s, since the 1940s.
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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.
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Because when, for example, an NFL player dies or donates their brain or is confirmed to have CTE, that makes big news.
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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.
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So it's a crisis.
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It's almost one death an hour of confirmed suicide by US military veterans, and that applies to anywhere with the military.
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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.
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He was a player for the uh Steelers at the time, and um also had major changes to his behavior.
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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.
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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.
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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.
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Yeah, after that, there was also the um person, for example, um Aaron Hernandez, and there's actually Netflix documentaries on both of them.
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Yeah.
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Uh Neil, we mentioned sorry, go ahead.
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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.
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Uh Neil, we mentioned it off the top that CTE can only be diagnosed after death.
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Why is that?
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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.
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There's other things that you can look at in the brain, but that's a biomarker.
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So tau is a protein.
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You see it in Alzheimer's disease and other uh disorders, but CTE is a known biomarker in CTE.
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So it's typically stained for afterlife.
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And pretty much everything we know about CTE is from these American football players who've donated their brains.
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It's pretty much all men and American football players.
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But um, there's no biomarker to image CTE in life.
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So that's what our lab is hoping to be, is the first lab in the world to do that.
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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.
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And that's something that's quite established.
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And how's it coming, Neil?
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Are you making progress on that?
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I believe we are.
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We're very excited with our work.
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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.
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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.
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So everything is trending in the right direction for us.
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And we've also looked at it in other non-Alzheimer's disease telopathies, like uh one is called PSP or progressive supernuclear policy.
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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.
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It's fascinating work.
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Obviously, we have nothing to we don't understand what the kind of work you're doing, but it's fascinating.
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And are you literally like doing hundreds of exams?
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Like, are you looking for volunteers?
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Like how how do how does the research work?
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So we are definitely looking for volunteers.
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We're gonna have to do hundreds and if not thousands of exams.
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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.
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We started uh working very heavily on imaging tau protein in Alzheimer's patients.
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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.
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And they've been used in well over 20,000 subjects worldwide.
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They've been used for patient selection, for drug discovery, for Alzheimer's therapeutics, and also for um confirming target engagement of new drugs.
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So it's very central to drug development, and uh we will need to get into those tens of thousands of subjects.
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Right now, our we're in early stages.
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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.
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Neil, is it possible to reverse uh the disease if it's caught early enough?
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This we don't know for sure, but that's what we're hoping.
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We're hoping to eventually there are things like tau clearing drugs, for example.
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There's uh ways to manage things so we can hopefully slow it, stop the disease in its tracks, and ultimately reverse it.
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That is the ultimate goal for us.
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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.
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Have you seen that trend as well, Doctor?
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Definitely for contact sports athletes and for military veterans.
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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.
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Um and these are things that tend to affect women more than men and tend to be very heavily underreported.
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Again, you see similar trends, for example, in the prison system and the homeless population.
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So there's certain vulnerable sectors that are not gonna get the same profile of exposure.
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Can I ask you even the when you talked about Claude Claude Lemieux?
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That story really impacted a lot of people in the country, a lot of hockey fans, because they knew him.
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He was a tough player, somebody that very recognizable uh multiple four times Stanley Chancellor, right?
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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?
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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?
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And I I think that it's very brave of the family to do to don't doing.
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How do those stories impact you when you see that, Doctor?
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It's absolutely heartbreaking to see exactly too.
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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.
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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.
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And uh it's the same thing in um veterans' mental health.
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It's very difficult.
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Uh is something personally and professionally I'm interested in because my mother served in the Canadian Armed Forces for over 30 years.
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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.
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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.
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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.
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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.
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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?
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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.
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So um it's much easier and faster to get a scan in.
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So this is why I think we can now start getting at these multi-center clinical trials.
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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.
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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.
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Just like the Alzheimer's tracers have been.
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Yeah, that's amazing.
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This might sound like a silly question, Doctor, but how rewarding is this work?
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It must be extremely rewarding.
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I think it's very rewarding at times like this because there's so many ways a radio tracer can fail.
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Just like most drugs fail, most radio tracers fail.
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And this is something, this has been a huge collective team effort that I'd like to mention.
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I mean, we've been working on this now.
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I've been working on TALPET for almost 15 years now.
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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.
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And almost everything we make does fail, right?
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So most of the tracers we make fail.
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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.
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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.
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That's amazing.
