Comparison of human polymorphonuclear leukocytes from peripheral blood and purulent exudates by high resolution 1H MRS

MR-visible lipids and the tumor microenvironment

MR-visible lipids or mobile lipids are defined as lipids that are observable using proton MRS in cells and tissues. These MR-visible lipids are composed of triglycerides and cholesterol esters that accumulate in neutral lipid droplets, where their MR visibility is conferred as a result of the increased molecular motion available in this unique physical environment. This review discusses the factors that lead to the biogenesis of MR-visible lipids in cancer cells and in other cell types, such as immune cells and fibroblasts. We focus on the accumulations of mobile lipids that are inducible in cultured cells by a number of stresses, including culture conditions, and in response to activating stimuli or apoptotic cell death induced by anticancer drugs. This is compared with animal tumor models, where increases in mobile lipids are observed in response to chemo- and radiotherapy, and to human tumors, where mobile lipids are observed predominantly in high-grade brain tumors and in regions of necrosis. Conducive conditions for mobile lipid formation in the tumor microenvironment are discussed, including low pH, oxygen availability and the presence of inflammatory cells. It is concluded that MR-visible lipids appear in cancer cells and human tumors as a stress response. Mobile lipids stored as neutral lipid droplets may play a role in the detoxification of the cell or act as an alternative energy source, especially in cancer cells, which often grow in ischemic/hypoxic environments. The role of MR-visible lipids in cancer diagnosis and the assessment of the treatment response in both animal models of cancer and human brain tumors is also discussed. Although technical limitations exist in the accurate detection of intratumoral mobile lipids, early increases in mobile lipids after therapeutic interventions may be useful as a potential biomarker for the assessment of treatment response in cancer.

In vivo 1D and 2D correlation MR spectroscopy of the soleus muscle at 7T

AIM

This study aims to (1) undertake and analyse 1D and 2D MR correlation spectroscopy from human soleus muscle in vivo at 7T, and (2) determine T1 and T2 relaxation time constants at 7T field strength due to their importance in sequence design and spectral quantitation.

METHOD

Six healthy, male volunteers were consented and scanned on a 7T whole-body scanner (Siemens AG, Erlangen, Germany). Experiments were undertaken using a 28cm diameter detunable birdcage coil for signal excitation and an 8.5cm diameter surface coil for signal reception. The relaxation time constants, T1 and T2 were recorded using a STEAM sequence, using the 'progressive saturation' method for the T1 and multiple echo times for T2. The 2D L-Correlated SpectroscopY (L-COSY) method was employed with 64 increments (0.4ms increment size) and eight averages per scan, with a total time of 17min.

RESULTS

T1 and T2 values for the metabolites of interest were determined. The L-COSY spectra obtained from the soleus muscle provided information on lipid content and chemical structure not available, in vivo, at lower field strengths. All molecular fragments within multiple lipid compartments were chemically shifted by 0.20-0.26ppm at this field strength. 1D and 2D L-COSY spectra were assigned and proton connectivities were confirmed with the 2D method.

CONCLUSION

In vivo 1D and 2D spectroscopic examination of muscle can be successfully recorded at 7T and is now available to assess lipid alterations as well as other metabolites present with disease. T1 and T2 values were also determined in soleus muscle of male healthy volunteers.

Magnetic resonance spectroscopy in the diagnosis and etiological definition of brain bacterial abscesses

We report two patients with bacterial brain abscesses whose etiological diagnosis was correctly proposed by association of diffusion weighted images (DWI) and magnetic resonance spectroscopy (MRS) with conventional MRI. Both patients presented ring enhancing lesions with evidences of restricted diffusion. On MRS, the abscess caused by aerobic bacteria presented lactate and aminoacids peaks and the abscess caused by anaerobic facultative bacteria showed also acetate and succinate peaks. These results are in agreement with an unique previous study that related MRS pattern with bacterial etiology. Conventional MRI, associated with DWI and MRS is effective in diagnosing bacterial abscess and promising in exploring its etiology.

