Cerebrospinal fluid in tuberculous meningitis exhibits only the L-enantiomer of lactic acid

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dc.contributor.authorMason, Shayneen_ZA
dc.contributor.authorReinecke, Carolus J.en_ZA
dc.contributor.authorKulik, Willemen_ZA
dc.contributor.authorVan Cruchten, Arnoen_ZA
dc.contributor.authorSolomons, Reganen_ZA
dc.date.accessioned2017-07-28T07:33:54Z
dc.date.available2017-07-28T07:33:54Z
dc.date.issued2016
dc.descriptionCITATION: Mason, S., et al. 2016. Cerebrospinal fluid in tuberculous meningitis exhibits only the L-enantiomer of lactic acid. BMC Infectious Diseases, 6:251, doi:10.1186/s12879-016-1597-9.en_ZA
dc.descriptionThe original publication is available at http://bmcinfectdis.biomedcentral.comen_ZA
dc.description.abstractBackground: The defining feature of the cerebrospinal fluid (CSF) collected from infants and children with tuberculous meningitis (TBM), derived from an earlier untargeted nuclear magnetic resonance (NMR) metabolomics study, was highly elevated lactic acid. Undetermined was the contribution from host response (L-lactic acid) or of microbial origin (D-lactic acid), which was set out to be determined in this study. Methods: In this follow-up study, we used targeted ultra-performance liquid chromatography–electrospray ionization–tandem mass spectrometry (UPLC–ESI–MS/MS) to determine the ratio of the L and D enantiomers of lactic acid in these CSF samples. Results: Here we report for the first time that the lactic acid observed in the CSF of confirmed TBM cases was in the L-form and solely a response from the host to the infection, with no contribution from any bacteria. The significance of elevated lactic acid in TBM appears to be that it is a crucial energy substrate, used preferentially over glucose by microglia, and exhibits neuroprotective capabilities. Conclusion: These results provide experimental evidence to support our conceptual astrocyte–microglia lactate shuttle model formulated from our previous NMR-based metabolomics study — highlighting the fact that lactic acid plays an important role in neuroinflammatory diseases such as TBM. Furthermore, this study reinforces our belief that the determination of enantiomers of metabolites corresponding to infectious diseases is of critical importance in substantiating the clinical significance of disease markers.en_ZA
dc.description.urihttps://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1597-9
dc.description.versionPublisher's versionen_ZA
dc.format.extent6 pages : illustrations (some colour)en_ZA
dc.identifier.citationMason, S., et al. 2016. Cerebrospinal fluid in tuberculous meningitis exhibits only the L-enantiomer of lactic acid. BMC Infectious Diseases, 6:251, doi:10.1186/s12879-016-1597-9en_ZA
dc.identifier.issn1471-2334 (Online)
dc.identifier.otherdoi:10.1186/s12879-016-1597-9
dc.identifier.urihttp://hdl.handle.net/10019.1/102020
dc.language.isoen_ZAen_ZA
dc.publisherBioMed Centralen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectLiquid chromatographyen_ZA
dc.subjectMeninges -- Tuberculosisen_ZA
dc.subjectCerebrospinal fluiden_ZA
dc.subjectLactic acid -- Biotechnologyen_ZA
dc.subjectEnantiomers -- Biotechnologyen_ZA
dc.titleCerebrospinal fluid in tuberculous meningitis exhibits only the L-enantiomer of lactic aciden_ZA
dc.typeArticleen_ZA
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