@article{8bf98c355a3249bf9755ec4ffed6fa58,
title = "Cerebral ketones detected by 3T MR spectroscopy in patients with high-grade glioma on an Atkins-based diet",
abstract = "BACKGROUND AND PURPOSE: Ketogenic diets are being explored as a possible treatment for several neurological diseases, but the physiologic impact on the brain is unknown. The objective of this study was to evaluate the feasibility of 3T MR spectroscopy to monitor brain ketone levels in patients with high-grade gliomas who were on a ketogenic diet (a modified Atkins diet) for 8 weeks. MATERIALS AND METHODS: Paired pre- and post-ketogenic diet MR spectroscopy data from both the lesion and contralateral hemisphere were analyzed using LCModel software in 10 patients. RESULTS: At baseline, the ketone bodies acetone and b -hydroxybutyrate were nearly undetectable, but by week 8, they increased in the lesion for both acetone (0.06 6 0.03 $ 0.27 6 0.06 IU, P = .005) and b -hydroxybutyrate (0.07 6 0.07 $ 0.79 6 0.32 IU, P = .046). In the contralateral brain, acetone was also significantly increased (0.041 6 0.01 $ 0.16 6 0.04 IU, P = .004), but not b -hydroxybutyrate. Acetone was detected in 9/10 patients at week 8, and b -hydroxybutyrate, in 5/10. Acetone concentrations in the contralateral brain correlated strongly with higher urine ketones (r = 0.87, P = .001) and lower fasting glucose (r = -0.67, P = .03). Acetoacetate was largely undetectable. Small-but-statistically significant decreases in NAA were also observed in the contralateral hemisphere at 8 weeks. CONCLUSIONS: This study suggests that 3T MR spectroscopy is feasible for detecting small cerebral metabolic changes associated with a ketogenic diet, provided that appropriate methodology is used.",
author = "A. Berrington and Schreck, {K. C.} and Barron, {B. J.} and L. Blair and Lin, {D. D.M.} and Hartman, {A. L.} and E. Kossoff and L. Easter and Whitlow, {C. T.} and Y. Jung and Hsu, {F. C.} and Cervenka, {M. C.} and Blakeley, {J. O.} and Barker, {P. B.} and Strowd, {R. E.}",
note = "Funding Information: We acknowledge use of the services and facilities of the Clinical Research Unit of the Wake Forest Clinical and Translational Sciences Institute, which is supported by National Center for Advancing Translational Sciences UL1TR001420. We also acknowledge philanthropy in memory of John Freeman. Funding Information: Disclosures: Bobbie J. Barron—UNRELATED: Board Membership: Nutricia, Comments: I have taken part in 1 Advisory Board meeting. The nutrition supplements Nutricia makes were offered as part of a compliance strategy during the fasting part of the intervention but were not required and were not critical to the study; Payment for Lectures Including Service on Speakers Bureaus: Nutricia, Comments: I have been a speaker at a Nutricia conference; Royalties: Springer Publishing Company/Demos Health, Comments: for coauthoring The Ketogenic and Modified Atkins Diets, 6th ed; Other: BioMarin and Therachon, Comments: I have been a consultant for pediatric anthropometry for BioMarin and Therachon, neither of which has any conflict with the current study. Eric Kossoff—UNRELATED: Board Membership: Atkins Nutritionals; Nutricia Royalties: Springer Publishing Company/Demos Health, Comments: for coauthoring The Ketogenic and Modified Atkins Diets, 6th ed. Linda Easter— RELATED: Grant: Wake Forest Baptist Health Clinical and Translational Sciences Institute, Comments: CTSA grant UL1TR001420*; UNRELATED: Consultancy: Allena Pharmaceuticals. Mackenzie C. Cervenka—RELATED: Grant: Elaine Freeman Charitable donation, Comments: The money was paid to Johns Hopkins and not to me personally*; UNRELATED: Consultancy: Nutricia, Sage Therapeutics, Comments: I am a consultant for Nutricia, which produces KetoCal (4:1 ratio ketogenic liquid used in patients on the GLAD protocol referenced in the study). I was not paid directly by Nutricia for participation in the study. I was also a prior consultant for Sage Therapeutics (unrelated to this study); Grants/Grants Pending: Nutricia, Vitaflo, the William and Ella Owens Medical Research Foundation, the BrightFocus Foundation, Payment for Lectures Including Service on Speakers Bureaus: Nutricia, Epigenix, LivaNova, Royalties: Demos, Comments: I receive royalties for the book The Ketogenic and Modified Atkins Diets: Treatments for Epilepsy and Other Disorders. Peter B. Barker—RELATED: I was supported, in part, by the National Institutes of Health P41EB015909. Jaishri O. Blakeley—RELATED: Comments: philanthropic gift to the institution to support nutritional interventions for brain tumors*; UNRELATED: Consultancy: SpringWorks Therapeutics, Comments: agreement in place, no payments made*; Grants/Grants Pending: Sanofi, Lily, Bristol-Myers Squibb*; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: AstraZeneca, SpringWorks Therapeutics, Exelixis. Roy E. Strowd—RELATED: Grant: National Institutes of Health, Comments: I was supported by the National Center for Advancing Translational Sciences National Institutes of Health KL2TR001421 and the National Cancer Institute{\textquoteright}s Cancer Center Support Grant award No. P30CA012197 issued to the Wake Forest Baptist Comprehensive Cancer Center. UNRELATED: Consultancy: Monteris Medical, Novocure. Grants: Southeastern Brain Tumor Foundation, American Society of Clinical Oncology, Conquer Cancer. *Money paid to the institution. Funding Information: This work was supported by the National Center for Advancing Translational Sciences, National Institutes of Health KL2TR001421 and CTSA grant UL1TR001420, and the National Cancer Institute's Cancer Center Support Grant award number P30CA012197 issued to the Wake Forest Baptist Comprehensive Cancer Center. It was also supported, in part, by the National Institutes of Health P41EB015909. Funding Information: Received June 17, 2019; accepted after revision September 04. From the Russell H. Morgan Departments of Radiology and Radiological Science (A.B., D.D.M.L., P.B.B.), Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.), Pediatrics (L.B., A.L.H.), and Institute of Clinical and Translational Research (B.J.B.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Clinical and Translational Science Institute (L.E., R.E.S.), Departments of Radiology (C.T.W., Y.J.), Biostatistics and Data Science (F.-C.H.), Division of Public Health Sciences, and Departments of Neurology, Hematology and Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, North Carolina; and F. M. Kirby Research Center for Functional Brain Imaging (P.B.B., R.E.S.), Kennedy Krieger Institute, Baltimore, Maryland. A. Berrington and K.C. Schreck contributed equally to this work. This work was undertaken while A.L. Hartman was a full-time employee of Johns Hopkins University. This work was supported by the National Center for Advancing Translational Sciences, National Institutes of Health KL2TR001421 and CTSA grant UL1TR001420, and the National Cancer Institute{\textquoteright}s Cancer Center Support Grant award number P30CA012197 issued to the Wake Forest Baptist Comprehensive Cancer Center. It was also supported, in part, by the National Institutes of Health P41EB015909. Publisher Copyright: {\textcopyright} 2019 American Society of Neuroradiology. All rights reserved.",
year = "2019",
doi = "10.3174/ajnr.A6287",
language = "English (US)",
volume = "40",
pages = "1908--1915",
journal = "American Journal of Neuroradiology",
issn = "0195-6108",
publisher = "American Society of Neuroradiology",
number = "11",
}