J Neurol Neurosurg Psychiatry 1998;64:486-491 ( April )

Interstitial glycerol as a marker for membrane phospholipid degradation in the acutely injured human brain

Lars Hillered,^{a b} Johann Valtysson,^{a c} Per Enblad,^a Lennart Persson^a

^a Department of Neurosurgery, ^b Department of Clinical Chemistry, ^c Department of Anesthesiology, Uppsala University Hospital, Uppsala, Sweden

Correspondence to: Dr Lars Hillered, Department of Neurosurgery, Uppsala University Hospital, S-751 85 Uppsala, Sweden. Fax 0046 18 55 86 17; email: Lars.Hillered{at}neurokir.uu.se

Received 16 April 1997 and in revised form 2 September 1997; Accepted 18 September 1997

OBJECTIVE Brain interstitial glycerol was studied as a potential marker for membrane phospholipid degradation in acute human brain injury.
METHODSGlycerol was measured in microdialysis samples from the frontal lobe cortex in four patients in the neurointensive care unit, during the acute phase after severe aneurysmal subarachnoid haemorrhage. Microdialysis probes were inserted in conjunction with a ventriculostomy used for routine intracranial pressure monitoring. Clinical events involving hypoxia/ischaemia were diagnosed by neurological signs, neuroimaging (CT and PET), and neurochemical changes of the dialysatefor example, lactate/pyruvate ratios and hypoxanthine concentrations.
RESULTSAltogether 1554 chemical analyses on 518 microdialysis samples were performed. Clinical events involving secondary hypoxia/ischaemia were generally associated with pronounced increases (up to 15-fold) of the dialysate glycerol concentration. In a patient with a stable condition and no signs of secondary hypoxia/ischaemia the glycerol concentration remained low. Simultaneous determination of glycerol in arterial plasma samples showed that the changes in brain interstitial glycerol could not be attributed to systemic changes and an injured blood brain barrier.
CONCLUSIONSThis study suggests that membrane phospholipid degradation occurs in human cerebral ischaemia. Interstitial glycerol harvested by microdialysis seems to be a promising tool for monitoring of membrane lipolysis in acute brain injury. The marker may be useful for studies on cell membrane injury mechanisms mediated by for example, Ca²⁺ disturbances, excitatory amino acids, and reactive oxygen species; and in the evaluation of new neuroprotective therapeutic strategies.

Keywords: human cerebral ischaemia; interstitial glycerol; membrane phospholipid degradation; oxygen radicals

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© 1998 by Journal of Neurology, Neurosurgery, and Psychiatry
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