1
|
Barros CDS, Coutinho A, Tengan CH. Arginine Supplementation in MELAS Syndrome: What Do We Know about the Mechanisms? Int J Mol Sci 2024; 25:3629. [PMID: 38612442 PMCID: PMC11011289 DOI: 10.3390/ijms25073629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
MELAS syndrome, characterized by mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes, represents a devastating mitochondrial disease, with the stroke-like episodes being its primary manifestation. Arginine supplementation has been used and recommended as a treatment for these acute attacks; however, insufficient evidence exists to support this treatment for MELAS. The mechanisms underlying the effect of arginine on MELAS pathophysiology remain unclear, although it is hypothesized that arginine could increase nitric oxide availability and, consequently, enhance blood supply to the brain. A more comprehensive understanding of these mechanisms is necessary to improve treatment strategies, such as dose and regimen adjustments; identify which patients could benefit the most; and establish potential markers for follow-up. This review aims to analyze the existing evidence concerning the mechanisms through which arginine supplementation impacts MELAS pathophysiology and provide the current scenario and perspectives for future investigations.
Collapse
Affiliation(s)
| | | | - Celia H. Tengan
- Division of Neurology, Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil; (C.D.S.B.); (A.C.)
| |
Collapse
|
2
|
Finsterer J, Mehri S. Pathophysiology of myocardial infarction in MELAS. Minerva Cardiol Angiol 2023; 71:702-703. [PMID: 37994634 DOI: 10.23736/s2724-5683.22.06194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Affiliation(s)
- Josef Finsterer
- Department of Neurology, Neurology and Neurophysiology Center, Vienna, Austria -
| | - Sounira Mehri
- Laboratory of Biochemistry, LR12ES05 "Nutrition-Functional Foods and Vascular Health", Faculty of Medicine, Monastir, Tunisia
| |
Collapse
|
3
|
Zheng H, Zhang X, Tian L, Liu B, He X, Wang L, Ding S, Guo Y, Cai J. Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes with an MT-TL1 m.3243A>G point mutation: Neuroradiological features and their implications for underlying pathogenesis. Front Neurosci 2023; 16:1028762. [PMID: 36685235 PMCID: PMC9853426 DOI: 10.3389/fnins.2022.1028762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Objective Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) is one of the most common inherited mitochondrial disorders. Due to the high clinical and genetic heterogeneity of MELAS, it is still a major challenge for clinicians to accurately diagnose the disease at an early stage. Herein, we evaluated the neuroimaging findings of MELAS with an m.3243A>G mutation in MT-TL1 and analyzed the possible underlying pathogenesis of stroke-like episodes. Materials and methods Fifty-nine imaging studies in 24 patients who had a confirmed genetic diagnosis of m.3243A>G (MT-TL1; tRNA Leu) associated with MELAS were reviewed in our case series. The anatomic location, morphological features, signal/intensity characteristics and temporal evolution of lesions were analyzed on magnetic resonance imaging (MRI), and computed tomography (CT) images. The supplying vessels and metabolite content of the lesions were also evaluated by using MR angiography (MRA)/CT angiography (CTA), and MR spectroscopy (MRS), respectively. Results The lesions were most commonly located in the posterior brain, with 37 (37/59, 63%) in the occipital lobe, 32 (32/59, 54%) in the parietal lobe, and 30 (30/59, 51%) in the temporal lobe. The signal characteristics of the lesions varied and evolved over time. Bilateral basal ganglia calcifications were found in 6 of 9 (67%) patients who underwent CT. Cerebral and cerebellar atrophy were found in 38/59 (64%) and 40/59 (68%) patients, respectively. Lesion polymorphism was found in 37/59 (63%) studies. MRS showed elevated lactate doublet peaks in 9/10 (90%) cases. MRA or CTA revealed that the lesion-related arteries were slightly dilated compared with those of the contralateral side in 4 of 6 (67%) cases. Conclusion The imaging features of MELAS vary depending on the disease stage. Polymorphic lesions in a single imaging examination should be considered a diagnostic clue for MELAS. Stroke-like episodes may be involved in a complex pathogenetic process, including mitochondrial angiopathy, mitochondrial cytopathy, and neuronal excitotoxicity.
