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Reichert S, Schepkin V, Kleimaier D, Zöllner FG, Schad LR. Sodium triple quantum MR signal extraction using a single-pulse sequence with single quantum time efficiency. Magn Reson Med 2024; 92:900-915. [PMID: 38650306 DOI: 10.1002/mrm.30107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/25/2024] [Accepted: 03/20/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Sodium triple quantum (TQ) signal has been shown to be a valuable biomarker for cell viability. Despite its clinical potential, application of Sodium TQ signal is hindered by complex pulse sequences with long scan times. This study proposes a method to approximate the TQ signal using a single excitation pulse without phase cycling. METHODS The proposed method is based on a single excitation pulse and a comparison of the free induction decay (FID) with the integral of the FID combined with a shifting reconstruction window. The TQ signal is calculated from this FID only. As a proof of concept, the method was also combined with a multi-echo UTE imaging sequence on a 9.4 T preclinical MRI scanner for the possibility of fast TQ MRI. RESULTS The extracted Sodium TQ signals of single-pulse and spin echo FIDs were in close agreement with theory and TQ measurement by traditional three-pulse sequence (TQ time proportional phase increment [TQTPPI)]. For 2%, 4%, and 6% agar samples, the absolute deviations of the maximum TQ signals between SE and theoretical (time proportional phase increment TQTPPI) TQ signals were less than 1.2% (2.4%), and relative deviations were less than 4.6% (6.8%). The impact of multi-compartment systems and noise on the accuracy of the TQ signal was small for simulated data. The systematic error was <3.4% for a single quantum (SQ) SNR of 5 and at maximum <2.5% for a multi-compartment system. The method also showed the potential of fast in vivo SQ and TQ imaging. CONCLUSION Simultaneous SQ and TQ MRI using only a single-pulse sequence and SQ time efficiency has been demonstrated. This may leverage the full potential of the Sodium TQ signal in clinical applications.
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Affiliation(s)
- Simon Reichert
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Cooperative Core Facility Animal Scanner ZI, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Victor Schepkin
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, USA
| | - Dennis Kleimaier
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Cooperative Core Facility Animal Scanner ZI, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Reichert S, Schepkin V, Kleimaier D, Zöllner FG, Schad LR. Comparison of triple quantum (TQ) TPPI and inversion recovery TQ TPPI pulse sequences at 9.4 and 21.1 T. NMR IN BIOMEDICINE 2024; 37:e5106. [PMID: 38263738 DOI: 10.1002/nbm.5106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE Both sodium T1 triple quantum (TQ) signal and T1 relaxation pathways have a unique sensitivity to the sodium molecular environment. In this study an inversion recovery time proportional phase increment (IRTQTPPI) pulse sequence was investigated for simultaneous and reliable quantification of sodium TQ signal and bi-exponential T1 relaxation times. METHODS The IRTQTPPI sequence combines inversion recovery TQ filtering and time proportional phase increment. The reliable and reproducible results were achieved by the pulse sequence optimized in three ways: (1) optimization of the nonlinear fit for the determination of both T1-TQ signal and T1 relaxation times; (2) suppression of unwanted signals by assessment of four different phase cycles; (3) nonlinear sampling during evolution time for optimal scan time without any compromises in fit accuracy. The relaxation times T1 and T2 and the TQ signals from IRTQTPPI and TQTPPI were compared between 9.4 and 21.1 T. The motional environment of the sodium nuclei was evaluated by calculation of correlation times and nuclear quadrupole interaction strengths. RESULTS Reliable measurements of the T1-TQ signals and T1 bi-exponential relaxation times were demonstrated. The fit parameters for all four phase cycles were in good agreement with one another, with a negligible influence of unwanted signals. The agar samples yielded normalized T1-TQ signals from 3% to 16% relative to single quantum (SQ) signals at magnetic fields of both 9.4 and 21.1 T. In comparison, the normalized T2-TQ signal was in the range 15%-35%. The TQ/SQ signal ratio was decreased at 21.1 T as compared with 9.4 T for both T1 and T2 relaxation pathways. The bi-exponential T1 relaxation time separation ranged from 15 to 18 ms at 9.4 T and 15 to 21 ms at 21.1 T. The T2 relaxation time separation was larger, ranging from 28 to 35 ms at 9.4 T and 37 to 40 ms at 21.1 T. CONCLUSION The IRTQTPPI sequence, while providing a less intensive TQ signal than TQTPPI, allows a simultaneous and reliable quantification of both the T1-TQ signal and T1 relaxation times. The unique sensitivities of the T1 and T2 relaxation pathways to different types of molecular motion provide a deeper understanding of the sodium MR environment.