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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?
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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.
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I'm not sure if you saw the CBC piece that came out.
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But Brandon is a military veteran who's um extremely um supportive of the research, wants to be the first person.
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He says if he's the first person diagnosed, he will be the first to beat it.
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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.
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So he's a huge advocate for us in the field and Canada and the military and everything.
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And um, another person too, I just want to give a massive shout out to is uh Tim Fleiser.
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He's the executive director of the Concussion Legacy Foundation of Canada.
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He used to play Harvard football.
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And um then uh I think 10 years in the CFL.
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I think he's the only person in the world who's won four Great Cups with great team, four teams, something like that.
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So he's had 10 years, and he's a part he's formed a partnership with our lab.
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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.
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And we have a great partnership with him.
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They've been amazing at helping us recruit contact sports athletes.
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He's personally volunteered for three scans with three tracers.
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Brendan's already come back for two.
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I think they're competing to see who's gonna get the most.
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But they've been huge advocates for us and CamH and just Canada in general for Contact Sports military and everything beyond.
00:19:27.279 --> 00:19:49.920
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.
00:19:50.079 --> 00:19:55.680
And uh, we really need the community to sort of pull together to do this as a as a team.
00:19:56.240 --> 00:20:01.359
Uh before we let you go, uh Neil, anything that uh we didn't ask you uh that maybe we should have?
00:20:03.200 --> 00:20:23.920
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.
00:20:24.480 --> 00:20:28.400
We can definitely accelerate this and de-risk the process.
00:20:28.480 --> 00:20:40.799
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.
00:20:40.880 --> 00:20:43.200
I'm hoping we'll start to see this for CTE as well.
00:20:43.519 --> 00:20:44.240
All right, there's Dr.
00:20:44.319 --> 00:20:49.680
Neil Vazdev, the director of the Brain Health Imaging Center at CamH uh in Toronto.
00:20:49.759 --> 00:20:52.240
It's incredibly important work that you're doing, uh doctor.
00:20:52.480 --> 00:20:55.599
So thank you for that and thank you for uh for this today.
00:20:56.160 --> 00:20:57.279
Thanks again for having me.
00:20:57.359 --> 00:20:58.559
It's been an honor.
00:21:01.039 --> 00:21:06.240
Uh that is tremendously uh important work uh that uh Neil and his team uh is doing.
00:21:06.319 --> 00:21:08.559
So I I can't wait to kind of follow that progress and see.
00:21:08.960 --> 00:21:09.680
It's fascinating.
00:21:09.920 --> 00:21:14.960
You know, uh we do we do talk about medical issues and and different breakthroughs on this show.
00:21:15.119 --> 00:21:22.480
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?
00:21:22.799 --> 00:21:26.079
It's amazing research and the the different groups of people that come together.
00:21:26.319 --> 00:21:40.799
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.
00:21:41.039 --> 00:21:41.119
Yeah.
00:21:41.359 --> 00:21:47.839
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.
00:21:48.240 --> 00:21:48.480
All right.
00:21:48.559 --> 00:21:49.200
Uh good stuff.
00:21:49.440 --> 00:21:52.720
I think that's uh a wrap for this week here on Closer Look.
00:21:52.880 --> 00:22:03.359
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.
00:22:03.519 --> 00:22:06.400
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00:22:09.920 --> 00:22:15.200
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00:22:15.279 --> 00:22:16.400
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00:22:16.559 --> 00:22:18.000
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00:22:18.079 --> 00:22:22.160
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00:22:22.400 --> 00:22:23.359
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00:22:23.440 --> 00:22:24.640
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00:22:24.720 --> 00:22:27.519
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00:22:27.759 --> 00:22:28.880
Okay, uh, that's it for us.
00:22:28.960 --> 00:22:35.519
Uh for Zach Trunzo, executive producer of the program, of course, uh Michael Friscolanti, our editor-in-chief here at Village Media.
00:22:35.599 --> 00:22:36.559
I'm Scott Sexmith.
00:22:36.640 --> 00:22:37.599
Thanks for your time uh today.
00:22:37.759 --> 00:22:39.359
Enjoy what's left of your weekend.
00:22:39.519 --> 00:22:43.519
We will see you next Sunday at eight, right here on Closer Look.
00:22:43.839 --> 00:22:48.000
Briscoe and Scott's wardrobe, provided in part by Morris Clothing for Men.
