Identification of a by-product of nitric oxide synthase activity in human acute brain injury with in vivo proton magnetic resonance spectroscopy.
OBJECTIVE
Laboratory studies have been used to identify nitric oxide as a notable mediator in neuronal death after acute brain injury. To our knowledge, this has not previously been confirmed with in vivo study in humans. Our purpose was to seek in vivo evidence for the induction of nitric oxide synthase (NOS) in human acute brain injury by using proton MR spectroscopy.


METHODS
In vitro proton MR spectra were obtained in neural extracts from 30 human cadavers, and in vivo spectra were obtained in 20 patients with acute brain injury and in a similar number of control subjects.


RESULTS
We identified a unique peak at 3.15 ppm by using in vivo proton MR spectroscopy in eight of 20 patients with acute brain injury but not in 20 healthy volunteers (P <.002). On the basis of in vitro data, we have tentatively assigned this peak to citrulline, a NOS by-product.


CONCLUSIONS
To our knowledge, our findings suggest, for the first time, that excitotoxicity may occur in human acute brain injury. Confirmation with the acquisition of spectra in very early acute cerebral injury would provide a rationale for the use of neuroprotective agents in these conditions, as well as a new noninvasive method for quantification.
Silberstein
Morry
M
Department of Radiology, University of Sydney, School of Medicine, Monash University, Australia.
Lane
Dianne
D
Dodd
Seetal
S
Opeskin
Kenneth
K
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001921:Brain / Q000378:metabolism; D001927:Brain Diseases / Q000175:diagnosis / Q000378:metabolism*; D001930:Brain Injuries / Q000175:diagnosis / Q000378:metabolism*; D016022:Case-Control Studies; D002956:Citrulline / Q000378:metabolism*; D006801:Humans; D007231:Infant, Newborn; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D019001:Nitric Oxide Synthase / Q000378:metabolism*
D002956:Citrulline; D019001:Nitric Oxide Synthase