The finding of an alkaline Pi pool has been established with 31P-NMRS in healthy resting skeletal muscle and the dystrophic muscle of GMRD dogs and DMD patients. The pH values corresponding to this Pi pool corresponds better with extracellular pH. Intracellular pH, however, can also be measured with 1H-NMRS, using carnosine. In a group of DMD patients, we observed that pH determined with 31P-NMRS were systematically increased, whereas this was not always the case for pH based on the measurement of carnosine, revealing two groups in dystrophic muscle: (1) pH elevated with 31P and 1H and (2) pH only elevated with 31P.
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