Collapse
Affiliation(s)
- Helin Zheng
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Radiology, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Zhang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Medical Affairs, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Tian
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Radiology, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Liu
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Radiology, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoya He
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Radiology, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Longlun Wang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Radiology, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Shuang Ding
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Radiology, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Guo
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Pediatric Neurology, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Yi Guo,
| | - Jinhua Cai
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Radiology, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China,Jinhua Cai,
| |
Collapse
|
4
|
Tai HF, Hua TT, Zhang ZQ, Duan YY, Zhuo ZZ, Wang A, Zhou Y, Liu SC, Lv S. Characteristic cerebral perfusion pattern in neuronal intranuclear inclusion disease. Front Neurosci 2022; 16:1081383. [PMID: 36570826 PMCID: PMC9768440 DOI: 10.3389/fnins.2022.1081383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background Neuronal intranuclear inclusion disease (NIID), which pathogenesis remains largely unclear, is a neurodegenerative disease caused by GGC repeat expansion in NOTCH2NLC gene. As case studies have reported dynamic cortical perfusion changes in NIID, this study aimed to explore the cerebral perfusion pattern in NIID patients. Materials and methods A total of 38 NIID patients and 34 healthy controls (HCs) were recruited, and 2 NIID patients who had had episodic symptoms within 2 months were excluded. Data on demographic characteristics and clinical features were collected. All participants underwent three-dimensional pseudo-continuous arterial spin labeling perfusion magnetic resonance imaging (MRI) scanning. Voxel-based comparisons of cerebral blood flow (CBF) were conducted. Results NIID patients showed decreased perfusion in the cortex but increased perfusion in the deep brain regions compared with HCs. The regions with significant hypoperfusion were distributed in the bilateral frontal, temporal, parietal, and occipital gyri, with the left frontal gyrus being the most prominent. The regions with significant hyperperfusion included the bilateral basal ganglia, midbrain, pons, para-hippocampal, and parts of the bilateral cerebellum, fusiform, lingual, rectus, orbital, and cingulum anterior gyri, which were adjacent to the midline (all FDR-corrected p <0.05). When comparing the mean CBF value of the whole brain, no significant differences were observed between NIID patients and HCs (28.81 ± 10.1 vs. 27.99 ± 5.68 ml/100 g*min, p = 0.666). Voxel-based analysis showed no significant difference in cerebral perfusion between NIID patients with and without episodic symptoms. The perfusion within the bilateral middle frontal and anterior cingulate gyri showed positive correlations with MMSE and MoCA scores using age, sex, and education as covariates (p <0.005 uncorrected). Conclusion NIID patients exhibited characteristic cortical hypoperfusion and deep brain hyperperfusion. The perfusion in the bilateral frontal lobe and cingulate gyrus was correlated with the severity of cognitive dysfunction. Cerebral perfusion change may be involved in NIID pathophysiology and serve as a potential indicator for monitoring NIID severity and progression.
Collapse
Affiliation(s)
- Hong-Fei Tai
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tian-Tian Hua
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Tiantan Image Research Center, National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zai-Qiang Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Neurological Diseases, Beijing, China,*Correspondence: Zai-Qiang Zhang,
| | - Yun-Yun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Tiantan Image Research Center, National Clinical Research Center for Neurological Diseases, Beijing, China,Yun-Yun Duan,
| | - Zhi-Zheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Tiantan Image Research Center, National Clinical Research Center for Neurological Diseases, Beijing, China
| | - An Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yi Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shao-Cheng Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shan Lv
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Tiantan Image Research Center, National Clinical Research Center for Neurological Diseases, Beijing, China
| |
Collapse
|
5
|
Al Yazidi G, Mulder J, Licht C, Harvey E, Tein I. Response to the Letter to the Editor "The apparent beneficial effect of L-arginine for stroke-like lesions can be accidental" by Josef Finsterer and Sinda Zarrouk. Neurohospitalist 2022; 12:715-720. [PMID: 36147768 PMCID: PMC9485703 DOI: 10.1177/19418744221090276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Affiliation(s)
- Ghalia Al Yazidi
- Division of Neurology, Dept. of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jaap Mulder
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christoph Licht
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Harvey
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ingrid Tein
- Division of Neurology, Dept. of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Genetics and Genome Biology Program, The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Cheng W, Zhang Y, He L. MRI Features of Stroke-Like Episodes in Mitochondrial Encephalomyopathy With Lactic Acidosis and Stroke-Like Episodes. Front Neurol 2022; 13:843386. [PMID: 35222261 PMCID: PMC8863858 DOI: 10.3389/fneur.2022.843386] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
Mitochondrial myopathy encephalopathy lactic acidosis and stroke-like episodes (MELAS) is an important cause of stroke-mimicking diseases that predominantly affect patients before 40 years of age. MELAS results from gene mutations in either mitochondrial DNA (mtDNA) or nuclear DNA (nDNA) responsible for the wide spectrum of clinical symptoms and imaging findings. Neurological manifestations can present with stroke-like episodes (the cardinal features of MELAS), epilepsy, cognitive and mental disorders, or recurrent headaches. Magnetic resonance imaging (MRI) is an important tool for detecting stroke-like lesions, accurate recognition of imaging findings is important in guiding clinical decision making in MELAS patients. With the development of neuroimaging technologies, MRI plays an increasingly important role in course monitoring and efficacy assessment of the disease. In this article, we provide an overview of the neuroimaging features and the application of novel MRI techniques in MELAS syndrome.
