AUTHOR=Lee Ha Neul , Yoon Choon-Sik , Lee Young-Mock 

TITLE=Correlation of Serum Biomarkers and Magnetic Resonance Spectroscopy in Monitoring Disease Progression in Patients With Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes Due to mtDNA A3243G Mutation

JOURNAL=Frontiers in Neurology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2018.00621

DOI=10.3389/fneur.2018.00621

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> Analysis of serum biomarkers and magnetic resonance spectroscopy (MRS) are useful for monitoring disease progression in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). We evaluated the correlation of serum biomarkers and MRS parameters during changes associated with stroke-like episodes.</p><p><bold>Methods:</bold> In 13 symptomatic MELAS patients carrying the A3243G mutation, we retrospectively obtained 207 voxels from 41 MRS studies, which were divided into three groups according to the temporal association with stroke-like episodes. The MRS NAA/Cr, Cho/Cr, NAA/Cho ratios, the presence of a lactate peak, serum biomarkers, serum lactate level and the pyruvate (Lac/Pyr) ratio were determined.</p><p><bold>Results:</bold> In regions with acute infarcts, the severity of serum Lac/Pyr and that of the MRS lactate peak (<italic>P</italic> = 0.0007) correlated; serum lactate (<italic>P</italic> = 0.02), severity of elevated serum lactate (<italic>P</italic> = 0.04), and serum Lac/Pyr (<italic>P</italic> = 0.02) correlated weakly. In previously infarcted regions, the severity of the MRS lactate peak and serum Lac/Pyr (<italic>P</italic> = 0.03), as well as the severity of serum Lac/Pyr (<italic>P</italic> = 0.02) were weakly correlated. In structurally normal regions, we found a weak to moderate negative correlation between serum lactate and MRS NAA/Cr (<italic>P</italic> = 0.008), and between the severity of elevated serum lactate and MRS NAA/Cr (<italic>P</italic> = 0.002) as well as MRS NAA/Cho (<italic>P</italic> = 0.02).</p><p><bold>Conclusions:</bold> MRS parameters correlate with specific serum biomarkers, and are useful for monitoring changes in brain metabolites, particularly as related to stroke-like episodes.</p>