title: 1H MRS identifies symptomatic and asymptomatic subjects with partial ornithine transcarbamylase deficiency.
abstract: OBJECTIVE
  To evaluate brain metabolism in subjects with partial ornithine transcarbamylase deficiency (OTCD) utilizing (1)H MRS.
  
  
  METHODS
  Single-voxel (1)H MRS was performed on 25 medically-stable adults with partial OTCD, and 22 similarly aged controls. Metabolite concentrations from frontal and parietal white matter (FWM, PWM), frontal gray matter (FGM), posterior cingulate gray matter (PCGM), and thalamus (tha) were compared with controls and IQ, plasma ammonia, glutamine, and disease severity.
  
  
  RESULTS
  Cases ranged from 19 to 59 years; average 34 years; controls ranged from 18 to 59 years; average 33 years. IQ scores were lower in cases (full scale 111 vs. 126; performance IQ 106 vs. 117). Decreased myoinositol (mI) in FWM (p=0.005), PWM (p<0.001), PCGM (p=0.003), and tha (p=0.004), identified subjects with OTCD, including asymptomatic heterozygotes. Glutamine (gln) was increased in FWM (p<0.001), PWM (p<0.001), FGM (p=0.002), and PCGM (p=0.001). Disease severity was inversely correlated with [mI] in PWM (r=-0.403; p=0.046) and directly correlated with [gln] in PCGM (r=0.548; p=0.005). N-Acetylaspartate (NAA) was elevated in PWM (p=0.002); choline was decreased in FWM (p=0.001) and tha (p=0.002). There was an inverse relationship between [mI] and [gln] in cases only. Total buffering capacity (measured by [mI/mI+gln] ratio, a measure of total osmolar capacity) was inversely correlated with disease severity in FWM (r=-0.479; p=0.018), PWM (r=-0.458; p=0.021), PCGM (r=-0.567; p=0.003), and tha (r=-0.345; p=0.037).
  
  
  CONCLUSIONS
  Brain metabolism is impaired in partial OTCD. Depletion of mI and total buffering capacity are inversely correlated with disease severity, and serve as biomarkers.
authors.affiliation: Department of Neurology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA. agropman@cnmc.org
authors.forename: A L
authors.initials: AL
authors.lastname: Gropman
authors.forename: S T
authors.initials: ST
authors.lastname: Fricke
authors.forename: R R
authors.initials: RR
authors.lastname: Seltzer
authors.forename: A
authors.initials: A
authors.lastname: Hailu
authors.forename: A
authors.initials: A
authors.lastname: Adeyemo
authors.forename: A
authors.initials: A
authors.lastname: Sawyer
authors.forename: J
authors.initials: J
authors.lastname: van Meter
authors.forename: W D
authors.initials: WD
authors.lastname: Gaillard
authors.forename: R
authors.initials: R
authors.lastname: McCarter
authors.forename: M
authors.initials: M
authors.lastname: Tuchman
authors.forename: M
authors.initials: M
authors.lastname: Batshaw
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007294:Inositol / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020163:Ornithine Carbamoyltransferase Deficiency Disease / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000378:metabolism*; D011859:Radiography; D012720:Severity of Illness Index
chemical_list: D007294:Inositol