Collapse
|
7
|
Haast RAM, De Coo IFM, Ivanov D, Khan AR, Jansen JFA, Smeets HJM, Uludağ K. OUP accepted manuscript. Brain Commun 2022; 4:fcac024. [PMID: 35187487 PMCID: PMC8853728 DOI: 10.1093/braincomms/fcac024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/26/2021] [Accepted: 02/01/2022] [Indexed: 11/14/2022] Open
Abstract
Mutations of the mitochondrial DNA are an important cause of inherited diseases that can severely affect the tissue’s homeostasis and integrity. The m.3243A > G mutation is the most commonly observed across mitochondrial disorders and is linked to multisystemic complications, including cognitive deficits. In line with in vitro experiments demonstrating the m.3243A > G’s negative impact on neuronal energy production and integrity, m.3243A > G patients show cerebral grey matter tissue changes. However, its impact on the most neuron dense, and therefore energy-consuming brain structure—the cerebellum—remains elusive. In this work, we used high-resolution structural and functional data acquired using 7 T MRI to characterize the neurodegenerative and functional signatures of the cerebellar cortex in m.3243A > G patients. Our results reveal altered tissue integrity within distinct clusters across the cerebellar cortex, apparent by their significantly reduced volume and longitudinal relaxation rate compared with healthy controls, indicating macroscopic atrophy and microstructural pathology. Spatial characterization reveals that these changes occur especially in regions related to the frontoparietal brain network that is involved in information processing and selective attention. In addition, based on resting-state functional MRI data, these clusters exhibit reduced functional connectivity to frontal and parietal cortical regions, especially in patients characterized by (i) a severe disease phenotype and (ii) reduced information-processing speed and attention control. Combined with our previous work, these results provide insight into the neuropathological changes and a solid base to guide longitudinal studies aimed to track disease progression.
Collapse
Affiliation(s)
- Roy A. M. Haast
- Correspondence to: Roy A. M. Haast Centre for Functional and Metabolic Mapping Robarts Research Institute Western University 1151 Richmond St N., London ON, Canada N6A 5B7 E-mail:
| | - Irenaeus F. M. De Coo
- Department of Toxicogenomics, Unit Clinical Genomics, Maastricht University, MHeNs School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Dimo Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Ali R. Khan
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, ON, Canada, N6A 5B7
- Brain and Mind Institute, Western University, London, ON, Canada, N6A 3K7
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada, N6A 5B7
| | - Jacobus F. A. Jansen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Hubert J. M. Smeets
- Department of Toxicogenomics, Unit Clinical Genomics, Maastricht University, MHeNs School for Mental Health and Neuroscience, Maastricht, the Netherlands
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Kâmil Uludağ
- IBS Center for Neuroscience Imaging Research, Sungkyunkwan University, Seobu-ro, 2066, Jangan-gu, Suwon, South Korea
- Department of Biomedical Engineering, N Center, Sungkyunkwan University, Seobu-ro, 2066, Jangan-gu, Suwon, South Korea
- Techna Institute and Koerner Scientist in MR Imaging, University Health Network, Toronto, ON, Canada, M5G 1L5
| |
Collapse
|
8
|
Almannai M, El-Hattab AW. Nitric Oxide Deficiency in Mitochondrial Disorders: The Utility of Arginine and Citrulline. Front Mol Neurosci 2021; 14:682780. [PMID: 34421535 PMCID: PMC8374159 DOI: 10.3389/fnmol.2021.682780] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/21/2021] [Indexed: 11/21/2022] Open
Abstract
Mitochondrial diseases represent a growing list of clinically heterogeneous disorders that are associated with dysfunctional mitochondria and multisystemic manifestations. In spite of a better understanding of the underlying pathophysiological basis of mitochondrial disorders, treatment options remain limited. Over the past two decades, there is growing evidence that patients with mitochondrial disorders have nitric oxide (NO) deficiency due to the limited availability of NO substrates, arginine and citrulline; decreased activity of nitric oxide synthase (NOS); and NO sequestration. Studies evaluating the use of arginine in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) presenting with stroke-like episodes showed symptomatic improvement after acute administration as well as a reduction in the frequency and severity of stroke-like episodes following chronic use. Citrulline, another NO precursor, was shown through stable isotope studies to result in a greater increase in NO synthesis. Recent studies showed a positive response of arginine and citrulline in other mitochondrial disorders besides MELAS. Randomized-controlled studies with a larger number of patients are warranted to better understand the role of NO deficiency in mitochondrial disorders and the efficacy of NO precursors as treatment modalities in these disorders.
