In the Genes?

It began on those long, lazy afternoons when longtime heavyweight boxing contender Jerry Quarry would have friends and family over to watch a fight or a football game.

When the fun was over, Quarry would stand up and say, “OK guys, I’m going home.”

“Jerry,” someone would say, “You are home.”

After an awkward silence, a confused Quarry would force a smile.

“Aw, I was just testing you guys,” he would say.

That brought nervous laughter from the crowd. Friends and relatives knew something was wrong. But none could have imagined how wrong. None could have known that Quarry had already taken the first steps into the dark tunnel of existence known by the medical term dementia pugilistica, a condition that includes loss of short-term memory, slurred speech and a staggered gait.

But now, after more than a century of boxing, nearly 70 years after fighters were first described as being “punch drunk,” there may be a light at the end of that tunnel for those still contemplating boxing careers.

A fighter’s susceptibility to chronic brain damage may depend as much on genetics as on the blows he receives in the ring, according to a new study.

California and New York researchers reported today that a genetic profile predisposing people to Alzheimer’s disease also makes them much more susceptible to long-term brain damage from boxing, suggesting it may be possible to identify individuals who should be warned away from the sport for their own protection.

In a study of 30 boxers, a team from Cornell University and the Charles R. Drew University of Medicine here report in the Journal of the American Medical Assn. that fighters who carried this genetic profile and had fought 12 or more professional bouts suffered much more severe brain damage than those with a more favorable genetic profile.

The study was conducted by Drs. Barry D. Jordan, Norman R. Relkin, Sam Gandy and several colleagues. Jordan, 41, who recently moved from Cornell to a joint appointment at Drew and UCLA, was a ringside physician for the New York State Athletic Commission for four years and the commission’s medical director for 7 1/2 years.

“This is a quite significant study, but it is a small study and needs to be repeated,” said Dr. George Lundberg, editor of JAMA. “If it turns out to be right, it is the first evidence that genetic tests could predict who is most likely to be susceptible to brain damage if hit a lot of times in the head. . . . It may be possible, although expensive, to screen aspiring boxers and say, ‘No, you can’t get a license to fight.’ ”

But Lundberg and others cautioned that the study’s results apply only to chronic, long-term damage and not to the acute brain damage caused by broken blood vessels and other damage in the brain, such as that which caused the death of super-featherweight Jimmy Garcia in 1995.

Today’s report is an outgrowth of studies first reported in 1992 by Dr. Allen Roses and his colleagues at Duke University Medical Center. They found that the gene for a protein called apolipoprotein E (ApoE) is strongly linked to Alzheimer’s disease, a devastating illness that affects more than 4 million Americans.

Every individual has two copies of the ApoE gene, one from each parent. Roses and his colleagues found that there are three slightly different forms of the gene, called ApoE 2, 3 and 4. They found that an individual’s risk of developing Alzheimer’s depends on which forms he or she inherits.

Roses found that a person with two copies of ApoE 4 is about 15 times as likely to develop Alzheimer’s as a person with no copies of it, whereas an individual with only one copy is about five times as likely. About 2% of the population has two copies of ApoE 4 and another 29% has one copy.

Subsequent studies have shown that trauma to the head can accelerate the onset of Alzheimer’s in individuals with an ApoE 4 gene. So the results reported today “are not at all surprising,” said Roses’ colleague, Dr. Warren Strittmatter of Duke. “The most fundamental implication is that ApoE 4 may be playing a role in the ability of the brain to respond to an injury.”

Of the 30 boxers studied by Jordan and his fellow researchers, 25 were volunteers and five were referred by the New York State Athletic Commission for neurological evaluation. Twenty-seven of the boxers were retired from the ring.

The team performed neurological examinations on each boxer, assigning scores on a Chronic Brain Injury (CBI) scale that measures permanent impairment. They also determined their ApoE types.

Among the 30 anonymous boxers, 11 were normal, 12 showed mild impairments (a CBI score of 1 to 2), four were moderately impaired (CBI of 3 to 4) and three were severely impaired (CBI of 4 or higher).

