phosphocreatine and Neuromuscular-Diseases

31P MRS and 1H MRI of skeletal muscle have become major new tools allowing a complete non invasive investigation of muscle function both in the clinical setting and in basic research. The comparative analysis of normal and diseased muscle remains a major requirement to further define metabolic events surrounding muscle contraction and the metabolic anomalies underlying pathologies. Also, standardized rest-exercise-recovery protocols for the exploration of muscle metabolism by P-31 MRS in healthy volunteers as well as in patients with intolerance to exercise have been developed. The CRMBM protocol is based on a short-term intense exercise, which is very informative and well accepted by volunteers and patients. Invariant metabolic parameters have been defined to characterize the normal metabolic response to the protocol. Deviations from normality can be directly interpreted in terms of specific pathologies in some favorable cases. This protocol has been applied to more than 4,000 patients and healthy volunteers over a period of 15 years. On the other hand, MRI investigations provide anatomical and functional information from resting and exercising muscle. From a diagnostic point of view, dedicated pulse sequences can be used in order to detect and quantify muscle inflammation, fatty replacement, muscle hyper and hypotrophy. In most cases, MR techniques provide valuable information which has to be processed in conjunction with traditional invasive biochemical, electrophysiological and histoenzymological tests. P-31 MRS has proved particularly useful in the therapeutic follow-up of palliative therapies (coenzyme Q treatment of mitochondriopathies) and in family investigations. It is now an accepted diagnostic tool in the array of tests which are used to characterize muscle disorders in clinical routine. As a research tool, it will keep bringing new information on the physiopathology of muscle diseases in animal models and in humans and should play a role in the metabolic characterization of gene and cell therapy.

Topics: Adenosine Triphosphate; Calibration; Energy Metabolism; Equipment Design; Exercise Test; Humans; Hydrogen; Magnetic Resonance Spectroscopy; Metabolism, Inborn Errors; Mitochondrial Myopathies; Muscle Contraction; Muscle, Skeletal; Muscular Diseases; Myositis; Neuromuscular Diseases; Phosphates; Phosphocreatine; Phosphorus Isotopes; Rest

Phosphorus magnetic resonance spectroscopy monitors muscle energy metabolism by recording the ratio of phosphocreatine to inorganic phosphate at rest, during exercise, and during recovery from exercise. In mitochondrial diseases, abnormalities may appear during some or all these phases. Low phosphocreatine-inorganic phosphate ratios at rest are not disease-specific, but can be increased by drug therapy in several myopathies. Phosphorus magnetic resonance spectroscopy can also record intracellular pH and thus identify disorders of glycogen metabolism in which the production of lactic acid is blocked during ischemic exercise. The measurements of accumulated sugar phosphate intermediates further delineate glycolytic muscle defects. Myophosphorylase deficiency responds to intravenous glucose administration with improved exercise bioenergetics, but no such response is seen in phosphofructokinase deficiency. The muscular dystrophies show no specific bioenergetic abnormality; however, elevation of phospholipids metabolites and phosphodiesters was detected in some cases. While phosphorus magnetic resonance spectroscopy remains primarily a research tool in metabolic myopathies, it will be clinically useful in identifying new therapies and monitoring their effects in a variety of neuromuscular disorders.

Topics: Energy Metabolism; Exercise; Glucose; Glycogen; Glycolysis; Humans; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Mitochondria, Muscle; Muscle Contraction; Muscle Relaxation; Muscles; Muscular Dystrophies; Neuromuscular Diseases; Oxidative Phosphorylation; Phosphates; Phosphocreatine; Phosphofructokinase-1; Phosphorus Isotopes; Phosphorylases

