Before this recent practice of the Waterloo Warriors varsity hockey team, a few players agreed to give saliva samples for a pilot study of a new rapid test that detects concussions.
Before an early November practice inside the University of Waterloo’s wood-beamed arena, a few players from the men’s hockey team agreed to spit into small plastic funnels in the name of science. It took just a few seconds on their way from the dressing room to the ice.
The saliva samples they left behind would later be tested as part of a pilot study for a new device that could be a game-changer in screening for concussions.
Currently, when an athlete sustains a head injury, a team’s athletic therapist has mostly subjective methods to detect concussions on the bench or sidelines: evaluations and questions to determine if the person is dizzy or nauseous, having problems with balance, memory or concentration. As a complement to those, HeadFirst Inc., a Waterloo-based biotechnology startup, is developing a tool it says would provide a quicker, more objective result – a simple rapid test that detects concussion from saliva, helping teams make more immediate and informed decisions about whether the athlete should return to play.
Andrew Cordssen-David, CEO of HeadFirst, collects the Warriors' saliva samples. He played for the team during his studies at the University of Waterloo.
HeadFirst’s founder and chief executive Andrew Cordssen-David is a former University of Waterloo hockey player – where he skated while pursuing science and business degrees – and his inspiration for the rapid test traces back to his own head injuries.
Born in Montreal and raised outside Philadelphia, Mr. Cordssen-David played hockey at a prep school in Minnesota, and junior hockey in Ontario and Quebec before university, growing into a tough 6-foot-5, 225-pound defenceman with a knack for big hits, fights and intimidation. He absorbed – and delivered – plenty of blows, and had a few diagnosed concussions, plus others that flew under the radar.
He recalls blacking out after smashing his head on the ice at 15, yet managing to give satisfactory answers to evaluation questions in the dressing room, which landed him right back in the game.
Later that night, he was nauseous and felt like his heart was beating in his head, before a doctor told him the next morning he had a concussion.
Years later, he suffered another concussion, which at first went undetected but eventually kept him off the ice for six months, his head spinning each time he looked at a screen or laid down to sleep.
The concussion screenings he was put through often involved some self reporting, and he knew first-hand that athletes’ answers can be unreliable, as some players overlook a symptom, or even lie to avoid being sidelined.
“An athlete might be working on four hours of sleep or stressed about exams, and then there’s the naive athletes who just want to stay in the game,” Mr. Cordssen-David said. “I personally did this because, hey, I was 16 and I was trying to make it to the NHL. I wasn’t thinking about what my brain might be like in my 40s.”
Columbia Icefield has been the Warriors' home arena since 1983. Decades of advances in concussion science have made it clearer how on-ice injuries can lead to lasting brain damage if untreated.
Professional leagues have tried to address the risks of concussions: employing people responsible for spotting when they happen and putting in place return-to-play protocols carried out on benches or inside of blue tents on sidelines. Many football players now wear padded shells called Guardian Caps on top of their helmets in practice, hoping to lessen the impact of collisions.
This is, in part, a result of the stream of retired NFL and NHL players who have shared their stories of suffering from dementia, depression and other brain ailments in the years after they quit playing; in some cases, after their death they were found to have chronic traumatic encephalopathy, or CTE. But for all that has been learned about the dangers and prevalence of concussions, diagnosing them has remained a grey area.
“We need something from an objective standpoint, whether you have a concussion or not, a black-and-white test,” Mr. Cordssen-David said.
The test, which is still in clinical trials, works by detecting a specific biomarker – a broad term that refers to a molecule found in the blood or other body fluids, which can be measured and may signal something is wrong.
The brain leaks a number of biomarkers through the blood-brain barrier and into bodily fluids when it swells from traumatic injury, and HeadFirst’s test is designed to detect a significant threshold of one of them found in saliva. (The sport innovation space is competitive, so the company is not revealing the biomarker for which it is testing, nor any proprietary information.)
The device looks similar to a COVID-19 rapid test or home pregnancy test. In this case, an athlete spits into a tube, and that saliva sample then goes through a quick treatment process to remove enzymes or antibodies that interfere with detection before it’s deposited onto the test strip. Blue dye travels through the test, and within minutes, it shows either one line for a negative result, or two lines to indicate a concussion.
