Biomarkers of Neurological Injury and Recovery in Urea Cycle Disorders

在近端尿素循环障碍（UCD），特别是鸟氨酸转氨甲酰酶缺乏症（OTCD）中，高氨血症（HA）引起脑谷氨酰胺（Gln）升高，而Gln的紊乱被认为是神经系统损伤的核心。相反，在远端UCD中，如瓜氨酸血症（氨基琥珀酸合成酶缺乏症; ASSD）和氨基琥珀酸尿症（氨基琥珀酸裂解酶缺乏症）;（ASLD），即使在没有急性HA的情况下，认知障碍和神经精神疾病也很常见。因此，瓜氨酸和氨基琥珀酸（阿萨）或其代谢产物都被认为具有神经毒性。在这个项目中，我们将使用最先进的神经影像学和神经心理学方法来研究OTCD患者是否具有与局部脑结构异常和神经认知功能障碍相关的慢性脑Gin升高和肌醇（ml）水平降低。我们将进一步研究在HA急性发作期间，脑Gln升高和ml水平降低是否与细胞毒性水肿的程度相关，以及是否可以确定Gln/ml比率阈值，在该阈值下细胞毒性水肿随后是细胞损失。最后，将研究ASSD和/或ASLD中的脑损伤区域是否与OTCD中的脑损伤区域不同，并将不存在HA的ASSD和ASLD中的脑Gln水平与OTCD中的脑Gln水平进行比较。我们还将试图确定是否可以在远端UCD患者的大脑中识别脑瓜氨酸和阿萨，以及它们是否与MRI和神经心理学测试中观察到的大脑异常相关。这个项目将阐明急性高氨血症和慢性UCD的脑病理学年表，以及近端和远端UCD在脑损伤的病理生理学方面是否不同。

In proximal urea cycle disorders (UCD), particularlyornithine transcarbamylase deficiency (OTCD), hyperammonemia (HA) causes increased brain glutamine (Gin) which perturbation is thoughtto be at the core of the neurological injury. In contrast, in distal UCD such as citrullinemia(argininosuccinatesynthetase deficiency; (ASSD) and argininosuccinicaciduria(argininosuccinatelyase deficiency); (ASLD) cognitive impairment and neuropsychiatric disease are common even in the absence of acute HA. As a consequence, both citrulline and argininosuccinate (ASA) or their metabolic products have been implicated as neurotoxic. In this project we will use state-of- the-art neuroimaging and neuropsychological methods to investigate whether patients with OTCD have chronically elevated brain Gin and reduced myo-inositol (ml) levels that correlate with regional brain structural abnormalities and neurocognitive dysfunction. We will further investigate whether during an acute episode of HA elevated brain Gin and decreased ml levels correlate with the magnitude of cytotoxic edema and whether a Gln/ml ratio threshold can be identified at which the cytotoxic edema is followed by cell loss. Finally, will investigate whether regions of brain damage in ASSD and/or ASLD are distinct from those in OTCD and compare brain Gin levels in ASSD and ASLD in the absence of HA to those in OTCD. We will also seek to determine if brain citrulline and ASA can be identified in the brains of patients with distal UCD and whether they correlate with brain abnormalities seen in MRI and neuropsychological testing. This project will elucidate the chronology of brain pathology both in acute hyperammonemia and chronic UCD and whether, proximal and distal UCD differ in their pathophysiology of brain damage.