All of those who were severely impaired had at least one ApoE 4 gene. Among those who had fought at least 12 professional bouts, fighters with at least one ApoE 4 gene had an average CBI of 3.9, but those with no ApoE 4 gene had a CBI average of 1.8 and were much less impaired.

*

The local boxing community appears to be receiving the latest report less than enthusiastically.

“It’s ‘Star Wars,’ ” said Dr. Robert Karns, chairman of the physicians’ advisory committee of the California State Athletic Commission. “We don’t want boxers to be tested at this point.

“Rather than just boxing, more likely the ApoE 4 has to do with everything, including general living.

“Nobody wants to know [that kind of information] right now. You get a [genetic] test, it comes out positive and what do you do, go home and say, ‘More than likely, I’m going to get Alzheimer’s in 20 years. Do you still want to be my wife?’ ”

But like it or not, such testing may be just around the corner.

“What do we do about it?” Karns asked. “I’m not quite sure. Probably nothing in 1997. I don’t believe we’re ready to use this information. Boxers do not want to know. If boxers are tested and they have ApoE 4, they should be told. But maybe it makes no difference whether they box or not. When you have the ApoE 4 protein, all kinds of bad things are going to happen to you and boxing may not even be one of them.”

If boxers were told that they had the potentially damaging gene, would they continue boxing? Two of Southern California’s biggest names are in opposite corners on this subject.

“I wouldn’t take that gamble,” said Genaro Hernandez, the 32-year-old World Boxing Council super-featherweight champion. “If it were a true fact, I would not take the gamble. Who would want to suffer through that? The way I see Bobby Chacon and Muhammad Ali [Chacon appears to have dementia pugilistica and Ali has symptoms of Parkinson’s disease], I would not want to suffer the same way.

“But I think there is a low percentage of fighters who would believe that way. They put so much time and effort into becoming a fighter, I do not think they would believe in those tests. I wouldn’t if I was 20. I started boxing at age 9. The last thing I would want to do is to quit at the age of 20. I would feel like I hadn’t even started yet.”

Gabriel Ruelas, the 27-year-old former WBC super-featherweight champion, said he wouldn’t consider quitting because of Tuesday’s report.

“Not one bit,” Ruelas said. “It’s not because I’m stubborn, but, to me, it’s similar to when they tell you three to four cups of coffee could be bad for you. I laugh at that.

“[Genetic testing] is nonsense to me. Others might think about it, but not me. . . . Since the day I started boxing, people said to me that I could get brain damage if I got hit in the head every day.

“I would be anxious to take a test if there was one, but it wouldn’t stop me from boxing. I’ve always had dreams of dying young, so, with every birthday I have, I thank God because I’ve already lived more than I thought I would. That’s why [the medical report] doesn’t scare me.”

*

Quarry, 52, is feeling the full effect of 237 amateur fights, 66 professional bouts and countless barroom brawls. He can’t shave himself. He can’t shower alone. He can’t dress himself. Read three words to him and he won’t be able to repeat all three.

Soon, Quarry may have to wear diapers.

But he is hardly alone in boxing’s twilight zone. One brother, Mike, a former light heavyweight contender, also has symptoms of dementia pugilistica. And another brother, Robert, also a former fighter, suffers tremors.

Similar damage can be found in varying degrees among boxers of all ages, races and levels of success.

Chacon, the former WBC featherweight and junior-lightweight champion who is now in his early 40s, carries a map of his neighborhood in his shirt pocket so he can find his way home.

Almost everyone is familiar with the condition of Ali, the three-time heavyweight champion whose once-strident voice has been reduced to a mumble, his sparkling personality dimmed to a mere glimmer by the ravages of Parkinson’s syndrome.

Said James Quarry, oldest of the brothers and the only one not physically impaired, probably because he never got seriously involved in boxing, “When you get 500 fighters together for a Hall of Fame ceremony, 400 have some signs of damage, either in their noses, their eyes, their ribs or some sort of scar tissue.”