Research and development engineer Oliver Aramini tests sample saliva on a strip not unlike a COVID-19 test, right down to the double stripe system.
Mr. Cordssen-David is part of a small team who have combined their expertise to develop the test. The project began in 2023, while he was studying in Waterloo’s Master of Business, Entrepreneurship and Technology program, where students aim to start a new company during the program. As part of his initial research, he spoke to around 100 experts on concussions – including doctors, athletic therapists and chiropractors – and found there could be a market for a simple, objective test that could prevent concussed players from returning to play too quickly, while their brains are still in a vulnerable state. After that, he sought out scientists who could help research and develop a device.
Dr. Shazia Tanvir, who joined as co-founder and chief technology officer, is a biomedical nanotechnology researcher at Waterloo with expertise in this specific kind of testing – called lateral flow assays. And Oliver Aramini, a recent graduate of Waterloo’s nanotechnology engineering program, came on as research and development engineer. After months of trial and error, the small team overcame a significant challenge – figuring out how to pretreat saliva to remove those things that interfere with the detection of their biomarker.
“The day we saw the lines, it was eureka,” Dr. Tanvir said. “I told Andrew, now there is a possibility.”
HeadFirst has received funding, lab space and business advice through Velocity, a business incubator based at the University of Waterloo. Since 2008, Velocity – which does not receive any equity in the businesses that take part in the program – has helped the founders of more than 400 startups achieve a collective enterprise value of $35-billion.
The team also has the guidance of two advisers in Waterloo’s chemical engineering department, professors Marc Aucoin and Bill Anderson, who saw wide-reaching potential for the product and helped them get some funding grants and resources. Prof. Aucoin, who has volunteered coaching with his two sons’ hockey teams for more than a dozen years, could personally envision how the test could keep young players safe. But beyond sports, he sees it some day becoming commonly available for purchase to anyone who wants to assess themselves after a head injury.
“Once this is deployed, the opportunities are limitless,” Prof. Aucoin said.
Mr. Aramini and Mr. Cordssen-David work with Dr. Shazia Tanvir, co-founder of HeadFirst, and Dr. Marc Aucoin, a Waterloo chemical engineering professor.
Other scientists around the world are also working on point-of-care tests that detect biomarkers associated with concussion. Abbott, an American medical devices company, created a handheld instrument that resembles a supermarket scanner and can analyze blood samples on insertible cartridges, producing a result in 15 minutes. In April, Abbott’s i-STAT TBI Cartridge – designed specifically to identify traumatic brain injuries – got clearance from the U.S Food and Drug Administration for use in health care settings. It tests for two biomarkers in blood.
When it comes to HeadFirst’s saliva-based test, there’s already been intrigue – one concussion clinic Mr. Cordssen-David spoke to wanted to order 500 tests right away – but it’s still at least a few years away from becoming available to athletes, or anyone else who suffers a head injury. There are patents and regulatory paths still to navigate, more funds to raise and further trials to complete.
HeadFirst developed the device primarily using artificial saliva, and has now begun a pilot study that involves collecting real saliva samples from varsity athletes in a range of sports at Waterloo.
The men’s hockey players who spit into the plastic funnel at the beginning of November were doing so to establish a baseline reading so that, later in the season, they could be tested again if a concussion is suspected.
Warriors coach Brian Bourque says his team, which often suffers six to eight concussions a season, is eager to assist HeadFirst.
Brian Bourque, who has coached Waterloo’s team for 20 years, said his players are keen to help with the study. Where historically some players used to impatiently rush back to the ice after a concussion, he says athletes are better informed now and they feel it’s more acceptable to take time recovering. In total, his team suffers about six to eight concussions a season, and a rapid test could be helpful in diagnosing, and then determining when it’s safe to return.
“If someone breaks a bone, you can get an image of it, and map out the recovery, but with a concussion, even the experts are making educated guesses,” Mr. Bourque said.
If a rapid test could become part of the concussion protocols that sports organizations devise, an earlier diagnosis could improve the recovery and hasten a player’s return to play, eliminating the risk of second-impact syndrome.
“It costs an organization to have a player out for six months because they didn’t put them out on the sidelines when they should have, all because they couldn’t properly detect a concussion,” Mr. Cordssen-David said. “If we can detect them better, maybe they can come back within two weeks, instead of six months.”
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