Most relevant original articles to our current projects:
Repetitive Head Impacts alter brain microstructure
Long-term exposure to repetitive head impacts is associated with measurable alterations in brain microstructure, brain neurochemistry, and brain morphometry. The original finding in youth soccer players has since been extended across sports (soccer, ice hockey, American football), age groups (youth, collegiate, professional, former players), and imaging modalities (diffusion MRI, magnetic resonance spectroscopy, structural volumetry). Together these findings established repetitive head impacts as biologically meaningful and reshaped the conceptualization of risk in contact sports, contributing to international policy changes in youth heading guidelines.
Koerte IK, Ertl-Wagner B, Reiser M, Zafonte R, Shenton ME. White matter integrity in the brains of professional soccer players without symptomatic concussion. JAMA, 2012;308(18):1859–1861. PMID: 23150002. DOI: 10.1001/jama.2012.13735
Koerte IK, Lin AP, Muehlmann M, Merugumala S, Liao H, Starr T, Kaufmann D, Mayinger M, Steffinger D, Fisch B, Karch S, Heinen F, Ertl-Wagner B, Reiser M, Stern RA, Zafonte R, Shenton ME. Altered neurochemistry in former professional soccer players without a history of concussion. Journal of Neurotrauma, 2015;32(17):1287–1293. PMID: 25843317. DOI: 10.1089/neu.2014.3715
Koerte IK, Mayinger M, Muehlmann M, Kaufmann D, Lin AP, Steffinger D, Fisch B, Rauchmann BS, Immler S, Karch S, Heinen FR, Ertl-Wagner B, Reiser M, Stern RA, Zafonte R, Shenton ME. Cortical thinning in former professional soccer players. Brain Imaging and Behavior, 2016;10(3):792–798. PMID: 26286826. DOI: 10.1007/s11682-015-9442-0
Koerte IK, Nichols E, Tripodis Y, Schultz V, Lehner S, Igbinoba R, Chuang AZ, Mayinger M, Muehlmann M, Kaufmann D, Lepage C, Heinen F, Schulte-Körne G, Zafonte RD, Shenton ME, Sereno AB. Impaired cognitive performance in youth athletes exposed to repetitive head impacts. Journal of Neurotrauma, 2017;34(16):2389–2395. PMID: 28381107. DOI: 10.1089/neu.2016.4960
Koerte IK, Bahr R, Filipcik P, Gooijers J, Leemans A, Lin AP, Tripodis Y, Shenton ME, Sochen N, Swinnen SP, Pasternak O; REPIMPACT Consortium Investigators. REPIMPACT — a prospective longitudinal multisite study on the effects of repetitive head impacts in youth soccer. Brain Imaging and Behavior, 2022;16(1):492–502. DOI: 10.1007/s11682-021-00484-x
Koerte IK, Wiegand TLT, Bonke EM, Kochsiek J, Shenton ME. Diffusion imaging of sport-related repetitive head impacts — a systematic review. Neuropsychology Review, 2023;33(1):122–143. PMID: 36508043. DOI: 10.1007/s11065-022-09566-z
Biological sex shapes vulnerability to repetitive head impacts and sports-related concussion
Female and male athletes exposed to comparable patterns of head impact show distinct brain alterations, recovery trajectories, and clinical profiles. This line of work established sex as a central, biology-grounded axis of vulnerability. The findings underpin the case for sex-stratified analyses, sex-specific variables, and the need for precision-medicine approaches that treat sex as a primary biological variable.
Sollmann N, Echlin PS, Schultz V, Viher PV, Lyall AE, Tripodis Y, Kaufmann D, Hartl E, Kinzel P, Forwell LA, Johnson AM, Skopelja EN, Lepage C, Bouix S, Pasternak O, Lin AP, Shenton ME, Koerte IK. Sex differences in white matter alterations following repetitive subconcussive head impacts in collegiate ice hockey players. Neuroimage: Clinical, 2017;17:642–649. PMID: 29204342. DOI: 10.1016/j.nicl.2017.11.020
Koerte IK, Schultz V, Sydnor VJ, Howell DR, Guenette JP, Dennis E, Kochsiek J, Kaufmann D, Sollmann N, Mondello S, Shenton ME, Lin AP. Sex-related differences in the effects of sports-related concussion: a review. Journal of Neuroimaging, 2020;30(4):387–409. PMID: 32533752. DOI: 10.1111/jon.12726
Li Z, Asiares AV, Betz A, Schuhmacher LS, Joyce J, Lohmann L, Sollmann N, Koerte IK. Sex-specific associations between repetitive head impact exposure and cerebral blood flow among active amateur soccer players. Journal of Neurotrauma, 2026 Jan 27. PMID: 41593837. DOI: 10.1177/08977151251408823
Repetitive head impacts disrupt brain clearance pathways
Brain clearance — the system by which metabolic waste, including pathological proteins, is removed from the brain — has emerged as a candidate mechanism linking repetitive head impacts to long-term neurodegeneration. Our work has shown that cumulative exposure to repetitive head impacts is associated with enlarged perivascular spaces in former American football players, and that perivascular space burden is related to cognitive impairment. The finding opens a new mechanistic line of investigation: head impacts may not only cause direct microstructural injury but may also impair the brain's ability to clear the very proteins implicated in chronic traumatic encephalopathy and other neurodegenerative conditions. Ongoing work extends this line into younger and active athletes, military populations, and into the glymphatic and perivascular dynamics that underlie clearance function.
