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Reduced Insular Glutamine and N-Acetylaspartate in Systemic Lupus Erythematosus: A Single-Voxel H-1-MR Spectroscopy Study

Cagnoli, Patricia; Harris, Richard E.; Frechtling, Dan; Berkis, George; Gracley, Richard H.; Graft, Courtney C.; Lowe, Suzan E.; Chenevert, Thomas L.; McCune, William J. and Gebarski, Stephen, et al. (2013) In Academic Radiology 20(10). p.1286-1296
Abstract
Rationale and Objectives: To investigate for differences in metabolic concentrations and ratios between patients with systemic lupus erythematosus (SLE) without (group SLE) and those with neurological symptoms (group NPSLE) compared to a healthy control (group HC) in three normal-appearing brain regions: the frontal white matter, right insula (RI), and occipital gray matter and whether changes in any of the metabolites or metabolic ratios are correlated to disease activity and other clinical parameters. Materials and Methods: Twenty patients with SLE (18 women and 2 men, age range 23.4-64.6 years, mean age 43.9 years), 23 NPSLE patients (23 women, age range 23.7-69.8 years, mean age 42.4 years), and 21 HC (19 women and 2 men, age range... (More)
Rationale and Objectives: To investigate for differences in metabolic concentrations and ratios between patients with systemic lupus erythematosus (SLE) without (group SLE) and those with neurological symptoms (group NPSLE) compared to a healthy control (group HC) in three normal-appearing brain regions: the frontal white matter, right insula (RI), and occipital gray matter and whether changes in any of the metabolites or metabolic ratios are correlated to disease activity and other clinical parameters. Materials and Methods: Twenty patients with SLE (18 women and 2 men, age range 23.4-64.6 years, mean age 43.9 years), 23 NPSLE patients (23 women, age range 23.7-69.8 years, mean age 42.4 years), and 21 HC (19 women and 2 men, age range 21.0-65.7 years, mean age 43.4 years) were included. All subjects had conventional brain magnetic resonance imaging and H-1 single-voxel spectroscopy, clinical assessment, and laboratory testing. Results: NPSLE patients had significantly reduced N-acetylaspartate (NAA)/creatine compared to HC (P = .02) and SLE patients (P = .01) in the RI. Lower glutamine/creatine levels were also detected in RI in both patient groups and in frontal white matter in NPSLE patients compared to HC (P = .01, P = .02). NAA/Cr ratio in the RI was significantly negatively correlated with the Systemic Lupus Erythematosus Disease Activity Index (r = -0.41; P = .008), and patients with active SLE symptoms also had a trend toward lower NAA/creatine ratios (1.02 vs 1.12; P = .07). Conclusions: The present data support previous findings of abnormal metabolic changes in normal-appearing regions in the brain of both SLE and NPSLE patients and raise the possibility that especially NAA, glutamine, and glutamate may be additional biomarkers for cerebral disease activity in SLE patients as these early metabolic changes occur in the brain of SLE patients before neurologic and imaging manifestations become apparent. (Less)
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Contribution to journal
publication status
published
subject
keywords
NSPLE, SLE, MRI, MRS, metabolites
in
Academic Radiology
volume
20
issue
10
pages
1286 - 1296
publisher
Elsevier
external identifiers
  • wos:000325194600014
  • scopus:84883506997
ISSN
1878-4046
DOI
10.1016/j.acra.2013.07.011
language
English
LU publication?
yes
id
2bab1a3d-f576-4613-9a94-ddf55c93ac66 (old id 4171891)
date added to LUP
2013-12-06 12:29:58
date last changed
2019-01-06 07:36:38
@article{2bab1a3d-f576-4613-9a94-ddf55c93ac66,
  abstract     = {Rationale and Objectives: To investigate for differences in metabolic concentrations and ratios between patients with systemic lupus erythematosus (SLE) without (group SLE) and those with neurological symptoms (group NPSLE) compared to a healthy control (group HC) in three normal-appearing brain regions: the frontal white matter, right insula (RI), and occipital gray matter and whether changes in any of the metabolites or metabolic ratios are correlated to disease activity and other clinical parameters. Materials and Methods: Twenty patients with SLE (18 women and 2 men, age range 23.4-64.6 years, mean age 43.9 years), 23 NPSLE patients (23 women, age range 23.7-69.8 years, mean age 42.4 years), and 21 HC (19 women and 2 men, age range 21.0-65.7 years, mean age 43.4 years) were included. All subjects had conventional brain magnetic resonance imaging and H-1 single-voxel spectroscopy, clinical assessment, and laboratory testing. Results: NPSLE patients had significantly reduced N-acetylaspartate (NAA)/creatine compared to HC (P = .02) and SLE patients (P = .01) in the RI. Lower glutamine/creatine levels were also detected in RI in both patient groups and in frontal white matter in NPSLE patients compared to HC (P = .01, P = .02). NAA/Cr ratio in the RI was significantly negatively correlated with the Systemic Lupus Erythematosus Disease Activity Index (r = -0.41; P = .008), and patients with active SLE symptoms also had a trend toward lower NAA/creatine ratios (1.02 vs 1.12; P = .07). Conclusions: The present data support previous findings of abnormal metabolic changes in normal-appearing regions in the brain of both SLE and NPSLE patients and raise the possibility that especially NAA, glutamine, and glutamate may be additional biomarkers for cerebral disease activity in SLE patients as these early metabolic changes occur in the brain of SLE patients before neurologic and imaging manifestations become apparent.},
  author       = {Cagnoli, Patricia and Harris, Richard E. and Frechtling, Dan and Berkis, George and Gracley, Richard H. and Graft, Courtney C. and Lowe, Suzan E. and Chenevert, Thomas L. and McCune, William J. and Gebarski, Stephen and Sundgren, Pia},
  issn         = {1878-4046},
  keyword      = {NSPLE,SLE,MRI,MRS,metabolites},
  language     = {eng},
  number       = {10},
  pages        = {1286--1296},
  publisher    = {Elsevier},
  series       = {Academic Radiology},
  title        = {Reduced Insular Glutamine and N-Acetylaspartate in Systemic Lupus Erythematosus: A Single-Voxel H-1-MR Spectroscopy Study},
  url          = {http://dx.doi.org/10.1016/j.acra.2013.07.011},
  volume       = {20},
  year         = {2013},
}