Collapse
Affiliation(s)
- Mohammed Almannai
- Section of Medical Genetics, Children's Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.,College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayman W El-Hattab
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Clinical Genetics, University Hospital Sharjah, Sharjah, United Arab Emirates
| |
Collapse
|
9
|
Sleight E, Stringer MS, Marshall I, Wardlaw JM, Thrippleton MJ. Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review. Front Physiol 2021; 12:643468. [PMID: 33716793 PMCID: PMC7947694 DOI: 10.3389/fphys.2021.643468] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022] Open
Abstract
Cerebrovascular reactivity (CVR) magnetic resonance imaging (MRI) probes cerebral haemodynamic changes in response to a vasodilatory stimulus. CVR closely relates to the health of the vasculature and is therefore a key parameter for studying cerebrovascular diseases such as stroke, small vessel disease and dementias. MRI allows in vivo measurement of CVR but several different methods have been presented in the literature, differing in pulse sequence, hardware requirements, stimulus and image processing technique. We systematically reviewed publications measuring CVR using MRI up to June 2020, identifying 235 relevant papers. We summarised the acquisition methods, experimental parameters, hardware and CVR quantification approaches used, clinical populations investigated, and corresponding summary CVR measures. CVR was investigated in many pathologies such as steno-occlusive diseases, dementia and small vessel disease and is generally lower in patients than in healthy controls. Blood oxygen level dependent (BOLD) acquisitions with fixed inspired CO2 gas or end-tidal CO2 forcing stimulus are the most commonly used methods. General linear modelling of the MRI signal with end-tidal CO2 as the regressor is the most frequently used method to compute CVR. Our survey of CVR measurement approaches and applications will help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.
Collapse
Affiliation(s)
- Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom,*Correspondence: Michael S. Stringer
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| |
Collapse
|
10
|
Rodan LH, Poublanc J, Fisher JA, Sobczyk O, Mikulis DJ, Tein I. L-arginine effects on cerebrovascular reactivity, perfusion and neurovascular coupling in MELAS (mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes) syndrome. PLoS One 2020; 15:e0238224. [PMID: 32881886 PMCID: PMC7470264 DOI: 10.1371/journal.pone.0238224] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE We previously showed that MELAS patients have decreased cerebrovascular reactivity (CVR) (p≤ 0.002) and increased cerebral blood flow (CBF) (p<0.0026); changes correlated with disease severity and % mutant mtDNA (inversely for CVR; directly for CBF). We ran a prospective pilot in 3 MELAS sibs (m.3243A>G tRNALeu(UUR)) with variable % mutant blood mtDNA to assess effects of L-Arginine (L-Arg) (single dose and 6-wk steady-state trial) on regional CBF, arterial CVR and neurovascular coupling. METHODS Patients were studied with 3T MRI using arterial spin labeling (ASL) to measure CBF and changes in % Blood Oxygen Level Dependent (BOLD) signal to changes in arterial partial pressure of CO2 to measure CVR. Task fMRI consisted of an alternating black and white checkerboard to evaluate visual cortex response in MELAS and controls. RESULTS Following L-Arg, there was restoration of serum Arg (76-230 μM) in MELAS sibs and a trend towards increasing CVR in frontal and corresponding decrease in occipital cortex; CVR was unchanged globally. There was a 29-37% reduction in baseline CBF in one patient following 6 wks of L-Arg. Pre-treatment fMRI activation in response to visual cortex stimulus was markedly decreased in the same patient compared to controls in primary visual striate cortex V1 and extrastriate regions V2 to V5 with a marked increase toward control values following a single dose and 6 wks of L-Arg. CONCLUSION Proposed "healing" effect may be due to more efficient utilization of energy substrates with increased cellular energy balances and ensuing reduction in signalling pathways that augment flow in the untreated state. CLASSIFICATION OF EVIDENCE This prospective pilot study provides Class III evidence that oral L-Arginine (100 mg/kg single dose or 100 mg/kg three times daily po X 6 weeks) normalizes resting blood flow from elevated pre-treatment levels in patients with MELAS syndrome, selectively increases their CVR from reduced pre-treatment levels in regions most impaired at the expense of less abnormal regions, and normalizes reduced BOLD fMRI activation in response to visual cortex stimulus. CLINICAL TRIALS.GOV (NIH) NCT01603446.