Although non-specific pain in the upper limb muscles of workers engaged in mild repetitive tasks is a common occupational health problem, much is unknown about the associated structural and biochemical changes. In this study, we compared the muscle energy metabolism of the extrinsic finger extensor musculature in instrumentalists suffering from work-related pain with that of healthy control instrumentalists using non-invasive phosphorus magnetic resonance spectroscopy ((31)P-MRS). We hypothesize that the affected muscles will show alterations related with an impaired energy metabolism.. We studied 19 volunteer instrumentalists (11 subjects with work-related pain affecting the extrinsic finger extensor musculature and 8 healthy controls). We used (31)P-MRS to find deviations from the expected metabolic response to exercise in phosphocreatine (PCr), inorganic phosphate (Pi), Pi/PCr ratio and intracellular pH kinetics. We observed a reduced finger extensor exercise tolerance in instrumentalists with myalgia, an intracellular pH compartmentation in the form of neutral and acid compartments, as detected by Pi peak splitting in (31)P-MRS spectra, predominantly in myalgic muscles, and a strong association of this pattern with the condition.. Work-related pain in the finger extrinsic extensor muscles is associated with intracellular pH compartmentation during exercise, non-invasively detectable by (31)P-MRS and consistent with the simultaneous energy production by oxidative metabolism and glycolysis. We speculate that a deficit in energy production by oxidative pathways may exist in the affected muscles. Two possible explanations for this would be the partial and/or local reduction of blood supply and the reduction of the muscle oxidative capacity itself.

Topics: Adolescent; Adult; Energy Metabolism; Exercise; Exercise Tolerance; Female; Fingers; Humans; Hydrogen-Ion Concentration; Intracellular Space; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Muscle, Skeletal; Music; Neuromuscular Diseases; Occupational Diseases; Pain; Phosphates; Phosphocreatine; Time Factors; Young Adult

Several neuromuscular disorders are associated with reductions in intramuscular adenosine triphosphate (ATP) and/or phosphocreatine (PCr). These alterations have been primarily characterized using (31)P-magnetic resonance spectroscopy ((31)P-MRS). We prospectively measured total creatine, PCr, and ATP in muscle biopsies from 81 patients: normal controls (n = 33), mitochondrial cytopathy (n = 8), neuropathic (n = 3), dystrophy/congenital myopathies (n = 7), inflammatory myopathy (n = 12), and miscellaneous myopathies (n = 18) using direct biochemical analysis. Intramuscular concentrations of PCr and ATP were lower for the dystrophy/congenital myopathy, inflammatory myopathy, and mitochondrial disease patients with ragged red fiber (RRF) as compared with normal controls (P < 0.05). Total creatine was lower for the dystrophy/congenital myopathy group as compared with the normal control group (P < 0.05). These values compare favorably to results from other studies using (31)P-MRS and provide external validation for the values obtained using that method. Given the reductions in high-energy phosphate compounds in these patients, there is the potential for therapeutic intervention with creatine monohydrate supplementation.

Topics: Adenosine Triphosphate; Adult; Aged; Biopsy; Creatine; Female; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Muscles; Neuromuscular Diseases; Phosphocreatine

Interest in creatine (Cr) as a nutritional supplement and ergogenic aid for athletes has surged over recent years. After cellular uptake, Cr is phosphorylated to phosphocreatine (PCr) by the creatine kinase (CK) reaction using ATP. At subcellular sites with high energy requirements, e.g. at the myofibrillar apparatus during muscle contraction, CK catalyzes the transphosphorylation of PCr to ADP to regenerate ATP, thus preventing a depletion of ATP levels. PCr is thus available as an immediate energy source, serving not only as an energy buffer but also as an energy transport vehicle. Ingestion of creatine increases intramuscular Cr, as well as PCr concentrations, and leads to exercise enhancement, especially in sprint performance. Additional benefits of Cr supplementation have also been noticed for high-intensity long-endurance tasks, e.g. shortening of recovery periods after physical exercise. The present article summarizes recent findings on the influence of Cr supplementation on energy metabolism, and introduces the Cr transporter protein (CreaT), responsible for uptake of Cr into cells, as one of the key-players for the multi-faceted regulation of cellular Cr homeostasis. Furthermore, it is suggested that patients with disturbances in Cr metabolism or with different neuro-muscular diseases may benefit from Cr supplementation as an adjuvant therapy to relieve or delay the onset of symptoms. Although it is still unclear how Cr biosynthesis and transport are regulated in health and disease, so far there are no reports of harmful side effects of Cr loading in humans. However, in this study, we report that chronic Cr supplementation in rats down-regulates in vivo the expression of the CreaT. In addition, we describe the presence of CreaT isoforms most likely generated by alternative splicing.

