A Brain Imaging Biomarker Study in Ketone Supplementation
Danielle Bazer1, Seyma Alcicek1, Lindsay Blair1, Ipek Ă–zdemir1, Zahra Shams2, Jannie Wijnen2, Karisa Schreck1, Vivek Yedavalli1, Georg Oeltzschner1, David Kamson1
1Johns Hopkins University, 2University Medical Center Utrecht
Objective:
To non-invasively detect and quantify ketones in the brain after exogenous ketone monoester supplementation (KME) using high-field proton magnetic resonance spectroscopy (1H-MRS).
Background:

Ketosis achieved through a ketogenic diet has been shown to have neuroprotective, anti-inflammatory, antiepileptic, and anti-neoplastic properties. The ketogenic diet requires a limited intake of carbohydrate rich foods and/or intermittent fasting periods; it is difficult for most patients to maintain prolonged ketosis. KME supplementation may overcome some difficulties with adherence and may support the health benefits of ketosis.

Design/Methods:

Four healthy and 2 IDH-mutant glioma participants (1 astrocytoma; 1 oligodendroglioma) were enrolled. We acquired data on a 7T Philips MRI before and after ingestion of 1 dose deltaG Tactical (KME). Single-voxel sLASER data were acquired from the posterior cingulate cortex in heathy, and the T2-FLAIR-hyperintense regions in patients. Data acquisition was performed before ingestion (1 measurement), immediately after ingestion (6 consecutive measurements), and after an idle period (6 consecutive measurements). Data were quantified using Osprey and LCModel linear-combination modeling software. Levels of bHB were normalized to the internal concentration reference total creatine (bHB/tCr). Blood ketone measurements were taken before KME ingestion and following the second and third MRS session.

Results:
 The median age of all participants was 32 (range: 30-43-years-old). The median BMI was 25.5 (range: 24-29). BHB peaks were identified in all patients following KME ingestion with similar durations of activity across all participants. The peak bHB/tCr among glioma patients were 0.35 and 0.17; time to peak was 55 and 59 minutes respectively. For healthy participants peak bHB/tCr were 0.12, 0.17, 0.19, 0.22 at 55, 36, 41, and 55 minutes respectively.
Conclusions:

Exogeneous KME supplementation raises the level of bHB above the threshold of detectability on MRS in normal-appearing brain as well as IDH-mutant glioma with peak reached approximately 1 hour after ingestion.

10.1212/WNL.0000000000208524
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.