Increase of interstitial glycerol reflects the degree ofischaemic brain damage: a PET and microdialysis study in a middlecerebral artery occlusion-reperfusion primate model

摘要

OBJECTIVE—To evaluate interstitial glycerol as a marker of ischaemia by studying the changes in glycerol in direct relation to changes in regional cerebral metabolic rate of oxygen (CMRO2), the lactate/pyruvate ratio (LP ratio), and glutamate.
METHODS—Transorbital 2 hour middle cerebral artery occlusion (MCAO) was performed in eight monkeys, which were studied with continuous microdialysis for 24 hours. Interstitial fluids were collected by microdialysis and analysed for glycerol, lactate, pyruvate, and glutamate with an enzymatic assay and high performance liquid chromatography. Sequential PET studies of cerebral blood flow (CBF), CMRO2, oxygen extraction ratio (OER), and cerebral blood volume (CBV) were performed. The microdialysis probe regions were classified as severe ischaemia or penumbra, depending on whether the mean CMRO2 side to side ratio was below or above 60%, respectively.
RESULTS—A nine-fold, sustained increase in glycerol was registered after MCAO in severe ischaemia regions. In penumbra regions, the increase in glycerol was five-fold, but the glycerol concentration returned to baseline within 8 hours of clip removal. The difference between severe ischaemia and penumbra glycerol values was statistically significant. As expectedfrom previous studies, the interstitial LP ratio and glutamateincreased markedly in severe ischaemia, with a less pronounced changein penumbra regions. There was a time lag between the biochemicalchanges in severe ischaemia regions, with the LP ratio precedingglutamate, followed by glycerol.
CONCLUSIONS—A marked,sustained increase in interstitial glycerol is indicative of severeischaemia in this stroke model. A transient, diminutive increase ininterstitial glycerol may reflect a penumbra situation. Interstitialglycerol in combination with other biochemical markers such as the LPratio and glutamate may be useful for clinical monitoring of theischaemic brain, reflecting a sequence of secondary pathophysiological events.