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Affiliation(s)
- Simon Reichert
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Cooperative Core Facility Animal Scanner ZI, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Victor Schepkin
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida, USA
| | - Dennis Kleimaier
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Cooperative Core Facility Animal Scanner ZI, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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A Mohamed S, Adlung A, Ruder AM, Hoesl MAU, Schad L, Groden C, Giordano FA, Neumaier-Probst E. MRI Detection of Changes in Tissue Sodium Concentration in Brain Metastases after Stereotactic Radiosurgery: A Feasibility Study. J Neuroimaging 2020; 31:297-305. [PMID: 33351997 DOI: 10.1111/jon.12823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND PURPOSE To date, treatment response to stereotactic radiosurgery (SRS) in brain metastases (BM) can only be determined by MRI evaluation of contrast-enhancing lesions in a long-time follow-up. Sodium MRI has been a subject of immense interest in imaging research as the measure of tissue sodium concentration (TSC) can give valuable quantitative information on cell viability. We aimed to analyze the longitudinal changes of TSC in BM measured with 23 Na MRI before and after SRS for assessment of early local tumor effects. METHODS Seven patients with a total of 12 previously untreated BM underwent SRS with 22 Gy. In addition to a standard MRI protocol including dynamic susceptibility-weighted contrast-enhanced perfusion, a 23 Na MRI was performed at three time points: (I) 2 days before, (II) 5 days, and (III) 40 days after SRS. Nine BMs were evaluated. The absolute TSC in the BM, the respective peritumoral edemas, and the normal-appearing corresponding contralateral brain area were assessed and the relative TSC were correlated to the changes in BM longest axial diameters. RESULTS TSC was elevated in nine BM at baseline before SRS with a mean of 73.4 ± 12.3 mM. A further increase in TSC was observed 5 days after SRS in all the nine BM with a mean of 86.9 ± 13 mM. Eight of nine BM showed a mean 60.6 ± 13.3% decrease in the longest axial diameter 40 days after SRS; at this time point, the TSC also had decreased to a mean 65.1 ± 7.9 mM. In contrast, one of the nine BM had a 13.4% increase in the largest axial diameter at time point III. The TSC of this BM showed a further TSC increase of 80.1 mM 40 days after SRS. CONCLUSION Changes in TSC using 23 Na MRI shows the possible capability to detect radiobiological changes in BM after SRS.
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Affiliation(s)
- Sherif A Mohamed
- Department of Neuroradiology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne Adlung
- Department of Computer Assisted Clinical Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Arne M Ruder
- Department of Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Michaela A U Hoesl
- Department of Computer Assisted Clinical Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Lothar Schad
- Department of Computer Assisted Clinical Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Eva Neumaier-Probst
- Department of Neuroradiology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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Hoesl MAU, Schad LR, Rapacchi S. Efficient 23 Na triple-quantum signal imaging on clinical scanners: Cartesian imaging of single and triple-quantum 23 Na (CRISTINA). Magn Reson Med 2020; 84:2412-2428. [PMID: 32463978 PMCID: PMC7402015 DOI: 10.1002/mrm.28284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To capture the multiquantum coherence (MQC) 23 Na signal. Different phase-cycling options and sequences are compared in a unified theoretical layout, and a novel sequence is developed. METHODS An open source simulation overview is provided with graphical explanations to facilitate MQC understanding and access to techniques. Biases such as B0 inhomogeneity and stimulated echo signal were simulated for 4 different phase-cycling options previously described. Considerations for efficiency and accuracy lead to the implementation of a 2D Cartesian single and triple quantum imaging of sodium (CRISTINA) sequence employing two 6-step cycles in combination with a multi-echo readout. CRISTINA was compared to simultaneous single-quantum and triple-quantum-filtered MRI of sodium (SISTINA) under strong static magnetic gradient. CRISTINA capabilities were assessed on 8 × 60 mL, 0% to 5% agarose phantom with 50 to 154 mM 23 Na concentration at 7 T. CRISTINA was demonstrated subsequently in vivo in the brain. RESULTS Simulation of B0 inhomogeneity showed severe signal dropout, which can lead to erroneous MQC measurement. Stimulated echo signal was highest at the time of triple-quantum coherences signal maximum. However, stimulated echo signal is separated by Fourier Transform as an offset and did not interfere with MQC signals. The multi-echo readout enabled capturing both single-quantum coherences and triple-quantum coherences signal evolution at once. Signal combination of 2 phase-cycles with a corresponding B0 map was found to recover the signal optimally. Experimental results confirm and complement the simulations. CONCLUSION Considerations for efficient MQC measurements, most importantly avoiding B0 signal loss, led to the design of CRISTINA. CRISTINA captures triple-quantum coherences and single-quantum coherences signal evolution to provide complete sodium signal characterization including T 2 ∗ fast, T 2 ∗ slow, MQC amplitudes, and sodium concentration.