Proton nuclear magnetic resonance-based metabonomics for rapid diagnosis of meningitis and ventriculitis

BACKGROUND

Reduction of mortality associated with bacterial meningitis and postsurgical cerebral ventriculitis is dependent on early diagnosis and institution of appropriate therapy. Metabonomics rapidly defines metabolic profiles of biological fluids through the use of high-throughput analytical techniques combined with statistical pattern recognition tools.

METHODS

Proton nuclear magnetic resonance (1H NMR)-based metabonomics was applied to (1) lumbar cerebrospinal fluid samples collected prospectively from a cohort of patients with bacterial, fungal, or viral meningitis and from control subjects without neurological disease and (2) ventricular cerebrospinal fluid samples from patients with ventriculitis associated with an external ventricular drain and from control subjects. 1H NMR spectra were analyzed by the unsupervised statistical method of principal components analysis.

RESULTS

Metabonomic analysis clearly distinguished patients with bacterial or fungal meningitis (11 patients) from patients with viral meningitis (12) and control subjects (27) and clearly distinguished patients with postsurgical ventriculitis (5) from postsurgical control subjects (10). Metabolites of microbial and host origin that were responsible for class separation were determined. Metabonomic data also correlated with the onset and course of infection in a patient with 2 episodes of bacterial ventriculitis and with response to therapy in another patient with cryptococcal meningitis.

CONCLUSIONS

Metabonomic analysis is rapid, requires minimal sample processing, and is not targeted to specific microbial pathogens, making the platform potentially suitable for use in the diagnostic laboratory. This pilot study indicates that metabonomic analysis of cerebrospinal fluid is feasible and a potentially more powerful diagnostic tool than conventional rapid laboratory indicators for distinguishing bacterial from viral meningitis and for monitoring therapy. This should have important implications for early management, reduced empirical use of antibiotics, and treatment duration.

Identification ofStaphylococcus aureusBrain Abscesses: Rat and Human Studies with1H MR Spectroscopy

PURPOSE

To determine the feasibility of a statistical classification strategy (SCS) and the identity of metabolites of bacterial and host origins that potentially contributed to the most discriminatory regions of magnetic resonance (MR) spectra from Staphylococcus aureus abscesses of biopsy material from controls, gliomas, and staphylococcal abscesses.

MATERIALS AND METHODS

Human and animal study received ethics committee approval, and informed patient consent was obtained. A rat model of S aureus brain abscess was developed. Histologic and microbiologic examination was performed to assess abscess development 3-4, 6-8, and 10-15 days after initiation. Metabolite profiles in pus (n = 62) and controls (n = 37) were characterized with ex vivo MR spectroscopy and compared with data from rat gliomas (n = 27). SCS, optimal region selection, and development of pairwise classifiers allowed MR spectra of abscesses (n = 42, day 6-8) to be distinguished from those of glioblastoma multiforme and controls. MR spectroscopy profiles of pus from animal abscesses were compared with in vivo MR spectra from patients with staphylococcal brain abscesses (n = 7, aged 6-67 years) and ex vivo pus MR spectra from patients with S aureus abscesses.

RESULTS

Histologically confirmed abscesses were present 6-8 days after stereotactic injection of S aureus in 42 of 47 rats (89%). MR spectra of abscesses and glioblastoma multiforme in the animal model were similar. Typical metabolites of abscesses due to anaerobe bacteria (acetate, succinate, amino acids) were not detectable in S aureus abscesses in rats or humans. MR spectroscopic findings from controls, abscesses, and gliomas were distinguished by means of SCS with an accuracy of 99%. Analysis of the most discriminatory regions with two-dimensional correlation spectra indicated that glutamine and/or glutamate and aspartate potentially contributed to successful classification.

CONCLUSION

S aureus is detectable in abscesses with a non-culture-based method in an animal model.