00:00:00.000 --> 00:00:03.520
There's no biomarker to image CTE in left.
00:00:03.680 --> 00:00:07.519
So that's what our lab is hoping to be, is the first lab in the world to do that.
00:00:25.120 --> 00:00:28.160
Welcome back to Closer Look Across the Village Media Network.
00:00:28.239 --> 00:00:30.239
It's Sunday, the 14th day of June.
00:00:30.320 --> 00:00:35.280
Michael Friscolanti, our editor in chief, is back for another week.
00:00:35.439 --> 00:00:38.960
I'm Scott Sexmith, Zach Trenzo in the room as well.
00:00:39.119 --> 00:00:40.960
Have you been watching the uh Stanley Cup final?
00:00:41.280 --> 00:00:42.320
I've caught glimpses of it, yes.
00:00:42.399 --> 00:00:42.560
Yeah.
00:00:42.880 --> 00:00:43.600
Fantastic hockey.
00:00:43.840 --> 00:00:50.399
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.
00:00:50.479 --> 00:00:51.759
Well, Hattrick in one period, right?
00:00:53.119 --> 00:00:55.759
That was almost four goals because he missed on a penalty shot.
00:00:55.920 --> 00:00:56.000
Yeah.
00:00:56.240 --> 00:00:58.000
But tell me he's not living his best life right now.
00:00:58.320 --> 00:00:58.640
It's amazing.
00:00:58.799 --> 00:01:02.560
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.
00:01:02.719 --> 00:01:08.159
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.
00:01:08.400 --> 00:01:10.239
That was the team he loved growing up, right?
00:01:10.480 --> 00:01:18.640
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.
00:01:19.200 --> 00:01:21.680
It's just a whole it's just a huge weight off your shoulders, right?
00:01:21.760 --> 00:01:23.120
There's the pressure's just way down.
00:01:23.280 --> 00:01:25.359
And he's had a great I mean he had a great Olympics, right?
00:01:26.560 --> 00:01:27.359
Yeah, he's played really well.
00:01:27.439 --> 00:01:27.599
Trevor Burrus, Jr.
00:01:27.920 --> 00:01:37.200
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.
00:01:37.280 --> 00:01:45.280
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.
00:01:45.599 --> 00:01:47.040
I've done I've done that with my team.
00:01:48.959 --> 00:01:50.400
I don't know why you were on the bottom of the list.
00:01:50.640 --> 00:01:51.680
You should have been right at the top.
00:01:52.239 --> 00:01:53.599
Look, I'm on the bottom of every list.
00:01:54.000 --> 00:01:54.719
You should have been right at the top.
00:01:54.799 --> 00:01:59.599
But you know what I'll tell you the best thing about the playoffs for me was the torch ceremony with the Montreal Canadians.
00:02:00.319 --> 00:02:03.439
There was I think at the beginning, they had Jean Bellevue's wife at one point.
00:02:04.159 --> 00:02:06.159
Did Guy Lafleur come out at one of the with one of those?
00:02:06.799 --> 00:02:08.319
No, because I believe he has passed.
00:02:08.719 --> 00:02:09.280
He passed away, yeah.
00:02:09.439 --> 00:02:10.960
So yeah, you tell you how well I know locked.
00:02:11.199 --> 00:02:12.319
Nobody does pump and circumstances.
00:02:13.280 --> 00:02:14.240
There was an old player that came out.
00:02:14.319 --> 00:02:15.680
It wasn't just Jean Belleville's wife.
00:02:17.199 --> 00:02:17.759
That's what I mixed up.
00:02:18.000 --> 00:02:18.159
Sorry.
00:02:18.240 --> 00:02:19.199
I must apologize.
00:02:19.680 --> 00:02:20.800
Apologies to the dead.
00:02:21.039 --> 00:02:24.400
Um that but it was fascinating, just the the emotions in that room.
00:02:24.639 --> 00:02:26.240
You get goosebumps watching it on TV.
00:02:26.479 --> 00:02:32.960
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.
00:02:33.120 --> 00:02:37.280
Um it was the the game that they got eliminated, and the crowd just went crazy.
00:02:37.840 --> 00:02:41.680
He was a tough guy in the league, you know, took a lot of took a lot of shots to the head for sure.
00:02:41.919 --> 00:02:42.000
Yeah.
