Could Ghrelin Become the First FDA-Approved Drug for Concussion?

When former NFL quarterback Alex Smith suffered a concussion while playing for the San Francisco 49ers, the consequences extended far beyond the moment of impact. Today, Smith has another connection to concussion: he serves on the board of directors of OXEIA Biopharmaceuticals, a company working toward something that does not currently exist—a pharmaceutical treatment specifically developed for concussion.

At the center of that research is a hormone most people associate with hunger. It is called ghrelin, and scientists are discovering that it may do much more than tell us when it is time to eat.

Concussion Still Has No FDA-Approved Drug Treatment

We have medications that can help manage individual symptoms after concussion, including headaches, nausea, dizziness, anxiety, depression, or sleep problems. Those treatments can be important. But researchers have been searching for something different: a treatment that could potentially influence biological processes occurring inside the injured brain and reduce the overall burden of symptoms that follows.

That search led trauma surgeon Dr. Vishal Bansal somewhere unexpected. It led him to the stomach, the gut–brain connection, and ghrelin.

What Does the “Hunger Hormone” Have to Do With the Brain?

Dr. Bansal is a trauma surgeon and the co-founder and Chief Scientific Officer of OXEIA Biopharmaceuticals. His research originally focused on what happens to the gut after traumatic brain injury, which brought his attention to the vagus nerve and hormones produced in the gastrointestinal system.

Ghrelin is produced primarily in the stomach and is best known for helping regulate hunger and appetite. But it can also communicate with the brain and appears to influence processes relevant to brain health. Experimental research has raised questions about its effects on neurons and recovery after brain injury.

The question that helped launch OXEIA was deceptively simple: what if ghrelin is not only a hunger hormone, but also part of the body’s response to brain injury?

Ghrelin, Mitochondria, and the Injured Brain

One of the most intriguing areas of this research involves mitochondria, the tiny power plants inside cells. They help convert nutrients into ATP—the energy cells need to function.

After a concussion, the brain enters what researchers often describe as an energy crisis. The injury disrupts the normal balance of ions such as sodium, potassium, and calcium. Brain cells must expend tremendous energy trying to restore that balance while mitochondrial function may be impaired.

This creates an unfortunate mismatch: the injured brain needs more energy at precisely the time its ability to produce energy efficiently may be compromised.

Dr. Bansal has described experimental evidence suggesting ghrelin may support mitochondrial health and reduce reactive oxygen species after brain injury. He has also discussed longer-term effects involving the hippocampus, which is critically involved in learning and memory, and axons, the long communication fibers connecting neurons.

From a Laboratory Observation to a Potential Concussion Drug

While working at the University of California, San Diego, Dr. Bansal was studying the relationship between brain injury and the gut when he encountered research showing effects of ghrelin on neurons. His laboratory subsequently studied ghrelin after brain injury in animals.

In one demonstration, mice with brain injury struggled to cross a balance beam, while animals treated with the experimental ghrelin intervention performed dramatically better. Animal studies, however, are only the beginning. The much harder question is whether a treatment works in human beings.

What Is OXE-103?

OXEIA is developing a synthetic form of ghrelin called OXE-103 as an investigational treatment for concussion. Synthetic ghrelin had previously been studied in people with ALS, giving OXEIA existing human safety and dosing information to build upon rather than beginning entirely from scratch.

OXEIA has conducted an early Phase 2a clinical trial in people with concussion. Dr. Bansal told me that the early trial showed encouraging movement in several symptoms, particularly sleep, memory, and irritability.

Could a Concussion Eventually Be Treated Immediately?

Dr. Bansal described a future possibility almost like an “EpiPen for concussion.” The analogy is about timing, not biology: could a medication someday be administered soon after a confirmed injury to help protect the brain during critical early changes?

Rather than waiting for persistent post-concussion symptoms to develop and then treating headaches, dizziness, sleep problems, memory difficulties, and other symptoms one by one, could clinicians intervene early enough to influence the trajectory of recovery? That remains a research question, but it is an important one.

What About People Who Already Have Post-Concussion Syndrome?

Many Life After Impact readers will understandably ask whether ghrelin could help if a concussion happened months or years ago. We do not know. OXEIA’s current development strategy is focused much earlier after concussion, with particular interest in the first 30 days and possibly even sooner.

That is different from treating persistent post-concussion symptoms six months, two years, or ten years after injury. The research may still teach us more about mitochondrial health, oxidative stress, neuroinflammation, axonal health, memory circuitry, and the gut–brain connection—areas that remain relevant to concussion recovery more broadly.

Why Is the NFL Interested?

Professional football has an obvious relationship with concussion and traumatic brain injury, which makes former NFL quarterback Alex Smith’s connection with OXEIA noteworthy. Smith’s experience brings the perspective of someone who has lived through concussion at the highest level of professional sport.

If researchers eventually demonstrate that an acute concussion medication is safe and effective, its relevance would not stop with professional football. It could potentially matter to high-school and collegiate athletes, people injured in car accidents, workers who sustain head injuries, military personnel, older adults who fall, and many others affected by concussion. But first, the science has to demonstrate that it works.

The FDA Is Asking the Question That Matters Most

Dr. Bansal’s research team has spent years investigating blood biomarkers associated with brain injury, including proteins such as GFAP and tau. When the company discussed its development program with the FDA, he said regulators emphasized a more fundamental question: how does the patient actually feel?

A laboratory marker could theoretically improve without a person’s life getting any better. Brain fog matters. Memory matters. Sleep matters. Headaches matter. Dizziness matters. Being able to work, exercise, read, drive, parent, socialize, and feel like yourself again matters.

Ultimately, a successful concussion treatment needs to produce a meaningful improvement in the person—not simply a more attractive laboratory result.

A New Direction for Concussion Treatment

We should be appropriately cautious about OXE-103. It is an investigational drug, not an FDA-approved concussion medication, and significant research remains ahead.

But the direction is worth watching. For decades, concussion care has largely focused on identifying the injury, managing symptoms, and helping the nervous system rehabilitate afterward. OXEIA is asking a different question: what if we could intervene in the biology of the injured brain early enough to change what happens next?

Perhaps the most fascinating part of the story is that one possible answer may have been inside our bodies all along—a signal associated with hunger that may also be relevant to brain health.

This article discusses investigational research and is for educational purposes only. It does not diagnose, treat, or recommend any medication. Talk with a qualified healthcare professional about your individual symptoms and care.