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Affiliation(s)
| | - Lothar R. Schad
- Computer Assisted Clinical MedicineHeidelberg UniversityMannheimGermany
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Intracellular Sodium Changes in Cancer Cells Using a Microcavity Array-Based Bioreactor System and Sodium Triple-Quantum MR Signal. Processes (Basel) 2020. [DOI: 10.3390/pr8101267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The sodium triple-quantum (TQ) magnetic resonance (MR) signal created by interactions of sodium ions with macromolecules has been demonstrated to be a valuable biomarker for cell viability. The aim of this study was to monitor a cellular response using the sodium TQ signal during inhibition of Na/K-ATPase in living cancer cells (HepG2). The cells were dynamically investigated after exposure to 1 mM ouabain or K+-free medium for 60 min using an MR-compatible bioreactor system. An improved TQ time proportional phase incrementation (TQTPPI) pulse sequence with almost four times TQ signal-to-noise ratio (SNR) gain allowed for conducting experiments with 12–14 × 106 cells using a 9.4 T MR scanner. During cell intervention experiments, the sodium TQ signal increased to 138.9 ± 4.1% and 183.4 ± 8.9% for 1 mM ouabain (n = 3) and K+-free medium (n = 3), respectively. During reperfusion with normal medium, the sodium TQ signal further increased to 169.2 ± 5.3% for the ouabain experiment, while it recovered to 128.5 ± 6.8% for the K+-free experiment. These sodium TQ signal increases agree with an influx of sodium ions during Na/K-ATPase inhibition and hence a reduced cell viability. The improved TQ signal detection combined with this MR-compatible bioreactor system provides a capability to investigate the cellular response of a variety of cells using the sodium TQ MR signal.
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Kleimaier D, Schepkin V, Hu R, Schad LR. Protein conformational changes affect the sodium triple-quantum MR signal. NMR IN BIOMEDICINE 2020; 33:e4367. [PMID: 32656956 DOI: 10.1002/nbm.4367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
The aim of this study was to investigate possible sodium triple-quantum (TQ) signal dependence on pH variation and protein unfolding which may happen in vivo. The model system, composed of bovine serum albumin (BSA), was investigated over a wide pH range of 0.70 to 13.05 and during urea-induced unfolding. In both experimental series, the sodium and BSA concentration were kept constant so that TQ signal changes solely arose from an environmental change. The experiments were performed using unique potential to detect weak TQ signals by implementing a TQ time proportional phase increment pulse sequence. At a pH of 0.70, in which case the effect of the negatively charged groups was minimized, the minimum TQ percentage relative to single-quantum of 1.34% ± 0.05% was found. An increase of the pH up to 13.05 resulted in an increase of the sodium TQ signal by 225%. Urea-induced unfolding of BSA, without changes in pH, led to a smaller increase in the sodium TQ signal of up to 40%. The state of BSA unfolding was verified by fluorescence microscopy. Results of both experiments were well fitted by sigmoid functions. Both TQ signal increases were in agreement with an increase of the availability of negatively charged groups. The results point to vital contributions of the biochemical environment to the TQ MR signals. The sodium TQ signal in vivo could be a valuable biomarker of cell viability, and therefore possible effects of pH and protein unfolding need to be considered for a proper interpretation of changes in sodium TQ signals.