00:02:42.240 --> 00:02:44.800
And tragically, he died three days later, committed suicide.
00:02:44.879 --> 00:02:45.759
His family's been opening.
00:02:46.479 --> 00:02:47.840
It's just a terribly tragic story.
00:02:47.919 --> 00:02:56.479
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.
00:02:56.719 --> 00:03:10.719
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.
00:03:11.039 --> 00:03:12.719
Uh, we're gonna talk about that condition today.
00:03:12.960 --> 00:03:15.360
It's something that it's been in the news a lot in the last few years.
00:03:15.439 --> 00:03:20.080
There's a lot of high-profile athletes and other people who have dealt with who but it can only be diagnosed after death.
00:03:20.319 --> 00:03:20.719
After death, right.
00:03:20.960 --> 00:03:27.520
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.
00:03:27.599 --> 00:03:29.439
And we're gonna chat about that today.
00:03:32.000 --> 00:03:36.240
For decades, CTE has remained one of medicine's biggest mysteries.
00:03:36.400 --> 00:03:41.199
It's been linked to athletes, military veterans, and others exposed to repeated head trauma.
00:03:41.360 --> 00:03:43.199
But there's been one major obstacle.
00:03:43.360 --> 00:03:47.680
Doctors have only been able to definitively diagnose it after death.
00:03:47.919 --> 00:03:48.960
Our guest today is Dr.
00:03:49.039 --> 00:03:53.439
Neil Vastev, director of the Brain Health Imaging Center at CamH in Toronto.
00:03:53.599 --> 00:04:02.639
His team is developing groundbreaking imaging technology that could allow scientists to detect signs of CTE in living patients for the first time.
00:04:02.800 --> 00:04:09.360
If successful, it could change how we diagnose, study, and eventually treat this devastating brain disease.
00:04:09.520 --> 00:04:09.680
Dr.
00:04:09.759 --> 00:04:11.199
Vastev, uh, welcome to the show.
00:04:11.280 --> 00:04:12.960
We appreciate your time today.
00:04:13.520 --> 00:04:14.319
Thank you for having me.
00:04:14.400 --> 00:04:15.439
I'm honored to be here.
00:04:15.680 --> 00:04:22.720
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.
00:04:22.959 --> 00:04:28.319
But just as a refresher, uh Doctor, can you talk about what it is and who it typically affects?
00:04:28.639 --> 00:04:36.720
That's a great comment about uh the high profile in media bringing CTE to the attention of people today.
00:04:37.199 --> 00:04:40.879
I think um the way this was really started is interesting.
00:04:40.959 --> 00:04:48.959
It was um Professor Bannet Amalu, who's um in University of California, uh I believe Davis at the time.
00:04:49.120 --> 00:04:51.439
And before that, he was at Pittsburgh.
00:04:51.600 --> 00:05:08.240
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.
00:05:08.800 --> 00:05:16.160
And uh that's where this whole field of um understanding this disease as CTE came about.
00:05:16.319 --> 00:05:21.839
Originally, it was originally called punch drunk, and then um other terms from that point on.
00:05:22.000 --> 00:05:29.279
It was something that they knew boxers used to get, but it was never really understood to affect the masses, like you mentioned.
00:05:29.360 --> 00:05:50.720
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.
00:05:50.879 --> 00:05:55.920
And even people who've been in car accidents and uh anyone who's suffered a head injury.
00:05:56.319 --> 00:05:58.959
And how long ago was that initial research done?
00:05:59.519 --> 00:06:05.199
That was um about 20, 25 years ago, uh, that I became known as CTE.
00:06:05.279 --> 00:06:10.240
But uh people have been studying this since the 40s, since the 1940s.
00:06:10.399 --> 00:06:22.959
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.
00:06:23.040 --> 00:06:30.800
Because when, for example, an NFL player dies or donates their brain or is confirmed to have CTE, that makes big news.
00:06:31.120 --> 00:06:46.959
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.
00:06:47.199 --> 00:06:48.879
So it's a crisis.
00:06:48.959 --> 00:06:55.680
It's almost one death an hour of confirmed suicide by US military veterans, and that applies to anywhere with the military.
00:06:55.920 --> 00:07:09.040
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.
00:07:09.120 --> 00:07:17.600
He was a player for the uh Steelers at the time, and um also had major changes to his behavior.
00:07:17.759 --> 00:07:42.959
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.
