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Global Translational Medicine Deep learning by NMR-biochemical

(NAAG)/Cr+PCr relative to creatine neurometabolites in 6.17. CNS system with rheumatic autoimmune
complicated and uncomplicated traumatic brain injury diseases
(TBI) patients. The NAA peaks and NAA values were lower Proton MRS measures neuronal loss or CNS damage with
in complicated and uncomplicated TBI groups compared autoimmune rheumatic diseases. An MRS study reviewed
to the control group. Neurometabolite alterations indicated vasculitis, Behcet’s disease, Sjogren’s syndrome, psoriasis,
the onset of both complicated and uncomplicated TBI with rheumatoid arthritis, juvenile idiopathic arthritis,
injury severity in mild TBI [117] . Furthermore, MRS is not a systemic sclerosis, and systemic lupus erythematosus from
biomarker option in the management of TBI. November 2003 to December 2019 [121] . Low NAA/Cr and
Mild TBI is a risk factor for dementia. The in vivo MRS high Cho/Cr ratios in different regions of the above brain
detected low NAA, high glutamate, low choline, and diseases showed an association with various CNS disease
variable Cr in frontal lobe brain white matter as membrane inflammatory activities and comorbidities with diseases.
high turnover changes after a negative routine CCT/ The neurometabolite abnormalities with non-overt CNS
MRI scan of frontal lobe acute or subacute mild TBI manifestations suggested the association of abnormal
within 3 months [118] . MRS correlated post-traumatic brain vascular reactivity and systemic inflammation with
metabolism with cognitive dysfunction to detect mTBI subclinical CNS manifestations.
patients at risk of post-traumatic neurodegeneration early.
However, the author suggests follow-up studies are needed 6.18. Diagnosis of mesial temporal lobe sclerosis
to correlate MRS with cognitive outcomes using different Recently, MRS metabolic features of the brain were reported
modified MRI sequences, high-field strength, accurate to classify mesial lobe epilepsy, hippocampal sclerosis,
voxel placements, voxel sizes, and reasonable Cramér-Rao mesial temporal sclerosis (MTS), and mesial and temporal
lower-bounds cutoffs. seizures [122] . A decreased NAA, NAA/(Cho+Cr) ratio, and
NAA/Cr ratio in the ipsilateral hippocampus and reduced
6.15. Evaluation of prognostic consciousness NAA levels in extra-hippocampal regions are suggested as
recovery in wakefulness syndrome individuals pre-surgical localization of epileptogenic focus.
Multi-voxel MRS of the frontal cortex, temporal cortex,
brain stem, fornix, internal capsule, thalamus, globus 6.19. Theranosis of mitochondrial diseases
pallidus, and putamen regions in patients with vegetative Serial MRS visualized the response of weekly intravenous
state/unresponsive wakefulness syndrome (VS/UWS) 500 mg/kg L-arginine therapy in MELAS, showing
showed low NAA/Cr ratio in the temporal cortex, capsula improvement clinically for the treatment of mitochondrial
interna, and thalamus, while higher NAA/Cr ratio in these encephalopathy with lactic acidosis and stroke-like events.
structures is indicative of recovery of consciousness [119] . L-arginine therapy normalizes brain lactate and NAA/
The low NAA/Cr and NAA/(NAA+Ch+Cr) ratios in mid‑ Cho ratio as a radiologic and clinical improvement [123] . The
brain regions were associated with hypoxia in patients. The consensus suggests that the management of mitochondrial
MRS accurately predicted recovery of consciousness from stroke-like episodes may be achievable through the
hypoxic brain damage in unconscious VS/UWS patients utilization of MRS [124] . Mitochondrial myopathies in the
with TBI to the level of emergence of a minimal conscious brain, muscle, and cardiac tissue were indicated by elevated
state (EMCS). lactate levels detected by MRS [125] .
6.16. Substance use disorders 7. Future directions and perspectives
1 H-MRS is used to evaluate the effect of narcotic In the future, clinical MRSI will be multimodal, robust,
substances such as methamphetamine, alcohol, fast, equipped with new supervised segmentation,
3,4-methylenedioxymethamphetamine (MDMA), nicotine, component-specific registration, and disease-specific
marijuana, cocaine, opiate, and opioid in after-use disorders. spatio-spectral-encoded trained pixel data sets
A decrease in NAA and Cho levels in brain regions was a (spectromics) by super-resolution DL toward customized
common feature in defining the substance-specific effect precision medicine [126-130] . A new perception of 3D-MRSI
of the above-said substance use. The author recommends clinical value will certainly depend on new computer
more MRS clinical trials to monitor novel substance abuse data generation and feature extraction using integrated
treatment. The H-MRS showed low NAA and low Cho diagnosis with high acceptance in medical practice [131,132] .
1
levels in the brain indicating altered neurometabolites in Hybrid approaches of HPLC-MR, biochemical-MR, and
addicts on MDMA, cocaine, alcohol, methamphetamine, digital histochemical-MR correlation may contribute
opiates/opioids, nicotine, and marijuana [120] . better. It seems that quantification of metabolite

Volume 2 Issue 3 (2023) 20 https://doi.org/10.36922/gtm.337