Collapse
Affiliation(s)
- Lance H. Rodan
- Division of Neurology, Dept. of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Julien Poublanc
- Dept. of Medical Imaging, The Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joseph A. Fisher
- Dept. of Anesthesiology, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Dept. of Physiology and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- The Toronto General Hospital Medical Research Institute, Toronto, Ontario, Canada
| | - Olivia Sobczyk
- Dept. of Medical Imaging, The Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David J. Mikulis
- Dept. of Medical Imaging, The Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ingrid Tein
- Division of Neurology, Dept. of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Genetics and Genome Biology Program, The Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Dept. of Laboratory Medicine and Pathobiology, The University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Narayanan S, Schmithorst V, Panigrahy A. Arterial Spin Labeling in Pediatric Neuroimaging. Semin Pediatr Neurol 2020; 33:100799. [PMID: 32331614 DOI: 10.1016/j.spen.2020.100799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Perfusion imaging using arterial spin labeling noninvasively evaluates cerebral blood flow utilizing arterial blood water as endogenous tracer. It does not require the need of radiotracer or intravenous contrast and offers unique complimentary information in the imaging of pediatric brain. Common clinical applications include neonatal hypoxic ischemic encephalopathy, pediatric stroke and vascular malformations, epilepsy and brain tumors. Future applications may include evaluation of silent ischemia in sickle cell patients, monitor changes in intracranial pressure in hydrocephalus, provide additional insights in nonaccidental trauma and chronic traumatic brain injury (TBI) and in functional Magnetic resonance imaging (MRI). The purpose of this review article is to evaluate the technical considerations including pitfalls, physiological variations, clinical applications and future directions of arterial spin labeling imaging.
Collapse
Affiliation(s)
- Srikala Narayanan
- Children's Hospital of Pittsburgh of UPMC, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Vincent Schmithorst
- Children's Hospital of Pittsburgh of UPMC, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ashok Panigrahy
- John F. Caffey Endowed Chair in Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|
12
|
Goel H, Szczepanczyk K, Mirza FS. Late-Onset Melas with Midd: An Uncommon Age of Presentation. AACE Clin Case Rep 2018. [DOI: 10.4158/ep171955.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
13
|
Reversible Dilation of Cerebral Macrovascular Changes in MELAS Episodes. Clin Neuroradiol 2018; 29:321-329. [DOI: 10.1007/s00062-018-0662-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/02/2018] [Indexed: 01/12/2023]
|
14
|
Li Y, Lin J. Current insight into MELAS: Clinical perspectives and multimodal MRI. J Magn Reson Imaging 2018; 47:583-584. [PMID: 28543782 DOI: 10.1002/jmri.25736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Lin
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
15
|
Finsterer J, Zarrouk-Mahjoub S. Regional cerebral hyperperfusion: A biomarker of upcoming stroke-like episodes? J Magn Reson Imaging 2018; 47:582. [DOI: 10.1002/jmri.25735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/30/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Sinda Zarrouk-Mahjoub
- University of Tunis El Manar and Genomics Platform, Pasteur Institute of Tunis; Tunisia
| |
Collapse
|
16
|
Haast RAM, Ivanov D, IJsselstein RJT, Sallevelt SCEH, Jansen JFA, Smeets HJM, de Coo IFM, Formisano E, Uludağ K. Anatomic & metabolic brain markers of the m.3243A>G mutation: A multi-parametric 7T MRI study. NEUROIMAGE-CLINICAL 2018; 18:231-244. [PMID: 29868447 PMCID: PMC5984598 DOI: 10.1016/j.nicl.2018.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/13/2017] [Accepted: 01/15/2018] [Indexed: 02/08/2023]