Detection of the inhibitory neurotransmitter GABA in macrophages by magnetic resonance spectroscopy

Macrophages are key components of the inflammatory response to tissue injury, but their activities can exacerbate neuropathology. High-resolution magnetic resonance spectroscopy was used to identify metabolite levels in perchloric acid extracts of cultured cells of the RAW 264.7 murine macrophage line under resting and lipopolysaccharide-activated conditions. Over 25 metabolites were identified including gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter not previously reported to be present in macrophages. The presence of GABA was also demonstrated in extracts of human peripheral blood monocyte-derived macrophages. This finding suggests that there may be communication between damaged central nervous system (CNS) tissue and recruited macrophages and resident microglia, which could help orchestrate the immune response. On activation, lactate, glutamine, glutamate, and taurine levels were elevated significantly, and GABA and alanine were reduced significantly. Strong resonances from glutathione, evident in the macrophage two-dimensional 1H spectrum, suggest that this may have potential as a noninvasive marker of macrophages recruited to the CNS, as it is only present at low levels in normal brain. Alternatively, a specific combination of spectroscopic changes, such as lactate, alanine, glutathione, and polyamines, may prove to be the most accurate means of detecting macrophage recruitment to the CNS.

Cerebral nocardiosis characterized by magnetic resonance spectroscopy in vivo

We describe a patient with multiple cerebral lesions that initially were believed to be tumor metastases but were later found to be caused by Nocardia asteroides, after magnetic resonance spectroscopy (MRS) findings suggested that the lesions were infective in origin. This case report demonstrates the ability of MRS, a noninvasive imaging modality, to aid in the diagnosis of brain infection.

Spectroscopic assessment of alterations in macromolecule and small-molecule metabolites in human brain after stroke

BACKGROUND AND PURPOSE

We sought to measure the temporal evolution and spatial distribution of lesion macromolecules and small molecules (lactate, N-acetyl compounds, creatine, and choline) in stroke patients by using short echo time in vivo proton MR spectroscopy.

METHODS

Single-voxel spectra with TE=22 ms were obtained with and without inversion recovery suppression of small-molecule resonances from 30 examinations of 24 patients 3 to 214 days after stroke. Subtraction of the suppressed from the unsuppressed spectra yielded metabolite spectra without overlap from macromolecules. Two-dimensional spectroscopic images were acquired with macromolecule and small-molecule suppression from 5 additional patients.

RESULTS

Macromolecule signals were elevated in lesions relative to normal brain and tended to increase in the subacute period, even as lactate peaks declined. Regions of increased lactate, increased macromolecule signal at 1.3 ppm, and decreased N-acetyl compounds were closely correlated in the 2D spectroscopic images.

CONCLUSIONS

Short echo time spectra can be acquired in vivo in a manner that improves signal-to-noise ratio over long echo experiments and resolves overlapping macromolecule and small-molecule signals. The prominent macromolecule signals seen in the subacute period in association with persistently elevated lactate may represent mobile lipids in macrophages or other cells.

Cerebral mucormycosis: proton MR spectroscopy and MR imaging

Proton magnetic resonance spectroscopy (MRS) was integrated with magnetic resonance imaging (MRI) in the evaluation of a case of cerebral mucormycosis. MRS showed markedly elevated lactate, depleted N-acetyl aspartate and metabolite resonances attributable to succinate and acetate. The spectroscopy profile is essentially similar to that of bacterial abscess but without the commonly seen resonances of the amino acids valine, leucine and isoleucine. Our extensive literature review did not yield any reports of MRS findings on cerebral mucormycosis. MRS prospectively limited the differential diagnoses given the otherwise nonspecific and complex MR imaging findings in our immunosuppressed patient.

The origin of 1H NMR-visible triacylglycerol in human neutrophils. Highfatty acid environments result in preferential sequestration of palmitic acid into plasma membrane triacylglycerol

Human neutrophils incubated for 1 h in vitro with 10% commercial pooled, human serum containing high levels of free fatty acids (1141 microM) displayed a distinct lipid signal, typical of triacylglycerol, in the 1H NMR spectrum. Concurrently their plasma membrane triacylglycerol mass increased 4.6-fold with a selective rise in the content of palmitic and linoleic acids. Although qualitatively similar, these effects were much greater than those observed after incubating neutrophils with 50 microg.mL-1 of lipopolysaccharide in the presence of 10% AB serum with normal free fatty acid content (345 microM, LPS/S). Incubation of neutrophils with an artificial mixture of free fatty acids at concentrations found in commercial serum, or with the fatty acid fraction isolated from commercial serum increased the 1H NMR-detectable triacylglycerol. The signal intensity of the 1H NMR-detectable triacylglycerol depended on the triacylglycerol composition, and correlated with increased membrane triacylglycerol mass. Cellular uptake of 3H-labelled palmitic or oleic acids increased in the presence of commercial serum but not with LPS/S, with little contribution in either case to the triacylglycerol pool that increased in mass. Pulse-chase experiments demonstrated that with LPS/S and commercial serum, radiolabelled palmitic acid was preferentially incorporated into triacylglycerol located in the plasma membrane. This process could occur at the plasma membrane, as cytoplasts efficiently convert exogenous fatty acids into triacylglycerol. We propose that LPS/S and serum containing high levels of free fatty acid, important in conditions of sepsis and inflammation, may facilitate the sequestration of palmitic acid into triacylglycerol by different pathways. This triacylglycerol originates from exogenous and endogenous free fatty acids, is 1H NMR-visible, and may have a role in regulating apoptosis.

