TY  - JOUR
A1  - Wenger-Alakmeh, Katharina Johanna
A1  - Wagner, Marlies
A1  - Harter, Patrick Nikolaus
A1  - Franz, Kea
A1  - Bojunga, Jörg
A1  - Fokas, Emmanouil
A1  - Imhoff, Detlef
A1  - Rödel, Claus
A1  - Rieger, Johannes
A1  - Hattingen, Elke
A1  - Steinbach, Joachim Peter
A1  - Pilatus, Ulrich
A1  - Vos, Martin
T1  - Maintenance of energy homeostasis during calorically restricted ketogenic diet and fasting-MR-spectroscopic insights from the ERGO2 trial
T2  - Cancers
N2  - Background: The ERGO2 (Ernaehrungsumstellung bei Patienten mit Rezidiv eines Glioblastoms) MR-spectroscopic imaging (MRSI) subtrial investigated metabolism in patients randomized to calorically restricted ketogenic diet/intermittent fasting (crKD-IF) versus standard diet (SD) in addition to re-irradiation (RT) for recurrent malignant glioma. Intracerebral concentrations of ketone bodies (KB), intracellular pH (pHi), and adenosine triphosphate (ATP) were non-invasively determined. Methods: 50 patients were randomized (1:1): Group A keeping a crKD-IF for nine days, and Group B a SD. RT was performed on day 4-8. Twenty-three patients received an extended MRSI-protocol (1H decoupled 31P MRSI with 3D chemical shift imaging (CSI) and 2D 1H point-resolved spectroscopy (PRESS)) at a 3T scanner at baseline and on day 6. Voxels were selected from the area of recurrent tumor and contralateral hemisphere. Spectra were analyzed with LCModel, adding simulated signals of 3-hydroxybutyrate (βOHB), acetone (Acn) and acetoacetate (AcAc) to the standard basis set. Results: Acn was the only reliably MRSI-detectable KB within tumor tissue and/or normal appearing white matter (NAWM). It was detected in 4/11 patients in Group A and in 0/8 patients in Group B. MRSI results showed no significant depletion of ATP in tumor tissue of patients at day 6 during crKD-IF, even though there were a significant difference in ketone serum levels between Group A and B at day 6 and a decline in fasting glucose in Group A from baseline to day 6. The tumor specific alkaline pHi was maintained. Conclusions: Our metabolic findings suggest that tumor cells maintain energy homeostasis even with reduced serum glucose levels and may generate additional ATP through other sources.r sources.
KW  - glioblastoma
KW  - ketogenic
KW  - diet
KW  - fasting
KW  - MR-spectroscopy
KW  - ketone body
KW  - ATP
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/57562
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-575627
SN  - 2072-6694
VL  - 12
IS  - Article 3549
PB  - MDPI
CY  - Basel
ER  -