Assessing metabolism and injury in acute human traumatic brain injury with magnetic resonance spectroscopy: current and future applications
Frontiers in Neurology
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Stovell, M., Yan, J., Sleigh, A., Mada, M., Carpenter, A., Hutchinson, P., & Carpenter, K. (2017). Assessing metabolism and injury in acute human traumatic brain injury with magnetic resonance spectroscopy: current and future applications. Frontiers in Neurology, 8 (426)https://doi.org/10.3389/fneur.2017.00426
Traumatic brain injury triggers a series of complex pathophysiological processes. These include abnormalities in brain energy metabolism; consequent to reduced tissue pO₂ arising from ischaemia or abnormal tissue oxygen diffusion, or due to a failure of mitochondrial function. In-vivo magnetic resonance spectroscopy (MRS) allows non-invasive interrogation of brain tissue metabolism in patients with acute brain injury. Nuclei with ‘spin’ e.g. ¹H, ³¹P and ¹³C, are detectable using MRS and are found in metabolites at various stages of energy metabolism, possessing unique signatures due to their chemical shift or spin-spin interactions (J-coupling). The most commonly used clinical MRS technique, ¹H MRS, uses the great abundance of hydrogen atoms within molecules in brain tissue. Spectra acquired with longer echo-times include N-acetylaspartate, creatine and choline. N-acetylaspartate, a marker of neuronal mitochondrial activity related to ATP, is reported to be lower in patients with TBI than healthy controls, and the ratio of N-acetylaspartate/creatine at early time points may correlate with clinical outcome. ¹H MRS acquired with shorter echo-times produces a more complex spectrum, allowing detection of a wider range of metabolites. ³¹P MRS detects high energy phosphate species, which are the end-products of cellular respiration: adenosine triphosphate (ATP) and phosphocreatine. ATP is the principal form of chemical energy in living organisms, and phosphocreatine (PCr) is regarded as a readily mobilised reserve for its replenishment during periods of high utilisation. The ratios of high energy phosphates are thought to represent a balance between energy generation, reserve and use in the brain Additionally, the chemical shift difference between Pi and PCr enables calculation of intracellular pH. ¹³C MRS detects the ¹³C-isotope of carbon in brain metabolites. As the natural abundance of ¹³C is low (1.1%), ¹³C MRS is typically performed following administration of ¹³C-enriched substrates which permits tracking of the metabolic fate of the infused ¹³C in the brain over time, and calculation of metabolic rates in a range of biochemical pathways, including glycolysis, the tricarboxylic acid (TCA) cycle, and glutamate-glutamine cycling. The advent of new hyperpolarization techniques to transiently boost signal in ¹³C-enriched MRS in-vivo studies shows promise in this field and further developments are expected.
¹H MRS, ³¹P MRS, ¹³C MRS, TBI, Energy Metabolism, Trauma, biomarker, Traumatic Brain Injury
The funding bodies acknowledged on the paper are: PJAH is supported by a National Institute for Health Research (NIHR) Research Professorship, Academy of Medical Sciences/Health Foundation Senior Surgical Scientist Fellowship and the National Institute for Health Research Biomedical Research Centre, Cambridge. PJAH and KLHC are supported by the NIHR Biomedical Research Centre, Cambridge. MGS is supported by PH’s NIHR Research Professorship. AS is funded by the NIHR via an award to the Cambridge NIHR/Wellcome Trust Clinical Research Facility.
Cambridge University Hospitals NHS Foundation Trust (CUH) (unknown)
External DOI: https://doi.org/10.3389/fneur.2017.00426
This record's URL: https://www.repository.cam.ac.uk/handle/1810/267448
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