Necrotic tumor versus brain abscess: importance of amino acids detected at 1H MR spectroscopy--initial results

PURPOSE

To assess the usefulness of the 0.9-ppm peak from amino acids (-CH3 moieties from valine, leucine, and isoleucine) for the differentiation of brain abscesses and tumors at in vivo hydrogen 1 magnetic resonance (MR) spectroscopy.

MATERIALS AND METHODS

Amino acid concentrations were determined in vitro in 13 purulent samples from brain and nonbrain tissues and in nine aseptic fluids from necrotic brain tumors at two-dimensional (2D) 1H MR spectroscopy and liquid chromatography. Thirty-four patients with cystic intracerebral mass lesions (28 tumors, six abscesses) were examined at 1H MR spectroscopy in vivo.

RESULTS

Amino acids were identified in vitro in both purulent and aseptic samples. Amino acid concentrations measured in the aseptic fluids at both liquid chromatography and 2D MR spectroscopy were far below the detection threshold of in vivo 1H MR spectroscopy. Quantitative results obtained at 2D MR spectroscopy showed no overlap in the ranges of amino acid concentrations in purulent and aseptic samples. In vivo, the proton spectra obtained with a 136-msec echo time (TE) revealed amino acids (inverted peak at 0.9 ppm) in only the abscesses.

CONCLUSION

The detection of amino acid resonance at 0.9 ppm at in vivo 1H MR spectroscopy (136-msec TE) is a promising tool for distinguishing bacterial abscesses and cystic brain tumors.

Role of in vivo proton magnetic resonance spectroscopy in the diagnosis and management of brain abscesses

OBJECTIVE

In vivo proton magnetic resonance spectroscopy was performed for 24 patients with pyogenic brain abscesses, to examine the consistency of the spectral patterns and to observe the changes in metabolites with treatment.

METHODS

Localized proton spectra were obtained from 4- to 8-ml volumes in the abscesses, using stimulated echo acquisition mode and spin echo sequences. Twenty-two patients were treated with combined surgical and medical therapy, and two patients were treated conservatively. High-resolution magnetic resonance spectroscopy was performed for 15 samples of abscesses obtained from these patients, to confirm the assignments of resonances seen in vivo. Postaspiration studies were performed for 12 patients treated with combined medical and surgical therapy and 2 patients treated medically.

RESULTS

Lactate and amino acids were seen in spectra for all patients, irrespective of the time of spectroscopy after the onset of combined medical and surgical therapy. Acetate and pyruvate disappeared after 1 week of combined treatment.

CONCLUSION

It was concluded that spectral patterns for brain abscesses are consistent and specific and can assist in the noninvasive diagnosis of abscesses. Responses to combined treatment could be monitored by showing the changes in metabolite patterns in serial spectroscopic studies.

Brain Macromolecules: In Vivo Measurement by Proton Magnetic Resonance Spectroscopy

New single- and multiple-volume in vivo proton magnetic resonance spectroscopy techniques detect signals from brain macromolecules and can separate them from overlapping small molecule resonances. In vitro and animal studies have identified these resonances as arising from cytosolic proteins and mobile lipids. Increased macromolecule signals from lipids have been detected in both subacute stroke and in active multiple sclerosis plaques that reflect tissue breakdown and, in conjunction with elevated lactate, can be used to monitor phagocytic cell activity. The ability to follow changes in brain lipids and proteins should help to elucidate biochemical abnormalities accompanying a variety of pathological conditions.

