title: A new metabolite contributing to N-acetyl signal in 1H MRS of the brain in Salla disease.
abstract: OBJECTIVE
  To determine whether N-acetylaspartate (NAA) is reduced in patients with Salla disease, a neurodegenerative disorder.
  
  
  BACKGROUND
  1H MRS allows the brain metabolism to be studied noninvasively in vivo. N-acetyl (NA) is composed primarily of NAA, which is regarded as a neuronal marker. The NA signal in 1H MRS is reduced in several neurodegenerative disorders. Increased NA signal has thus far only been found in Canavan's disease as a result of NAA accumulation in the brain tissue. In Salla disease, an autosomal recessive free sialic acid storage disorder, N-acetylneuraminic acid (NANA), accumulates in lysosomes of brain tissue.
  
  
  METHODS
  The authors studied eight patients with Salla disease (age range, 6 to 44 years) and eight age-matched healthy volunteers using quantitative 1H MRS. The spectra were obtained from two selected 8-cm3 volumes of interest localized in the basal ganglia and in the parietal white matter using conventional 1.5-T MRI equipment. The spectral resonance lines of NA groups, creatine and phosphocreatine (Cr), and choline-containing compounds (Cho) were analyzed quantitatively. All MR images were evaluated to verify the state of myelination.
  
  
  RESULTS
  1H MRS from parietal white matter revealed 34% higher NA and 47% higher Cr concentrations, and a 35% lower Cho concentration in the patients with Salla disease compared with the age-matched control subjects. The patients had a 22% higher water content in their parietal white matter, whereas in the basal ganglia the water concentrations did not differ significantly. In the patients' basal ganglia the Cr concentration was 53% higher.
  
  
  CONCLUSIONS
  NAA is considered to be a neuronal marker that, except for Canavan's disease, has been found or assumed to be either stable or reduced. However, in Salla disease the high NA signal may have a contribution from accumulated lysosomal NANA, which offsets the possible loss of NAA. The high Cr is in line with the increased glucose uptake found in our earlier 2-fluoro-2-deoxy-D-glucose-PET study, reflecting increased energy demand. It is worth noting that in a conventional 1H MRS ratio-based analysis these underlying abnormalities would have remained undetected. Our study thus emphasizes the importance of a quantitative assessment of metabolite concentrations in 1H MRS for detecting altered brain metabolism.
authors.affiliation: Department of Medical Genetics, University of Turku, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Varho
authors.forename: M
authors.initials: M
authors.lastname: Komu
authors.forename: P
authors.initials: P
authors.lastname: Sonninen
authors.forename: I
authors.initials: I
authors.lastname: Holopainen
authors.forename: S
authors.initials: S
authors.lastname: Nyman
authors.forename: T
authors.initials: T
authors.lastname: Manner
authors.forename: M
authors.initials: M
authors.lastname: Sillanpää
authors.forename: P
authors.initials: P
authors.lastname: Aula
authors.forename: N
authors.initials: N
authors.lastname: Lundbom
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000378:metabolism* / Q000473:pathology; D002648:Child; D006801:Humans; D016464:Lysosomal Storage Diseases / Q000378:metabolism* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D011522:Protons
chemical_list: D011522:Protons