Pomschar A, Koerte IK, Lee S, Laubender RP, Straube A, Heinen F, Ertl-Wagner B, Alperin N. MRI evidence for altered venous drainage and intracranial compliance in mild traumatic brain injury. PLoS ONE, 2013;8(2):e55447. PMID: 23405151. DOI: 10.1371/journal.pone.0055447
Jung LB, Wiegand TLT, Tuz-Zahra F, Tripodis Y, Iliff JJ, Piantino J, Arciniega H, Kim CL, Pankatz L, Bouix S, Lin AP, Alosco ML, Daneshvar DH, Mez J, Sepehrband F, Rathi Y, Pasternak O, Coleman MJ, Adler CH, Bernick C, Balcer L, Cummings JL, Reiman EM, Stern RA, Shenton ME, Koerte IK; DIAGNOSE CTE Research Project.Repetitive head impacts and perivascular space volume in former American football players. JAMA Network Open, 2024;7(8):e2428687. PMID: 39186275. DOI: 10.1001/jamanetworkopen.2024.28687
Repetitive head impacts are linked to neurodegeneration and its biomarkers
The mechanistic link between repetitive head impact exposure and long-term neurodegeneration — including chronic traumatic encephalopathy (CTE) and Traumatic Encephalopathy Syndrome (TES) — is one of the most consequential open questions in the field. Our work has contributed to this question on three fronts: identifying in-vivo imaging signatures of injury that map onto the clinical syndromes, linking cumulative head impact exposure to fluid biomarkers of neurodegeneration, and developing a biological framework for how mechanical exposure produces progressive brain pathology over decades. The current trajectory of this line moves from descriptive associations toward defined biological mechanisms including pathways of pathological protein spread that can be measured, predicted, and ultimately targeted.
Lin A, Charney M, Shenton ME, Koerte IK. Chronic traumatic encephalopathy: neuroimaging biomarkers. Handbook of Clinical Neurology, 2018;158:309–322. PMID: 30482359. DOI: 10.1016/B978-0-444-63954-7.00029-X
Iverson GL, Castellani RJ, Cassidy JD, Schneider GM, Schneider KJ, Echemendia RJ, Bailes JE, Hayden KA, Koerte IK, Manley GT, McNamee M, Patricios JS, Tator CH, Cantu RC, Dvorak J. Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies. British Journal of Sports Medicine, 2023;57(12):810–821. PMID: 37316187. DOI: 10.1136/bjsports-2023-106890
Alosco ML, Mariani ML, Adler CH, Balcer LJ, Bernick C, Au R, Banks SJ, Barr WB, Bouix S, Cantu RC, Coleman MJ, Dodick DW, Farrer LA, Geda YE, Katz DI, Koerte IK, Kowall NW, Lin AP, Marcus DS, Marek KL, McClean MD, McKee AC, Mez J, Palmisano JN, Peskind ER, Tripodis Y, Turner RW 2nd, Wethe JV, Cummings JL, Reiman EM, Shenton ME, Stern RA; DIAGNOSE CTE Research Project Investigators. Developing methods to detect and diagnose chronic traumatic encephalopathy during life: rationale, design, and methodology for the DIAGNOSE CTE Research Project. Alzheimer's Research and Therapy, 2021;13(1):136. PMID: 34384490. DOI: 10.1186/s13195-021-00872-x