00:07:43.040 --> 00:07:49.040
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.
00:07:49.199 --> 00:07:58.639
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.
00:07:58.800 --> 00:08:07.439
Yeah, after that, there was also the um person, for example, um Aaron Hernandez, and there's actually Netflix documentaries on both of them.
00:08:08.720 --> 00:08:08.959
Yeah.
00:08:09.279 --> 00:08:12.240
Uh Neil, we mentioned sorry, go ahead.
00:08:12.879 --> 00:08:29.120
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.
00:08:29.439 --> 00:08:33.519
Uh Neil, we mentioned it off the top that CTE can only be diagnosed after death.
00:08:33.679 --> 00:08:34.720
Why is that?
00:08:36.559 --> 00:08:47.360
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.
00:08:47.519 --> 00:08:51.440
There's other things that you can look at in the brain, but that's a biomarker.
00:08:51.519 --> 00:08:53.200
So tau is a protein.
00:08:53.919 --> 00:09:01.759
You see it in Alzheimer's disease and other uh disorders, but CTE is a known biomarker in CTE.
00:09:01.840 --> 00:09:05.120
So it's typically stained for afterlife.
00:09:05.279 --> 00:09:11.440
And pretty much everything we know about CTE is from these American football players who've donated their brains.
00:09:11.519 --> 00:09:15.039
It's pretty much all men and American football players.
00:09:15.440 --> 00:09:19.759
But um, there's no biomarker to image CTE in life.
00:09:19.840 --> 00:09:23.600
So that's what our lab is hoping to be, is the first lab in the world to do that.
00:09:23.679 --> 00:09:44.240
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.
00:09:44.720 --> 00:09:46.399
And that's something that's quite established.
00:09:46.720 --> 00:09:47.759
And how's it coming, Neil?
00:09:47.840 --> 00:09:49.039
Are you making progress on that?
00:09:50.240 --> 00:09:51.120
I believe we are.
00:09:51.200 --> 00:09:52.799
We're very excited with our work.
00:09:52.879 --> 00:10:02.960
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.
00:10:03.200 --> 00:10:17.279
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.
00:10:17.440 --> 00:10:20.000
So everything is trending in the right direction for us.
00:10:20.159 --> 00:10:28.000
And we've also looked at it in other non-Alzheimer's disease telopathies, like uh one is called PSP or progressive supernuclear policy.
00:10:28.080 --> 00:10:36.080
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.
00:10:36.399 --> 00:10:37.120
It's fascinating work.
00:10:37.200 --> 00:10:40.480
Obviously, we have nothing to we don't understand what the kind of work you're doing, but it's fascinating.
00:10:40.559 --> 00:10:42.639
And are you literally like doing hundreds of exams?
00:10:42.720 --> 00:10:44.000
Like, are you looking for volunteers?
00:10:44.080 --> 00:10:46.080
Like how how do how does the research work?
00:10:46.639 --> 00:10:48.960
So we are definitely looking for volunteers.
00:10:49.039 --> 00:10:52.159
We're gonna have to do hundreds and if not thousands of exams.
00:10:52.399 --> 00:11:00.879
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.
00:11:01.120 --> 00:11:05.440
We started uh working very heavily on imaging tau protein in Alzheimer's patients.
00:11:05.519 --> 00:11:14.320
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.
00:11:14.480 --> 00:11:17.440
And they've been used in well over 20,000 subjects worldwide.
00:11:17.600 --> 00:11:27.039
They've been used for patient selection, for drug discovery, for Alzheimer's therapeutics, and also for um confirming target engagement of new drugs.
00:11:27.200 --> 00:11:35.440
So it's very central to drug development, and uh we will need to get into those tens of thousands of subjects.
00:11:35.600 --> 00:11:37.840
Right now, our we're in early stages.
00:11:37.919 --> 00:11:48.559
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.
00:11:49.120 --> 00:11:53.600
Neil, is it possible to reverse uh the disease if it's caught early enough?
00:11:54.559 --> 00:11:57.039
This we don't know for sure, but that's what we're hoping.
00:11:57.279 --> 00:12:02.799
We're hoping to eventually there are things like tau clearing drugs, for example.
00:12:02.960 --> 00:12:11.360
There's uh ways to manage things so we can hopefully slow it, stop the disease in its tracks, and ultimately reverse it.
00:12:11.519 --> 00:12:13.279
That is the ultimate goal for us.