Abstract
One of the most common mitochondrial DNA (mtDNA) mutations, the A to G transition at base pair 3243, has been linked to changes in the brain, in addition to commonly observed hearing problems, diabetes and myopathy. However, a detailed quantitative description of m.3243A>G patients' brains has not been provided so far. In this study, ultra-high field MRI at 7T and volume- and surface-based data analyses approaches were used to highlight morphology (i.e. atrophy)-, microstructure (i.e. myelin and iron concentration)- and metabolism (i.e. cerebral blood flow)-related differences between patients (N = 22) and healthy controls (N = 15). The use of quantitative MRI at 7T allowed us to detect subtle changes of biophysical processes in the brain with high accuracy and sensitivity, in addition to typically assessed lesions and atrophy. Furthermore, the effect of m.3243A>G mutation load in blood and urine epithelial cells on these MRI measures was assessed within the patient population and revealed that blood levels were most indicative of the brain's state and disease severity, based on MRI as well as on neuropsychological data. Morphometry MRI data showed a wide-spread reduction of cortical, subcortical and cerebellar gray matter volume, in addition to significantly enlarged ventricles. Moreover, surface-based analyses revealed brain area-specific changes in cortical thickness (e.g. of the auditory cortex), and in T1, T2* and cerebral blood flow as a function of mutation load, which can be linked to typically m.3243A>G-related clinical symptoms (e.g. hearing impairment). In addition, several regions linked to attentional control (e.g. middle frontal gyrus), the sensorimotor network (e.g. banks of central sulcus) and the default mode network (e.g. precuneus) were characterized by alterations in cortical thickness, T1, T2* and/or cerebral blood flow, which has not been described in previous MRI studies. Finally, several hypotheses, based either on vascular, metabolic or astroglial implications of the m.3243A>G mutation, are discussed that potentially explain the underlying pathobiology. To conclude, this is the first 7T and also the largest MRI study on this patient population that provides macroscopic brain correlates of the m.3243A>G mutation indicating potential MRI biomarkers of mitochondrial diseases and might guide future (longitudinal) studies to extensively track neuropathological and clinical changes.
Collapse
Key Words
- 15-WLT, 15-Words Learning Task
- 7T MRI
- ADL, Activities daily life
- ASL, Arterial spin labeling
- Brain
- CBF, Cerebral blood flow
- CN, Caudate nucleus
- CNR, Contrast-to-noise ratio
- CSF, Cerebral spinal fluid
- DN, Dentate nucleus
- EPI, Echo planar imaging
- FWHM, Full-width half maximum
- GM, Gray matter
- GP, Globus pallidus
- IQR, Interquartile range
- LDST, Letter-Digit Substitution test
- Leu, Leucine
- MANOVA, Multivariate analysis of variance
- MELAS, Mitochondrial encephalopathy lactic acidosis and stroke-like episodes
- MIDD, Mitochondrial inherited deafness and diabetes
- Mitochondrial
- NMDAS, Newcastle Mitochondrial Disease Adult Scale
- OXPHOS, Oxidative phosphorylation
- Pu, Putamen
- Quantitative
- RF, Radio frequency
- RN, Red nucleus
- ROI, Region of interest
- SLEs, Stroke-like cortical episodes
- SN, Substantia nigra
- SNR, Signal-to-noise ratio
- T, Tesla
- UECs, Urine epithelial cells
- UHF, Ultra-high field
- WM, White matter
- WMLs, White matter lesions
- cGM, Cortical gray matter
- eTIV, Estimated total intracranial volume
- m.3243A>G
- mtDNA, Mitochondrial DNA
Collapse
Affiliation(s)
- Roy A M Haast
- Department of Cognitive Neuroscience, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands; Maastricht Centre for Systems Biology, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands.