*

Jordan was long intrigued by the seemingly haphazard occurrences of chronic damage in fighters, the slow, insidious harm done by years of wear and tear in the ring.

Why did some fighters exhibit all the classic symptoms of dementia pugilistica while others, who had fought as much or more and absorbed just as many or more blows, appear to have escaped with their mental faculties largely unaffected?

Why, for example, is George Foreman, three decades after he started fighting, still articulate enough to do commercials, act in sitcoms and serve as a television analyst, while his most celebrated opponent, Ali, can hardly utter a complete sentence?

Just luck?

Jordan and his fellow researchers didn’t think so.

Neither does Linda Roger, who heads the Southwest Institute for Clinical Research in Rancho Mirage. She is working with the Jerry Quarry Foundation, a nonprofit organization formed by James Quarry to improve prospects for boxers on the legislative and medical fronts. Roger hopes to set up research programs to explore the causes of dementia pugilistica.

Roger, whose primary focus is Alzheimer’s patients, says there are strong similarities between the way the brains of an Alzheimer’s victim and someone with atrophy associated with dementia pugilistica.

Roger, 43, asked the same question as Jordan: Why don’t boxers with similar time in the ring have a similar degree of brain damage?

Her experience with boxing has largely been limited to her study of the Quarry family.

“Jerry Quarry can tell you incredibly detailed information about fights he had long ago,” Roger said. “That’s because that information was already stored in his brain before the damage began.

“But if I give him three words--’ball, flag, tree’--and then ask him to spell a word, when I ask him to repeat the first three words, he can only remember one of the three.”

Roger would like to see if the presence of plaque and nerve tangles, found in Alzheimer’s patients, are also found in boxers with dementia pugilistica.

Jordan doesn’t want to limit his research to boxing.

“Ninety percent of all deaths in football involve the brain or spinal cord,” he said.

He also wants to take a look at soccer, whose players regularly use their heads to propel the ball.

“This [report] has as much to do with soccer as with boxing,” Karns said. “Players practice heading the ball for hours and it does take its toll.”

*

So where can all this lead? Will we someday reach the point where those with the ApoE 4 protein will not be allowed in boxing? Or football? Or soccer?

Not necessarily, Jordan said. But he would at least like those with the ApoE 4 protein to know they are more susceptible to brain injury, if that is indeed the case.

“I would like to be able to tell a 20-year-old kid that he may be at higher risk 20 or 30 years from now,” Jordan said.

“Maybe boxing commissions would require an MRI for those at risk. Instead of just trying to protect kids with additional headgear, we might be able to tell them that they probably shouldn’t box.”

Even if they don’t listen, Roger thinks the effort must at least be made.

“I think we have a responsibility to inform,” she said. “Maybe it would ultimately have to be left up to the parents to decide whether their child should fight.”

However, Jordan said, it may never even come to that.

“There may be ways to protect boxers,” Jordan said. “Perhaps something like Vitamin E, which appears promising for Alzheimer’s patients, or some other substance may be effective [against the ApoE 4 protein]. Maybe not in my lifetime, but perhaps 30 or 40 years from now, we might be able to give a boxer a pill to protect himself.

“The neurological advances in this past decade alone have been astounding. Now we are on the verge of a very promising new century. You never know.”

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Hard Hitting

California and New York researchers reported today that a genetic profile predisposing people to Alzheimer’s disease also makes them much more susceptible to long-term brain damage from boxing.

Normal Brain

The cavum septum pellucidum is the butterfly shape in the center of the brain.

Brain of Boxer With Damage

The larger dark area is fluid that has filled in spaces where the brain has atrophied.

The Study

30 anonymous boxers.

Normal: 11

Mild impairment: 12

Moderately impaired: 4

Severely impaired: 3

(All three had the gene predisposing people to chronic brain damage.)

Source: Southwest Institute for Clinical Research