1H NMR study of renal trimethylamine responses to dehydration and acute volume loading in man

Identifying disease progression in chronic kidney disease using proton magnetic resonance spectroscopy

Chronic kidney disease (CKD) affects approximately 10% of the world population, higher still in some developing countries, and can cause irreversible kidney damage eventually leading to kidney failure requiring dialysis or kidney transplantation. However, not all patients with CKD will progress to this stage, and it is difficult to distinguish between progressors and non-progressors at the time of diagnosis. Current clinical practice involves monitoring estimated glomerular filtration rate and proteinuria to assess CKD trajectory over time; however, there remains a need for novel, validated methods that differentiate CKD progressors and non-progressors. Nuclear magnetic resonance techniques, including magnetic resonance spectroscopy and magnetic resonance imaging, have the potential to improve our understanding of CKD progression. Herein, we review the application of magnetic resonance spectroscopy both in preclinical and clinical settings to improve the diagnosis and surveillance of patients with CKD.

Balancing the Equation: A Natural History of Trimethylamine and Trimethylamine-N-oxide

Trimethylamine (TMA) and its N-oxide (TMAO) are ubiquitous in prokaryote and eukaryote organisms as well as in the environment, reflecting their fundamental importance in evolutionary biology, and their diverse biochemical functions. Both metabolites have multiple biological roles including cell-signaling. Much attention has focused on the significance of serum and urinary TMAO in cardiovascular disease risk, yet this is only one of the many facets of a deeper TMA-TMAO partnership that reflects the significance of these metabolites in multiple biological processes spanning animals, plants, bacteria, and fungi. We report on analytical methods for measuring TMA and TMAO and attempt to critically synthesize and map the global functions of TMA and TMAO in a systems biology framework.

High dynamic-range magnetic resonance spectroscopy (MRS) time-domain signal analysis

In the absence of water signal suppression, the proton magnetic resonance spectroscopy ((1)H MRS) in vivo water resonance signal-to-noise ratio (SNR) is orders of magnitude larger than the SNR of all the other resonances. In this case, because the high-SNR water resonance dominates the data, it is difficult to obtain reliable parameter estimates for the low SNR resonances. Herein, a new model is described that offers a solution to this problem. In this model, the time-domain signal for the low SNR resonances is represented as the conventional sum of exponentially decaying complex sinusoids. However, the time-domain signal for the high SNR water resonance is assumed to be a complex sinusoid whose amplitude is slowly varying from pure exponential decay and whose phase is slowly varying from a constant frequency. Thus, the water resonance has only an instantaneous amplitude and frequency. The water signal is neither filtered nor subtracted from the data. Instead, Bayesian probability theory is used to simultaneously estimate the frequencies, decay-rate constants, and amplitudes for all the low SNR resonances, along with the water resonance's time-dependent amplitude and phase. While computationally intensive, this approach models all of the resonances, including the water and the metabolites of interest, to within the noise level.

Regional proton nuclear magnetic resonance spectroscopy differentiates cortex and medulla in the isolated perfused rat kidney

Volume-localized proton nuclear magnetic resonance spectroscopy was used as an assay of regional biochemistry in the isolated perfused rat kidney. This model eliminated artifacts caused by respiratory and cardiac motion experienced in vivo. Immersion of the kidney under its venous effluent reduced the susceptibility artifacts evoked by tissue-air interfaces. The rapid acquisition with relaxation enhancement imaging sequence was used for scout imaging. This gave excellent spatial resolution of the cortex, outer medulla, and inner medulla. Spectra were then acquired in 10 minutes using the volume-selective multipulse spectroscopy sequence from voxels with a volume of approximately 24 microL located within the cortical or medullary regions. Spectral peaks were assigned by the addition of known compounds to the perfusion medium and by comparison with spectra of protein-free extracts of cortex and medulla. The medullary region spectra were characterized by signals from the osmolytes betaine, glycerophosphorylcholine, and inositol. The spectra from the cortex were more complex and contained lesser contributions from osmolytes.

Migration and accumulation of silicone in the liver of women with silicone gel-filled breast implants

1H NMR localized spectroscopy (STEAM), combined with echocardiography (ECG), respiratory gating, and water and fat suppression, was used to quantify silicone concentrations in the liver of women with silicone gel-filled breast implants. Localized spectroscopy was performed on 15 patients with silicone gel-filled breast prostheses and on eight volunteers with no implants. The 1H spectra in the liver of patients showed silicone resonances from 0.3 to -0.8 ppm, attributable to protons in the methyl groups of silicone. The presence of silicone in the liver could first be detected 3-4 years after breast prostheses implantation. No correlation between silicone concentrations and implantation times was observed. However, our results indicated that silicone concentrations may reflect implant integrity: detectable silicone concentrations in the liver appeared to be higher when the implants were ruptured than when the implants appeared intact. Moreover, new resonances in the range of -2.6 to -4 ppm were observed in most patients after long-term implantation. As these species increase with implantation time, the new resonances may reflect chemically changed silicone (paramagnetically shifted silicon complexes bound to iron) accumulated over time. The sensitivity of 1H NMR localized spectroscopy is sufficient to detect silicon concentrations as low as 0.20 mM. Results from one patient whose implants had been removed 14 months prior to the NMR examination showed no detectable silicone in the liver, indicating that it may have been excreted via bile or degraded to silica and high coordinated silicon complexes. Quantitative 1H localized spectroscopy of the liver in women with silicone gel-filled breast implants may provide valuable information concerning silicone accumulation and degradation in vivo, as well as about the kinetics of its elimination from the body after implant removal.

Localized proton MR spectroscopy of the human kidney in vivo by means of short echo time STEAM sequences

In order to obtain proton magnetic resonance spectra from the normal human kidney in vivo, we employed a STEAM sequence with delay times TE = 10 ms and TM = 30 ms. Signals are attenuated during STEAM sequences by J-coupling effects and by macroscopic movement of the sample. The combination of short echo times and respiratory triggering ensured that the kidney was stationary during the pulse sequence, and allowed us to detect strongly coupled resonances between 3 and 4.2 ppm. Analysis of spectra of extracts of bovine kidneys suggested that the renal MR-visible metabolites could include the osmolytes betaine, myo-inositol, and glycerophosphocholine. Four volunteers were subjected to overnight dehydration followed by rehydration, and we found that these signals increased significantly after dehydration, and decreased significantly 4 h after rehydration, thus supporting the assignment of the resonances as osmotically active metabolites.