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. 2013 Oct;20(10):1286-96.
doi: 10.1016/j.acra.2013.07.011.

Reduced Insular Glutamine and N-acetylaspartate in systemic lupus erythematosus: a single-voxel (1)H-MR spectroscopy study

Patricia Cagnoli  1 , Richard E Harris, Dan Frechtling, George Berkis, Richard H Gracley, Courtney C Graft, Suzan E Lowe, Thomas L Chenevert, William J McCune, Stephen Gebarski, Pia C Sundgren
Affiliations

Reduced Insular Glutamine and N-acetylaspartate in systemic lupus erythematosus: a single-voxel (1)H-MR spectroscopy study

Patricia Cagnoli et al. Acad Radiol. 2013 Oct.

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 (1)H 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.

Keywords: MRI; MRS; NSPLE; SLE; metabolites.

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Figures

Figure 1
Figure 1
Voxel placements (red box) and corresponding metabolic spectra in anterior frontal white matter (a,b) and right insula (c,d). Cho, choline; mI, myoinositol; Cr, creatine; NAA, N-acetylaspartate.
Figure 2
Figure 2
Bar graph demonstrating the different metabolic ratios in the insula in the systemic lupus erythematosus without neurological symptoms (SLE), NPSLE (neuropsychiatric systemic lupus erythematosus), and healthy control (HC) groups. NAA, N-acetylaspartate; Glu, glutamate; Gln, glutamine; Glx, Glu plus Gln; Cho, choline; mIns, myoinositol.
Figure 3
Figure 3
Bar graph demonstrating the longitudinal changes of the different metabolic ratios in the insula in the neuropsychiatric systemic lupus erythematosus (NPSLE) group. NAA, N-acetylaspartate; Glu, glutamate; Gln, glutamine; Glx, Glu plus Gln; Cho, choline; mIns, myoinositol.
Figure 4
Figure 4
Scatterplot demonstrating the N-acetylaspartate (NAA)/creatine (Cr) ratios in the insula between the three groups (a) and the correlation between the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score and the NAA/Cr ratios in the insular region neuropsychiatric systemic lupus erythematosus (NPSLE) group (b).
See this image and copyright information in PMC

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