1H-magnetic resonance spectroscopic observation of cultured malignant cells pharmacologically induced to different phenotypes

RATIONALE AND OBJECTIVES

We evaluated the 1H nuclear magnetic resonance spectra of malignant cells after the administration of drugs that cause morphologic changes.

METHODS

1H spectra of a human lung adenocarcinoma cell line cultured with interferon gamma, dexamethasone, or sodium butyrate were obtained. The peaks were assigned by two-dimensional homonuclear Hartmann-Hahn spectroscopy spectra of the cells and their perchloric acid extracts. Differential spectra were used to evaluate relative changes in the peaks.

RESULTS

In the control culture, choline/phosphocholine peaks were increased in the cell-growth phase, and the 1.26-ppm peak was increased in the confluent state. Treatment by interferon gamma and dexamethasone induced reproducible changes in the peaks of differential spectra corresponding to 1.26 ppm, choline/phosphocholine, and glutamate/glutamine. Dexamethasone treatment broadened lipid peaks. Changes after treatment with sodium butyrate were obscure. Microscopically, cells were induced to morphologically different phenotypes by each drug.

CONCLUSION

Cells induced to exhibit morphologically different phenotypes present different 1H spectra.

1H MRS of human brain abscesses in vivo and in vitro

Five patients, each with a brain abscess, were examined by means of 1H MR spectroscopic imaging in vivo. The aspirated pus was analyzed in vitro by means of 1D and 2D COSY 1H MRS. In addition to resonance lines from compounds (lactate, alanine and lipids) often found in the spectra from intracranial tumors, resonance lines were detected from a number of markers of infectious involvement (acetate, succinate, and various amino acids). These results suggest that 1H MRS in vivo might contribute in establishing noninvasively a differential diagnosis between brain abscess and tumor.

The presence of cytoplasmic lipid droplets is not sufficient to account for neutral lipid signals in the 1H MR spectra of neutrophils

Stimulation of human peripheral blood neutrophils with lipopolysaccharide (LPS), arachidonic acid (AA) and oleic acid (OA) resulted in significant increases in cytoplasmic lipid droplets. This phenomenon was also observed in enucleated and degranulated cytoplasts prepared from neutrophils stimulated with LPS. In contrast, only LPS and high concentrations of OA (10 microM) produced an increase in the lipid intensities of the MR spectra of neutrophils as determined by COSY cross peak volume measurements. Lipid intensities in cells stimulated with OA (2.5 microM) and AA (2.5 microM) and phorbol myristate acetate (20 nM) were not elevated. LPS stimulation of resting cytoplasts resulted in increased lipid droplets but not MR lipid intensities. These data suggest that while cytoplasmic lipid droplets may correlate with MR lipid intensity under some circumstances, their presence is not sufficient to account for increased neutral lipid signals.

The appearance of neutral lipid signals in the 1H NMR spectra of a myeloma cell line correlates with the induced formation of cytoplasmic lipid droplets

The appearance of high resolution neutral lipid signals in the 1H NMR spectra of myeloma cells grown in the presence of oleate was shown to correlate with the appearance of cytoplasmic lipid droplets observable by electron microscopy. The spin-spin relaxation times of these lipid signals were similar to those measured previously for lipid resonances in other cell types. These data suggest that cytoplasmic lipid droplets could make a significant contribution to the neutral lipid signals observed in the 1H NMR spectra of some cells.

GMP-140 (P-selectin) inhibits human neutrophil activation by lipopolysaccharide: analysis by proton magnetic resonance spectroscopy

Proton magnetic resonance spectroscopy has been used to monitor the effect of GMP-140 on the stimulation of human peripheral blood neutrophils. Stimulation of neutrophils by lipopolysaccharide gives rise to a high resolution lipid spectrum from the intact cells. Fluid phase GMP-140, which prevents adhesion and development of inflammatory responses of neutrophils, was found to inhibit these changes in the lipid spectrum by up to 40%. Anti-GMP-140 Fab fragments reversed this effect while non-immune Fab fragments did not affect the observed inhibition by GMP-140.