Proton spectroscopy of brain glutamine in acute liver failure

McConnell, James R.; Antonson, Dean L.; Ong, Chin Siong; Chu, Wei-Kom; Fox, Ira J.; Heffron, Thomas G.; Langnas, Alan Norman; Shaw, Byers W.

doi:10.1016/0270-9139(95)90354-2

Cited by 14 publications

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“…Results of the present study are consistent with these findings. McConnell et al [19] reported decreased myo-inositol in brain of patients with ALF, and normalization of myo-inositol decrease was observed in the brain of a patient with ALF after clinical recovery [11]. More convincing evidence for a role of myoinositol in the pathogenesis of brain edema in ALF is provided by results of the present study showing a significant attenuation of brain myo-inositol concentrations following the prevention of brain edema by mild hypothermia.…”

Section: Discussionsupporting

confidence: 76%

Selective alterations of brain osmolytes in acute liver failure: protective effect of mild hypothermia

et al. 2004

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Zwingmann, C. et al., 2004. Selective alterations of brain osmolytes in acute liver failure: protective effect of mild hypothermia. Brain Research, 999(1), ABSTRACTThe principal cause of mortality in patients with acute liver failure (ALF) is brain herniation resulting from intracranial hypertension caused by a progressive increase of brain water. In the present study, ex vivo highresolution 1 H-NMR spectroscopy was used to investigate the effects of ALF, with or without superimposed hypothermia, on brain organic osmolyte concentrations in relation to the severity of encephalopathy and brain edema in rats with ALF due to hepatic devascularization. In normothermic ALF rats, glutamine concentrations in frontal cortex increased more than fourfold at precoma stages, i.e. prior to the onset of severe encephalopathy, but showed no further increase at coma stages. In parallel with glutamine accumulation, the brain organic osmolytes myo-inositol and taurine were significantly decreased in frontal cortex to 63% and 67% of control values, respectively, at precoma stages (p<0.01), and to 58% and 67%, respectively, at coma stages of encephalopathy (p<0.01). Hypothermia, which prevented brain edema and encephalopathy in ALF rats, significantly attenuated the depletion of myo-inositol and taurine. Brain glutamine concentrations, on the other hand, did not respond to hypothermia. These findings demonstrate that experimental ALF results in selective changes in brain organic osmolytes as a function of the degree of encephalopathy which are associated with brain edema, and provides a further rationale for the continued use of hypothermia in the management of this condition.

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Section: Discussionsupporting

confidence: 76%

Selective alterations of brain osmolytes in acute liver failure: protective effect of mild hypothermia

et al. 2004

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“…10,12,[27][28][29][30][31][32][33][34] The concentrations of many cerebral metabolites, such as glutamine, glutamate, and lactate, can be measured in the brain under in vivo conditions with MRS (see Fig. 4).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, both ICP and brain lactate were assumed to reflect the extent of cerebral edema during acute liver failure. Because other brain metabolites, such as glutamine and glutamate, may contribute to the formation of cerebral edema, [9][10][11][12][13] concentrations of glutamine and glutamate were also determined by MRS in this study.…”

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confidence: 99%

Brain lactate by magnetic resonance spectroscopy during fulminant hepatic failure in the dog

1998

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“…Furthermore, technical improvements allow for operator-independent automated postprocessing and quantification of lactate signals. Previous studies indicated increased Glx levels in brains of patients with neonatal jaundice, with hepatic encephalopathy and with ALF [4][5][6][7]. In previous documentations of brain MRS results in ALF peak intensities were assessed qualitatively by means of peak intensity ratios in one single voxel containing both grey and white matter tissue [6,7].…”

Section: Introductionmentioning

confidence: 99%

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

et al. 2008

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Acute liver failure (ALF)-related encephalopathy was previously characterized by MR spectroscopy of single voxels containing both grey and white matter brain tissue. Quantitative multivoxel MRS was used here to compare grey and white matter brain tissue concentrations of glutamate/glutamine (Glx) and lactate in ALF and associate the results with other liver function parameters. Five pediatric patients with ALF-related encephalopathy and five controls, examined after successful liver transplantation, were examined by brain MRI/MRS. ALF patients had higher Glx and lactate concentrations in brain white matter than controls (Glx + 125%: P<0.01; lactate + 33%, P<0.05) and higher Glx in grey matter (Glx + 125%: P< 0.01). Within the group of ALF patients positive correlations were found between grey or white matter lactate concentration and serum ammonia (P<0.05), and negative correlations between grey or white matter Glx and venous pH (P<0.001). This is the first study presenting evidence of high Glx levels in both white and grey matter brain tissue in ALF-related encephalopathy. The elevations in CNS Glx and lactate concentrations appear to relate to hepatic detoxification (ammonia, venous pH), rather than to liver parenchymal integrity (aspartate aminotransferase, alanine aminotransferase) or biliary cholestasis (bilirubin, γ-glutamyl transpeptidase, alkaline phosphatase).

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Proton spectroscopy of brain glutamine in acute liver failure

Cited by 14 publications

References 0 publications

Selective alterations of brain osmolytes in acute liver failure: protective effect of mild hypothermia

Selective alterations of brain osmolytes in acute liver failure: protective effect of mild hypothermia

Brain lactate by magnetic resonance spectroscopy during fulminant hepatic failure in the dog

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

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