Kochsiek J, O'Donnell LJ, Zhang F, Bonke EM, Sollmann N, Tripodis Y, Wiegand TLT, Kaufmann D, Umminger L, Di Biase MA, Kaufmann E, Schultz V, Alosco ML, Martin BM, Lin AP, Coleman MJ, Rathi Y, Pasternak O, Bouix S, Stern RA, Shenton ME, Koerte IK. Exposure to repetitive head impacts is associated with corpus callosum microstructure and plasma total tau in former professional American football players. Journal of Magnetic Resonance Imaging, 2021;54(6):1819–1829. PMID: 34137112. DOI: 10.1002/jmri.27774
Alosco ML, Su Y, Stein TD, Protas H, Cherry JD, Adler CH, Balcer LJ, Bernick C, Pulukuri SV, Abdolmohammadi B, Coleman MJ, Palmisano JN, Tripodis Y, Mez J, Rabinovici GD, Marek KL, Beach TG, Johnson KA, Huber BR, Koerte IK, Lin AP, Bouix S, Cummings JL, Shenton ME, Reiman EM, McKee AC, Stern RA; DIAGNOSE CTE Research Project. Associations between near end-of-life flortaucipir PET and postmortem CTE-related tau neuropathology in six former American football players. European Journal of Nuclear Medicine and Molecular Imaging, 2023;50(2):435–452. PMID: 36152064. DOI: 10.1007/s00259-022-05963-x
Rueb M, Rauen K, Koerte IK et al. Traumatic Encephalopathy Syndrome and tauopathy in a 19-year-old with child abuse. Neurotrauma Reports, 2023;4(1):857–862. DOI: 10.1089/neur.2023.0078
Wiegand TLT, Pankatz L, Arciniega H, Jung LB, Tuz-Zahra F, Bouix S, Lubeck H, Rojczyk P, Schuhmacher LS, Buring J, Katz DI, Tripodis Y, Pasternak O, Cetin-Karayumak S, Rathi Y, Adler CH, McKee AC, Balcer LJ, Bernick C, Coleman MJ, Colasurdo EA, Lin AP, Peskind ER, Ashton NJ, Blennow K, Zetterberg H, Alosco ML, Cummings JL, Reiman EM, Stern RA, Shenton ME, Koerte IK; DIAGNOSE CTE Research Project. Diffusion alterations at the gray matter/white matter boundary in Traumatic Encephalopathy Syndrome. Journal of Neurotrauma, 2025. PMID: 41218808. DOI: 10.1177/08977151251393966
Mild traumatic brain injury alters brain structure and developmental trajectories — with a focus on the pediatric brain
Mild traumatic brain injury (mTBI) is the most common form of brain injury across the lifespan, yet outcomes vary widely: some individuals recover fully within weeks, while others develop persistent cognitive, behavioral, and psychiatric symptoms that can last years. Our work has shown that mTBI is associated with measurable alterations in brain microstructure, cortical morphology, and functional integrity — alterations that are biologically real even when standard clinical imaging appears normal. A central focus of this research line is the developing brain. Pediatric mTBI affects executive functioning, behavior, sleep, social development, and neurobehavioral trajectories in ways that can extend long after the acute injury, and our work has helped define these trajectories using prospective cohorts, large open-data resources such as the ABCD Study, and advanced multimodal neuroimaging. In parallel, our group has contributed to the development and validation of clinical assessment tools including the QOLIBRI-KID/ADO family of instruments that allow outcomes after pediatric brain injury to be measured rigorously and across cultures.