| | - Dimo Ivanov
- Department of Cognitive Neuroscience, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands
| | | | - Suzanne C E H Sallevelt
- Department of Clinical Genetics, Maastricht University Medical Centre, PO Box 5800, 6202AZ Maastricht, Netherlands
| | - Jacobus F A Jansen
- Department of Radiology, Maastricht University Medical Centre and School for Mental Health and Neuroscience, Maastricht University, PO Box 5800, 6202AZ Maastricht, Netherlands
| | - Hubert J M Smeets
- Department of Genetics and Cell Biology, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands; NeMo Expertise Centre, Postbus 2060, 3000CB Rotterdam, Netherlands; Research School GROW, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands
| | - Irenaeus F M de Coo
- Department of Neurology, Erasmus MC, Postbus 2040, 3000CA Rotterdam, Netherlands; NeMo Expertise Centre, Postbus 2060, 3000CB Rotterdam, Netherlands
| | - Elia Formisano
- Department of Cognitive Neuroscience, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands; Maastricht Centre for Systems Biology, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands
| | - Kâmil Uludağ
- Department of Cognitive Neuroscience, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands.
| |
Collapse
|
17
|
|
18
|
Rapid cerebrovascular reactivity mapping: Enabling vascular reactivity information to be routinely acquired. Neuroimage 2017; 159:214-223. [PMID: 28756241 DOI: 10.1016/j.neuroimage.2017.07.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/17/2017] [Accepted: 07/23/2017] [Indexed: 11/22/2022] Open
Abstract
Cerebrovascular reactivity mapping (CVR), using magnetic resonance imaging (MRI) and carbon dioxide as a stimulus, provides useful information on how cerebral blood vessels react under stress. This information has proven to be useful in the study of vascular disorders, dementia and healthy ageing. However, clinical adoption of this form of CVR mapping has been hindered by relatively long scan durations of 7-12 min. By replacing the conventional block presentation of carbon dioxide enriched air with a sinusoidally modulated stimulus, the aim of this study was to investigate whether more clinically acceptable scan durations are possible. Firstly, the conventional block protocol was compared with a sinusoidal protocol of the same duration of 7 min. Estimates of the magnitude of the CVR signal (CVR magnitude) were found to be in good agreement between the stimulus protocols, but estimates of the relative timing of the CVR response (CVR phase) were not. Secondly, data from the sinusoidal protocol was reanalysed using decreasing amounts of data in the range 1-6 min. The CVR magnitude was found to tolerate this reduction in scan duration better than CVR phase. However, these analyses indicate that scan durations in the range of 3-5 min produce robust data.
Collapse
|
19
|
Lax NZ, Gorman GS, Turnbull DM. Review: Central nervous system involvement in mitochondrial disease. Neuropathol Appl Neurobiol 2016; 43:102-118. [PMID: 27287935 PMCID: PMC5363248 DOI: 10.1111/nan.12333] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/03/2016] [Accepted: 06/11/2016] [Indexed: 12/13/2022]
Abstract
Mitochondrial respiratory chain defects are an important cause of inherited disorders affecting approximately 1 in 5000 people in the UK population. Collectively these disorders are termed ‘mitochondrial diseases’ and they result from either mitochondrial DNA mutations or defects in nuclear DNA. Although they are frequently multisystem disorders, neurological deficits are particularly common, wide‐ranging and disabling for patients. This review details the manifold neurological impairments associated with mitochondrial disease, and describes the efforts to understand how they arise and progressively worsen in patients with mitochondrial disease. We describe advances in our understanding of disease pathogenesis through detailed neuropathological studies and how this has spurred the development of cellular and animal models of disease. We underscore the importance of continued clinical, molecular genetic, neuropathological and animal model studies to fully characterize mitochondrial diseases and understand mechanisms of neurodegeneration. These studies are instrumental for the next phase of mitochondrial research that has a particular emphasis on finding novel ways to treat mitochondrial disease to improve patient care and quality of life.