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Affiliation(s)
- Dennis Kleimaier
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
| | - Victor Schepkin
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, USA
| | - Ruomin Hu
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
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Kleimaier D, Goerke S, Nies C, Zaiss M, Kunz P, Bachert P, Ladd ME, Gottwald E, Schad LR. The cellular heat shock response monitored by chemical exchange saturation transfer MRI. Sci Rep 2020; 10:11118. [PMID: 32632120 PMCID: PMC7338423 DOI: 10.1038/s41598-020-68022-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/17/2020] [Indexed: 02/01/2023] Open
Abstract
CEST-MRI of the rNOE signal has been demonstrated in vitro to be closely linked to the protein conformational state. As the detectability of denaturation and aggregation processes on a physiologically relevant scale in living organisms has yet to be verified, the aim of this study was to perform heat-shock experiments with living cells to monitor the cellular heat-shock response of the rNOE CEST signal. Cancer cells (HepG2) were dynamically investigated after a mild, non-lethal heat-shock of 42 °C for 20 min using an MR-compatible bioreactor system at 9.4 T. Reliable and fast high-resolution CEST imaging was realized by a relaxation-compensated 2-point contrast metric. After the heat-shock, a substantial decrease of the rNOE CEST signal by 8.0 ± 0.4% followed by a steady signal recovery within a time of 99.1 ± 1.3 min was observed in two independent trials. This continuous signal recovery is in coherence with chaperone-induced refolding of heat-shock induced protein aggregates. We demonstrated that protein denaturation processes influence the CEST-MRI signal on a physiologically relevant scale. Thus, the protein folding state is, along with concentration changes, a relevant physiological parameter for the interpretation of CEST signal changes in diseases that are associated with pathological changes in protein expression, like cancer and neurodegenerative diseases.
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Affiliation(s)
- Dennis Kleimaier
- Computer Assisted Clinical Medicine, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Steffen Goerke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cordula Nies
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Moritz Zaiss
- Neuroradiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Patrick Kunz
- Division of Functional Genome Analysis, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany.,Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Eric Gottwald
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Hoesl MAU, Kleimaier D, Hu R, Malzacher M, Nies C, Gottwald E, Schad LR. 23 Na Triple-quantum signal of in vitro human liver cells, liposomes, and nanoparticles: Cell viability assessment vs. separation of intra- and extracellular signal. J Magn Reson Imaging 2019; 50:435-444. [PMID: 30681221 DOI: 10.1002/jmri.26666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Triple-quantum (TQ) filtered sequences have become more popular in sodium MR due to the increased usage of scanners with field strengths exceeding 3T. Disagreement as to whether TQ signal can provide separation of intra- and extracellular compartments persists. PURPOSE To provide insight into TQ signal behavior on a cellular level. STUDY TYPE Prospective. PHANTOM/SPECIMEN Cell-phantoms in the form of liposomes, encapsulated 0 mM, 145 mM, 154 mM Na+ in a double-lipid membrane similar to cells. Poly(lactic-co-glycolic acid) nanoparticles encapsulated 154 mM Na+ within a single-layer membrane structure. Two microcavity chips with each 6 × 106 human HEP G2 liver cells were measured in an MR-compatible bioreactor. FIELD STRENGTH/SEQUENCE Spectroscopic TQ sequence with time proportional phase-increments at 9.4T. ASSESSMENT The TQ signal of viable, dead cells, and cell-phantoms was assessed by a fit in the time domain and by the amplitude in the frequency domain. STATISTICAL TESTS The noise variance (σ) was evaluated to express the deviation of the measured TQ signal amplitude from noise. RESULTS TQ signal >20σ was found for liposomes encapsulating sodium ions. Liposomal encapsulation of 0 mM Na+ and 154 mM Na+ encapsulation in the nanoparticles resulted in <2σ TQ signal. Cells under normal perfusion resulted in >9σ TQ signal. Compared with TQ signal under normal perfusion, a 56% lower TQ signal of was observed (25σ) during perfusion stop. TQ signal returned to 92% of the initial signal after reperfusion. DATA CONCLUSION Our measurements indicate that TQ signal in liposomes was observed due to the trapping of ions within the double-lipid membrane rather than from the intraliposomal space. Transfer to the cell results suggests that TQ signal was observed from motion restriction equivalent to trapping. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:435-444.
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Affiliation(s)
- Michaela A U Hoesl
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
| | - Dennis Kleimaier
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
| | - Ruomin Hu
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
| | - Matthias Malzacher
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
| | - Cordula Nies
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Eric Gottwald
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
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