Shenton ME, Hamoda HM, Schneiderman JS, Bouix S, Pasternak O, Rathi Y, Vu MA, Purohit MP, Helmer K, Koerte IK, Lin AP, Westin CF, Kikinis R, Kubicki M, Stern RA, Zafonte R. A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging and Behavior, 2012;6(2):137–192. PMID: 22438191. DOI: 10.1007/s11682-012-9156-5
Guenette JP, Shenton ME, Koerte IK. Imaging of concussion in young athletes. Neuroimaging Clinics of North America, 2018;28(1):43–53. PMID: 29157852. DOI: 10.1016/j.nic.2017.09.004
Pankatz L, Rojczyk P, Seitz-Holland J, Bouix S, Jung LB, Wiegand TLT, Bonke EM, Sollmann N, Kaufmann E, Carrington H, Puri T, Rathi Y, Coleman MJ, Pasternak O, George MS, McAllister TW, Zafonte R, Stein MB, Marx CE, Shenton ME, Koerte IK. Adverse outcome following mild traumatic brain injury is associated with microstructure alterations at the gray and white matter boundary. Journal of Clinical Medicine, 2023;12(16):5415. PMID: 37629457. DOI: 10.3390/jcm12165415
von Steinbuechel N, Krenz U, Bockhop F, Koerte IK, Timmermann D, Cunitz K, Zeldovich M, Andelic N, Rojczyk P, Bonfert MV, Berweck S, Kieslich M, Brockmann K, Roediger M, Lendt M, Buchheim A, Muehlan H, Holloway I, Olabarrieta-Landa L. A multidimensional approach to assessing factors impacting health-related quality of life after pediatric traumatic brain injury. Journal of Clinical Medicine, 2023;12(12):3895. PMID: 37373590. DOI: 10.3390/jcm12123895
Betz AK, Cetin-Karayumak S, Bonke EM, Seitz-Holland J, Zhang F, Pieper S, O'Donnell LJ, Tripodis Y, Rathi Y, Shenton ME, Koerte IK. Executive functioning, behavior, and white matter microstructure in the chronic phase after pediatric mild traumatic brain injury: results from the Adolescent Brain Cognitive Development study. Psychological Medicine, 2024. PMID: 38497117. DOI: 10.1017/S0033291724000229
Mac Donald CL, Yuh EL, Vande Vyvere T, Edlow BL, Li LM, Mayer AR, Mukherjee P, Newcombe VFJ, Wilde EA, Koerte IK, Yurgelun-Todd D, Wu YC, Duhaime AC, Awwad HO, Dams-O'Connor K, Doperalski A, Maas AIR, McCrea MA, Umoh N, Manley GT. Neuroimaging characterization of acute traumatic brain injury with focus on frontline clinicians: recommendations from the 2024 NINDS TBI Classification and Nomenclature Initiative Imaging Working Group. Journal of Neurotrauma, 2025. PMID: 40393517. DOI: 10.1089/neu.2025.0079
Betz AK, MacLaren HSR, Villagran Asiares AG, Schuhmacher LS, Koerte IK. Sleep Disturbances and Cognition, Behavior, and Brain Structure in Children With mTBI. JAMA Netw Open. 2026 Mar 2;9(3):e260229. doi: 10.1001/jamanetworkopen.2026.0229. PMID: 41805957; PMCID: PMC12976784.
Neurosteroid biology links brain injury to recovery and outcome
Neurosteroids are endogenously produced steroids that modulate neural function, neuroinflammation, and synaptic signaling. They represent a biologically defined class of candidate biomarkers and intervention targets for brain injury. Our work has shown that serum levels of neurosteroids are associated with cortical thickness and white matter microstructure in individuals with a history of mild traumatic brain injury, that neurosteroid signatures track psychological functioning after injury, and that neurosteroid alterations are recapitulated in translational animal models. This line, anchored by the ERC-funded NEUROPRECISE project, establishes neurosteroid biology as a tractable molecular axis for individualized prognosis and for the future design of biomarker-guided interventions in pediatric and adult brain injury.
Kinzel P, Marx CE, Sollmann N, Hartl E, Guenette JP, Kaufmann D, Bouix S, Pasternak O, Rathi Y, Coleman MJ, van der Kouwe A, Helmer K, Kilts JD, Naylor JC, Morey RA, Shutter L, Andaluz N, Coimbra R, Lang AJ, George MS, McAllister TW, Zafonte R, Stein MB, Shenton ME, Koerte IK. Serum neurosteroid levels are associated with cortical thickness in individuals diagnosed with posttraumatic stress disorder and history of mild traumatic brain injury. Clinical EEG and Neuroscience, 2020;51(4):285–299. PMID: 32186207. DOI: 10.1177/1550059420909676
Umminger LF, Rojczyk P, Seitz-Holland J, Sollmann N, Kaufmann E, Kinzel P, Zhang F, Kochsiek J, Langhein M, Kim CL, Wiegand TLT, Kilts JD, Naylor JC, Grant GA, Rathi Y, Coleman MJ, Bouix S, Tripodis Y, Pasternak O, George MS, McAllister TW, Zafonte R, Stein MB, O'Donnell LJ, Marx CE, Shenton ME, Koerte IK. White matter microstructure is associated with serum neuroactive steroids and psychological functioning. Journal of Neurotrauma, 2023. PMID: 36324218. DOI: 10.1089/neu.2022.0111
Umeasalugo KE, Khalin I, Seker B, Liere P, Pianos A, Sanchez-Garcia M, Schumacher M, Koerte IK, Plesnila N.Mild TBI changes brain and plasma neurosteroid levels in mice. Neurotrauma Reports, 2025;6(1):39–52. PMID: 39990706. DOI: 10.1089/neur.2024.0151
Brain injury interacts with psychological trauma, stress, and lived adversity
Brain injury rarely occurs in isolation. It interacts with concurrent and prior exposures — psychological trauma, posttraumatic stress disorder (PTSD), chronic stress, sleep disturbance, intimate partner violence, and adverse experiences earlier in life — to shape both the biology of the brain and the trajectory of recovery. Our work has shown that the brain alterations associated with mild traumatic brain injury are systematically modified by co-occurring PTSD, war-zone-related stress, and posttraumatic survivor guilt, and that intimate-partner-violence-related head trauma is intensified by adverse childhood experiences. These findings reframe brain injury as a layered exposure rather than a discrete event, and establish trauma interactions as a core determinant of brain vulnerability and resilience across the lifespan. They also provide an empirical foundation for the lab's broader research program on brain resilience: understanding why some individuals withstand and recover from injury, and others do not.
