1H NMR urine metabolomics is an effective prognostic indicator in acute spinal cord injury (ASCI): A prospective case-control study

Acute spinal cord injury (ASCI) is an extremely overwhelming disease with high morbidity and mortality. Despite significant successes in understanding the pathophysiology of ASCI, little is known about limiting neurological damage and predicting recovery. Biofluid metabolomics by 1H NMR spectroscopy for metabolites quantification specific to nervous tissue injury may determine the injury and progression. This study evaluates the urinary metabolic profile in ASCI cases on two different treatment modalities. One forty participants were enrolled.  Group-1, “healthy control, n=70”, ASCI cases in Group-2 “fixation with stem cells therapy, n=35” and ASCI cases in Group-3, “fixation alone n=35”. Urine samples were collected at baseline and regular follow-ups up to the 6th month for 1H NMR spectroscopy. The sample spectra were subjected to multivariate Orthogonal Partial Least Square Discriminant Analysis (OPLS-DA) and Variable Importance to the Projection (VIP) analysis. The significant metabolites were correlated with neurological recovery. Acetate, creatinine, creatine, creatine phosphate, urea, and phenylalanine were found to be significant. The 3D scattered score plots in OPLS-DA represented the shifting of cases towards control in the final follow-up. It was further substantiated on VIP score plots. The metabolic aberrations in urine with disease severity in ASCI could be a potential biomarker of neurological recovery. Key words: NMR spectroscopy, metabolomics, acute spinal cord injury (ASCI), Asia impairment scale (AIS), neurological recovery.