Casey Toohill recently announced his retirement after a six-year NFL career and the defensive end admits to playing with a certain amount of “existential dread" when it came to the pounding his brain took during years of competitive football.
Sure, he knew of the health risks. But outside of quitting the sport, was there anything anyone could really do about it?
Now that his playing days are over, he's encouraged that answers are being sought.
"We have these clinical trials happening — we’re making progress,” said Toohill, now an advocate for former players with head injuries. “We’re trying to help people. We’re not helpless in this situation.”
Toohill became a member last month of the advisory board of the Concussion & CTE Foundation, which is joining with Emory University School of Medicine to start a clinical trial on whether an FDA-approved medication called baricitinib that reduces inflammation can improve depression and cognitive symptoms in former football players.
The trial comes as medical researchers are trying to pinpoint how to diagnose chronic traumatic encephalopathy (CTE) in the living. The degenerative brain disease — which can only be diagnosed after death — has been found in more than 100 former NFL players, casting a pall over the United States’ most popular sports league.
“This is a special moment,” said Chris Nowinski, CEO of the Concussion & CTE Foundation. “This is the scientific community, which is not normally part of the world of CTE research or concussion research, recognizing there’s a problem and stepping forward to provide information.
“This will hopefully be the first of many studies showing the scientific community coming to the aid of the football community.”
CTE can affect regions of the brain involved with regulating behavior and emotions. This can lead to memory loss, depression, violent mood swings and other cognitive and behavioral issues, though researchers note these symptoms can also be linked to other illnesses such as Alzheimer's.
The current study is seeking adult men ages 30-55 who played 11 or more years of tackle football and have depression and cognitive concerns.
“We're not trying to treat CTE, we're not saying the (former football players) have CTE, but we do understand that they are at risk for CTE,” Nowinski said. “We know this community needs hope and needs answers."
Bad inflammation may be key to problems
Christina Gavegnano — a co-principal investigator on the study who is an associate professor at Emory — said it's important to make a distinction between good and bad inflammation when talking about head injuries.
Acute inflammation in the brain after injuries like a concussion is a natural response to trauma and helps with the initial healing process. The problem is if it never goes away after the initial injury.
“What we've found is that when there's inflammation in the brain — when there's too much of it — it causes neurons to ball up, die and not be able to talk to each other," Gavegnano said. "We see this with many different diseases, whether it's depression, ALS, Parkinson's, Alzheimer's or dementia.”
The hypothesis is that symptoms from a variety of brain diseases — including CTE — could improve if inflammation is returned to normal levels.
Some high-profile professional football players diagnosed with CTE after their deaths include Hall of Famers like linebacker Junior Seau and quarterback Ken Stabler, along with former Patriots tight end Aaron Hernandez.
Gavegnano said baricitinib is a particularly promising drug for many reasons, including that it's a once-a-day pill that has been heavily researched and targets specific inflammatory factors.
“We know how it behaves, we know how to dose it, we know the safety,” Gavegnano said. “We're really going in ahead of the game with a drug that's already on the market, we know so much about. We already have it in clinical trials for many other diseases that have inflammation in the brain.”
She added that baricitinib is also a good choice because it's considered safe and even been approved in use for young children.
Toohill is eager to help
Toohill played in the NFL for the Washington Commanders, Philadelphia Eagles and Buffalo Bills and upon retirement quickly become an advocate for former players dealing with head injuries.
The 30-year-old Toohill, who played in college at Stanford, said he was only diagnosed with one concussion during his NFL days and feels good, but said that concussions are only one potential consequence of repeated head impacts.
“It's the large head impacts that you have consistently in games and in practice that's the concern,” Toohill said. “My health has been good, but at the same time, this is such a wake-up call for so many players. You realize, even if I didn't have a diagnosed concussion, there could still be harmful effects.”
Toohill said he didn't play quite long enough to join the current study, but is working to get in contact with former teammates who might be a good match. He's hopeful that potential treatments will give NFL players hope that there's a way to mitigate the symptoms of potential brain trauma.
“Let's push forward, let's make progress,” Toohill said.
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