Sydnor VJ, Bouix S, Pasternak O, Hartl E, Levin-Gleba L, Reid B, Tripodis Y, Guenette JP, Kaufmann D, Makris N, Fortier C, Salat DH, Rathi Y, Milberg WP, McGlinchey RE, Shenton ME, Koerte IK. Mild traumatic brain injury impacts associations between limbic system microstructure and post-traumatic stress disorder symptomatology. Neuroimage: Clinical, 2020;26:102190. PMID: 32070813. DOI: 10.1016/j.nicl.2020.102190
Kaufmann E, Rojczyk P, Sydnor VJ, Guenette JP, Tripodis Y, Kaufmann D, Umminger L, Seitz-Holland J, Sollmann N, Rathi Y, Bouix S, Fortier CB, Salat D, Pasternak O, Hinds SR, Milberg WP, McGlinchey RE, Shenton ME, Koerte IK. Association of war-zone-related stress with alterations in limbic gray matter microstructure. JAMA Network Open, 2022;5(9):e2231891. PMID: 36112375. DOI: 10.1001/jamanetworkopen.2022.31891
Rojczyk P, Seitz-Holland J, Kaufmann E, Sydnor VJ, Kim CL, Umminger LF, Wiegand TLT, Guenette JP, Zhang F, Rathi Y, Bouix S, Pasternak O, Fortier CB, Salat D, Hinds SR, Heinen F, O'Donnell LJ, Milberg WP, McGlinchey RE, Shenton ME, Koerte IK. Sleep quality disturbances are associated with white matter alterations in veterans with post-traumatic stress disorder and mild traumatic brain injury. Journal of Clinical Medicine, 2023;12(5):2079. PMID: 36902865. DOI: 10.3390/jcm12052079
Esopenko C, Jain D, Adhikari SP, Dams-O'Connor K, Ellis M, Haag HL, Hovenden ES, Keleher F, Koerte IK, Lindsey HM, Marshall AD, Mason K, McNally JS, Menefee DS, Merkley TL, Read EN, Rojczyk P, Shultz SR, Sun M, Toccalino D, Valera EM, van Donkelaar P, Wellington C, Wilde EA. Intimate partner violence-related brain injury: unmasking and addressing the gaps. Journal of Neurotrauma, 2024. PMID: 38323539. DOI: 10.1089/neu.2023.0543
Rojczyk P, Heller C, Seitz-Holland J, Kaufmann E, Sydnor VJ, Berger L, Pankatz L, Rathi Y, Bouix S, Pasternak O, Salat D, Hinds SR, Esopenko C, Fortier CB, Milberg WP, Shenton ME, Koerte IK. Intimate partner violence perpetration among veterans: associations with neuropsychiatric symptoms and limbic microstructure. Frontiers in Neurology, 2024;15:1360424. PMID: 38882690. DOI: 10.3389/fneur.2024.1360424
Rojczyk P, Seitz-Holland J, Heller C, Marcolini S, Marshall AD, Sydnor VJ, Kaufmann E, Jung LB, Bonke EM, Berger L, Umminger LF, Wiegand TLT, Cho KIK, Rathi Y, Bouix S, Pasternak O, Hinds SR, Fortier CB, Salat D, Milberg WP, Shenton ME, Koerte IK. Posttraumatic survivor guilt is associated with white matter microstructure alterations. Journal of Affective Disorders, 2024;361:768–777. PMID: 38897303. DOI: 10.1016/j.jad.2024.06.047