title: Brain manganese deposition and blood levels in patients undergoing home parenteral nutrition.
abstract: BACKGROUND
  Extrapyramidal syndrome and alterations in brain magnetic resonance images are described in patients undergoing long-term home parenteral nutrition (HPN) and in cholestatic patients. These abnormalities have been correlated to basal ganglia manganese (Mn) accumulation.
  
  
  METHODS
  A longitudinal 1-year study was conducted on 15 patients undergoing HPN (median duration, 3.8 years; range, 1.7-10; median Mn parenteral supplementation, 0.1 mg/d). Whole-blood, plasma, intra-erythrocytes, and urinary Mn concentrations were measured and brain magnetic resonance was performed at the beginning (time 0) and after 1 year of Mn intravenous supplementation withdrawal (time 1). No patients showed psychosis, extrapyramidal syndrome, or cholestasis.
  
  
  RESULTS
  At time zero, 10 of 15 patients (67%) showed paramagnetic accumulation on cerebral magnetic resonance images; at time 1 there was a reduction of cerebral Mn accumulation. In all patients, blood-Mn levels were significantly reduced after 1 year of Mn intravenous supplementation withdrawal.
  
  
  CONCLUSIONS
  Patients receiving long-term HPN showed an elevated incidence of alterations in brain magnetic resonance images with a median Mn intravenous supplementation of 0.1 mg/d. Mn supplementation withdrawal significantly decreased metal levels in blood and brain storage. We noticed that the intra-erythrocyte Mn level was a good index of Mn status.
authors.affiliation: Dipartimento Medico-Chirurgico delle Malattie dell'Apparato Digerente e della Nutrizione, Azienda Ospedaliera San Giovanni Battista, Torino, Italy. rizzetto@molinette.unito.it
authors.forename: D B
authors.initials: DB
authors.lastname: Bertinet
authors.forename: M
authors.initials: M
authors.lastname: Tinivella
authors.forename: F A
authors.initials: FA
authors.lastname: Balzola
authors.forename: A
authors.initials: A
authors.lastname: de Francesco
authors.forename: O
authors.initials: O
authors.lastname: Davini
authors.forename: L
authors.initials: L
authors.lastname: Rizzo
authors.forename: P
authors.initials: P
authors.lastname: Massarenti
authors.forename: M A
authors.initials: MA
authors.lastname: Leonardi
authors.forename: F
authors.initials: F
authors.lastname: Balzola
mesh_terms: D000328:Adult; D000368:Aged; D001480:Basal Ganglia Diseases / Q000209:etiology / Q000517:prevention & control*; D001921:Brain / Q000378:metabolism* / Q000473:pathology; D019587:Dietary Supplements / Q000009:adverse effects; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008345:Manganese / Q000008:administration & dosage / Q000097:blood / Q000378:metabolism*; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*
chemical_list: D008345:Manganese