00:12:13.759 --> 00:12:22.879
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.
00:12:23.360 --> 00:12:25.360
Have you seen that trend as well, Doctor?
00:12:26.399 --> 00:12:32.399
Definitely for contact sports athletes and for military veterans.
00:12:33.200 --> 00:12:45.200
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.
00:12:45.360 --> 00:12:53.840
Um and these are things that tend to affect women more than men and tend to be very heavily underreported.
00:12:54.000 --> 00:13:01.039
Again, you see similar trends, for example, in the prison system and the homeless population.
00:13:01.200 --> 00:13:06.799
So there's certain vulnerable sectors that are not gonna get the same profile of exposure.
00:13:07.360 --> 00:13:10.320
Can I ask you even the when you talked about Claude Claude Lemieux?
00:13:10.480 --> 00:13:14.720
That story really impacted a lot of people in the country, a lot of hockey fans, because they knew him.
00:13:14.879 --> 00:13:21.120
He was a tough player, somebody that very recognizable uh multiple four times Stanley Chancellor, right?
00:13:21.440 --> 00:13:28.879
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?
00:13:28.960 --> 00:13:34.799
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?
00:13:34.960 --> 00:13:38.000
And I I think that it's very brave of the family to do to don't doing.
00:13:38.320 --> 00:13:41.120
How do those stories impact you when you see that, Doctor?
00:13:42.480 --> 00:13:45.200
It's absolutely heartbreaking to see exactly too.
00:13:45.279 --> 00:13:58.480
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.
00:13:58.639 --> 00:14:16.799
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.
00:14:16.879 --> 00:14:20.559
And uh it's the same thing in um veterans' mental health.
00:14:20.639 --> 00:14:21.759
It's very difficult.
00:14:21.840 --> 00:14:28.320
Uh is something personally and professionally I'm interested in because my mother served in the Canadian Armed Forces for over 30 years.
00:14:28.399 --> 00:14:42.559
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.
00:14:42.720 --> 00:14:53.039
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.
00:14:53.600 --> 00:15:05.440
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.
00:15:05.519 --> 00:15:18.879
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.
00:15:19.440 --> 00:15:27.679
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?
00:15:28.879 --> 00:15:43.519
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.
00:15:43.759 --> 00:15:47.759
So um it's much easier and faster to get a scan in.
00:15:47.840 --> 00:15:52.240
So this is why I think we can now start getting at these multi-center clinical trials.
00:15:52.320 --> 00:16:00.399
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.
00:16:00.639 --> 00:16:15.919
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.
00:16:16.399 --> 00:16:18.080
Just like the Alzheimer's tracers have been.
00:16:18.320 --> 00:16:18.960
Yeah, that's amazing.
00:16:19.279 --> 00:16:22.000
This might sound like a silly question, Doctor, but how rewarding is this work?
00:16:22.080 --> 00:16:23.840
It must be extremely rewarding.
00:16:24.720 --> 00:16:30.799
I think it's very rewarding at times like this because there's so many ways a radio tracer can fail.
00:16:31.039 --> 00:16:34.960
Just like most drugs fail, most radio tracers fail.
00:16:35.120 --> 00:16:38.799
And this is something, this has been a huge collective team effort that I'd like to mention.
00:16:38.960 --> 00:16:41.279
I mean, we've been working on this now.
00:16:41.519 --> 00:16:45.120
I've been working on TALPET for almost 15 years now.
00:16:45.600 --> 00:17:00.720
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.
00:17:00.799 --> 00:17:04.000
And almost everything we make does fail, right?
00:17:04.079 --> 00:17:06.000
So most of the tracers we make fail.
00:17:06.160 --> 00:17:14.400
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.
00:17:14.559 --> 00:17:30.240
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.
00:17:31.119 --> 00:17:31.839
That's amazing.
00:17:32.000 --> 00:17:38.319
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?
00:17:39.519 --> 00:17:48.720
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.
00:17:48.960 --> 00:17:51.119
I'm not sure if you saw the CBC piece that came out.
00:17:52.720 --> 00:18:02.880
But Brandon is a military veteran who's um extremely um supportive of the research, wants to be the first person.
00:18:03.279 --> 00:18:07.039
He says if he's the first person diagnosed, he will be the first to beat it.
00:18:07.200 --> 00:18:22.960
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.