Topics: Amino Acid Sequence; Animals; Carrier Proteins; Creatine; Dietary Supplements; Down-Regulation; Energy Metabolism; Exercise; Humans; Membrane Transport Proteins; Molecular Sequence Data; Muscle Proteins; Muscle, Skeletal; Neuromuscular Diseases; Phosphocreatine; Rats; Sports

Phosphorus-31 magnetic resonance (MR) spectra of leg muscles in patients with the neuromuscular diseases Duchenne dystrophy, myotonic dystrophy, postpoliomyelitis, Werdnig-Hoffmann disease, and pedal dystonia were recorded. Ratios of beta-adenosine triphosphate (ATP), inorganic phosphate (Pi), alpha-glycerophosphorylcholine (GPC), and phosphomonoesters to phosphocreatine (PCr) were calculated from peak integrals and compared with normal muscle ratios. In all diseases studied, beta-ATP/PCr and Pi/PCr values showed an increase from normal values. The extent of increase in beta-ATP/PCr was related to the clinical severity of the disease, suggesting that this could be a useful noninvasive means of monitoring effectiveness of therapy for neuromuscular disorders. In myotonic dystrophy and Werdnig-Hoffmann disease, GPC/PCr values increased greatly. The intracellular pH in Duchenne and postpoliomyelitis muscles was slightly elevated compared with that in normal muscles. Hydrogen-1 MR images of muscles showed fat infiltration in all patients, more in weaker muscles and less in stronger muscles.

Topics: Adenosine Triphosphate; Adolescent; Adult; Child; Child, Preschool; Dystonia; Glycerylphosphorylcholine; Humans; Leg; Magnetic Resonance Spectroscopy; Middle Aged; Muscles; Muscular Dystrophies; Neuromuscular Diseases; Phosphates; Phosphocreatine; Poliomyelitis; Spinal Muscular Atrophies of Childhood

Concentrations of the high-energy phosphates, ATP and creatine phosphate, were investigated in slow-twitch (ST) and fast-twitch (FT) muscle fibres of patients with myotonia congenita (n = 6), dystrophia myotonica (n = 5), myopathia ocularis (n = 2) and hyperornithinemia with gyrate atrophy (HOGA) (n = 3) and compared with those of normal subjects (n = 4). At rest, the patients with HOGA had lower values of ATP in ST muscle fibres than the controls (P less than 0.05). They also had lower values of creatine phosphate in these fibres than the patients with dystrophia myotonica (P less than 0.03) and myotonia congenita (P less than 0.05). After 30 s bicycle ergometer exercises there was an increase in ATP in the ST muscle fibres of the patients with myotonia congenita, but in all other patient groups there was a decrease.

Topics: Adenosine Triphosphate; Adolescent; Adult; Female; Humans; Male; Middle Aged; Muscles; Myotonia Congenita; Myotonic Dystrophy; Neuromuscular Diseases; Oculomotor Muscles; Organ Specificity; Ornithine; Phosphocreatine; Physical Exertion; Syndrome

Topics: Electromyography; Humans; Muscle Contraction; Neural Conduction; Neuromuscular Diseases; Phosphocreatine

Decreased cerebrospinal fluid concentrations of cyclic nucleotides in human motor neuron disease and decreased spinal cord concentrations of cyclic nucleotides in murine (Wobbler) motor neuron disease suggest that an abnormality in cyclic nucleotide metabolism may play a role in motor neuron degeneration. Retroviruses cause decreased cellular levels of cyclic nucleotides in infected cells. We induced a motor neuron degeneration with a neurotropic retrovirus, but not with a non-neurotropic retrovirus. In paralyzed mice, mean cAMP was decreased 21% in posterior horn segments and 34% in anterior horn segments compared to controls. The proportion of spinal cord phosphorylase a decreased 24% in paralyzed mice compared to controls. The content of cGMP decreased 48% in the cerebellum and 25% in both anterior and posterior horn segments of the spinal cords of paralyzed mice compared to controls. White matter content of these chemicals did not decrease in the posterior column of affected animals. Spinal cord content of ATP increased 20-22% in all three compartments, but the spinal cord content of phosphocreatine increased dramatically in white matter (46%), posterior horn gray matter (69%), and anterior horn gray matter (103%) compared to controls. Changes in high-energy phosphate intermediate and cyclic nucleotide metabolites occurred only in topographical regions showing neuronal and astrocyte pathological changes, but did not occur in the cerebral cortex.

Topics: Adenosine Triphosphate; Animals; Cerebral Cortex; Cyclic AMP; Energy Metabolism; Female; gamma-Aminobutyric Acid; Motor Neurons; Muridae; Neuromuscular Diseases; Phosphocreatine; Pregnancy; Retroviridae Infections; Spinal Cord