Collapse
Affiliation(s)
- N Z Lax
- The Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - G S Gorman
- The Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D M Turnbull
- The Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
20
|
Li R, Xiao HF, Lyu JH, J.J. Wang D, Ma L, Lou X. Differential diagnosis of mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) and ischemic stroke using 3D pseudocontinuous arterial spin labeling. J Magn Reson Imaging 2016; 45:199-206. [PMID: 27348222 DOI: 10.1002/jmri.25354] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/09/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- Rui Li
- Department of Radiology; Chinese PLA General Hospital; Beijing China
- School of Medicine; Nankai University; Tianjin China
| | - Hua-feng Xiao
- Department of Radiology; Chinese PLA General Hospital; Beijing China
- Department of Radiology; Chinese PLA 302 Hospital; Beijing China
| | - Jin-hao Lyu
- Department of Radiology; Chinese PLA General Hospital; Beijing China
| | - Danny J.J. Wang
- Department of Neurology; University of California; Los Angeles California USA
| | - Lin Ma
- Department of Radiology; Chinese PLA General Hospital; Beijing China
| | - Xin Lou
- Department of Radiology; Chinese PLA General Hospital; Beijing China
- Department of Neurology; University of California; Los Angeles California USA
| |
Collapse
|
21
|
Kim JA, Leung J, Lerch JP, Kassner A. Reduced cerebrovascular reserve is regionally associated with cortical thickness reductions in children with sickle cell disease. Brain Res 2016; 1642:263-269. [PMID: 27026656 DOI: 10.1016/j.brainres.2016.03.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 03/10/2016] [Accepted: 03/25/2016] [Indexed: 01/13/2023]
Abstract
Sickle cell disease (SCD) is a genetic disorder which adversely affects cerebrovascular health. Previous studies have demonstrated regional cortical thinning in SCD. However, the reason behind regional reductions in cortical thickness remains unclear. Therefore, we aimed to explore the possible link between the state of cerebrovascular health and cortical thickness. In this study, we obtained magnetic resonance (MR) based measures of cerebrovascular reactivity (CVR), a measure of vascular health, and cortical thickness in SCD patients (N=60) and controls of similar age and similar gender ratio (N=27). The group comparison analysis revealed significant regionally specific reductions in CVR and cortical thickness in the SCD group compared to the controls. In addition, a regional association analysis was performed between CVR and cortical thickness in the SCD group which revealed a significant regional association in several brain regions with the highest strength of association observed in the left cuneus, right post central gyrus and the right temporal pole. The regional association analysis revealed that significant associations were found in brain regions with high metabolic activity (anterior cingulate, posterior cingulate, occipital gyrus, precuneus) thus demonstrating that these regions could be most vulnerable to structural damage under hypoxic conditions.
Collapse
Affiliation(s)
- Junseok A Kim
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada M5S1A8; Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada M5G0A4
| | - Jackie Leung
- Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada M5G0A4
| | - Jason P Lerch
- Mouse Imaging Centre, The Toronto Centre for Phenogenomics, Toronto, ON, Canada M5T3H7; Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada M5G1X8
| | - Andrea Kassner
- Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada M5G0A4; Departmentment of Medical Imaging, University of Toronto, Toronto, ON, Canada M5T1W7.
| |
Collapse
|
22
|
Fryer RH, Bain J, De Vivo D. Mitochondrial Encephalomyopathy Lactic Acidosis and Stroke-Like Episodes (MELAS): A Case Report and Critical Reappraisal of Treatment Options. Pediatr Neurol 2016; 56:59-61. [PMID: 26797286 PMCID: PMC4789111 DOI: 10.1016/j.pediatrneurol.2015.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/15/2015] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Stroke-like episodes signal progression and significant disability in the mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes syndrome. Arginine is widely used as a treatment for stroke-like episode, although there is little evidence for this intervention. We discuss the management of a patient with mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes who presented with a stroke-like episode. OBSERVATION During a seizure, which triggers the stroke-like episode, neurons are forced to utilize glycolysis as a source of adenosine triphosphate. Glycolytic by-products are damaging to the neuron. Breakdown of the blood-brain barrier leads to vasogenic edema. CONCLUSION Treatment of stroke-like episode should include anticonvulsants interictally to prevent seizures and dexamethasone ictally to help repair the blood-brain barrier.
Collapse
Affiliation(s)
- Robert H. Fryer
- Department of Neurology, Columbia University Medical Center, New York, NY,Corresponding Author: Robert H. Fryer, MD, PHD, 180 Fort Washington Avenue, Harkness 5th floor, New York, NY 10032, 212-342-2919 (P), 212-342-6865 (F),
| | - Jennifer Bain
- Department of Neurology, Columbia University Medical Center, New York, NY
| | - Darryl De Vivo
- Department of Neurology, Columbia University Medical Center, New York, NY
| |
Collapse
|