Spectroscopie RMN, des stratégies couramment utilisées en clinique vers les techniques de demain.

Abstract : Parkinson's disease is a neurodegenerative disorder characterized by motor troubles such as akinesia, rigidity and tremor. The loss of dopaminergic neurons from the nigro-striatal pathway will lead to biochemical changes in the putamen. Especially, works on electrophysiology, micro dialysis and magnetic resonance spectroscopy (MRS) suggests hyperactivity of the glutamatergic cortico-striatal pathway associated with glial microenvironment changes. These observations suggest a modification of the glutamate-glutamine cycle occurring between neurons and astrocytes in response to neuronal loss.In this thesis, two approaches have been developed in order to follow by MRS the metabolic changes occuring in Parkinson's disease. In particular, we want to follow the changes in glutamate-glutamine cycle inside the putamen.in a first study, a a 1H MRS approach was used to assess the metabolic changes inside the putamen of Parkinson's disease without or under dopaminergic treatment. In this study, changes in N-acetylaspartate, creatine and myo-inositol were observed in Parkinsonian patients, but no change in glutamatergic metabolism was observed. This could be due to the lack of sensitivity of the technique to differentiate glutamate and glutamine pools.Thus, we chose to use a new 13C carbon MRS approach in order to follow dynamically in vivo the glutamate-glutamine cycle inside the brain: dynamic nuclear polarization (DNP). Thanks to the high sensitivity of this technique, it is now possible to follow metabolic pathways in vivo in real time. The implementation of DNP was assessed under a control group of animals. This technique offers a new promising tool for the analysis of this flow under pathologic conditions.To conclude, the MRS strategies for clinical diagnostic strategies remain, at present, poorly sensitive for the study of glutamate-glutamine cycle in vivo in humans. The development of DNP opens the door to a new approach for real-time monitoring of this cerebral metabolism Even if DNP is mainly used in preclinical studies at present, the development of new clinical systems could lead to its emergence as a new diagnostic strategy in clinical imaging.
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Leslie Mazuel. Spectroscopie RMN, des stratégies couramment utilisées en clinique vers les techniques de demain.. Médecine humaine et pathologie. Université d'Auvergne - Clermont-Ferrand I, 2014. Français. ⟨NNT : 2014CLF1MM12⟩. ⟨tel-01845995⟩

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