00:18:23.279 --> 00:18:29.119
So he's a huge advocate for us in the field and Canada and the military and everything.
00:18:29.279 --> 00:18:33.839
And um, another person too, I just want to give a massive shout out to is uh Tim Fleiser.
00:18:34.480 --> 00:18:38.319
He's the executive director of the Concussion Legacy Foundation of Canada.
00:18:38.400 --> 00:18:40.319
He used to play Harvard football.
00:18:40.559 --> 00:18:44.480
And um then uh I think 10 years in the CFL.
00:18:44.559 --> 00:18:49.599
I think he's the only person in the world who's won four Great Cups with great team, four teams, something like that.
00:18:49.759 --> 00:18:53.680
So he's had 10 years, and he's a part he's formed a partnership with our lab.
00:18:53.839 --> 00:19:02.400
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.
00:19:02.640 --> 00:19:04.880
And we have a great partnership with him.
00:19:04.960 --> 00:19:08.640
They've been amazing at helping us recruit contact sports athletes.
00:19:08.720 --> 00:19:12.079
He's personally volunteered for three scans with three tracers.
00:19:12.240 --> 00:19:14.240
Brendan's already come back for two.
00:19:14.480 --> 00:19:17.359
I think they're competing to see who's gonna get the most.
00:19:18.000 --> 00:19:27.119
But they've been huge advocates for us and CamH and just Canada in general for Contact Sports military and everything beyond.
00:19:27.279 --> 00:19:49.920
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.
00:19:50.079 --> 00:19:55.680
And uh, we really need the community to sort of pull together to do this as a as a team.
00:19:56.240 --> 00:20:01.359
Uh before we let you go, uh Neil, anything that uh we didn't ask you uh that maybe we should have?
00:20:03.200 --> 00:20:23.920
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.
00:20:24.480 --> 00:20:28.400
We can definitely accelerate this and de-risk the process.
00:20:28.480 --> 00:20:40.799
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.
00:20:40.880 --> 00:20:43.200
I'm hoping we'll start to see this for CTE as well.
00:20:43.519 --> 00:20:44.240
All right, there's Dr.
00:20:44.319 --> 00:20:49.680
Neil Vazdev, the director of the Brain Health Imaging Center at CamH uh in Toronto.
00:20:49.759 --> 00:20:52.240
It's incredibly important work that you're doing, uh doctor.
00:20:52.480 --> 00:20:55.599
So thank you for that and thank you for uh for this today.
00:20:56.160 --> 00:20:57.279
Thanks again for having me.
00:20:57.359 --> 00:20:58.559
It's been an honor.
00:21:01.039 --> 00:21:06.240
Uh that is tremendously uh important work uh that uh Neil and his team uh is doing.
00:21:06.319 --> 00:21:08.559
So I I can't wait to kind of follow that progress and see.
00:21:08.960 --> 00:21:09.680
It's fascinating.
00:21:09.920 --> 00:21:14.960
You know, uh we do we do talk about medical issues and and different breakthroughs on this show.
00:21:15.119 --> 00:21:22.480
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?
00:21:22.799 --> 00:21:26.079
It's amazing research and the the different groups of people that come together.
00:21:26.319 --> 00:21:40.799
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.
00:21:41.039 --> 00:21:41.119
Yeah.
00:21:41.359 --> 00:21:47.839
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.
00:21:48.240 --> 00:21:48.480
All right.
00:21:48.559 --> 00:21:49.200
Uh good stuff.
00:21:49.440 --> 00:21:52.720
I think that's uh a wrap for this week here on Closer Look.
00:21:52.880 --> 00:22:03.359
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00:22:27.759 --> 00:22:28.880
Okay, uh, that's it for us.
00:22:28.960 --> 00:22:35.519
Uh for Zach Trunzo, executive producer of the program, of course, uh Michael Friscolanti, our editor-in-chief here at Village Media.
00:22:35.599 --> 00:22:36.559
I'm Scott Sexmith.
00:22:36.640 --> 00:22:37.599
Thanks for your time uh today.
00:22:37.759 --> 00:22:39.359
Enjoy what's left of your weekend.
00:22:39.519 --> 00:22:43.519
We will see you next Sunday at eight, right here on Closer Look.
00:22:43.839 --> 00:22:48.000
Briscoe and Scott's wardrobe, provided in part by Morris Clothing for Men.
