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Radiomics nomograms based on R2* mapping and clinical biomarkers for staging of liver fibrosis in patients with chronic hepatitis B: a single-center retrospective study. Eur Radiol 2023; 33:1653-1667. [PMID: 36149481 DOI: 10.1007/s00330-022-09137-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/05/2022] [Accepted: 09/01/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the value of R2* mapping-based radiomics nomograms in staging liver fibrosis in patients with chronic hepatitis B. METHODS Between January 2020 and December 2020, 151 patients with chronic hepatitis B were randomly divided into training (n = 103) and validation (n = 48) cohorts. From January to February 2021, 58 patients were included in a test cohort. Radiomics features were selected using the interclass correlation coefficient and least absolute shrinkage and selection operator method. Three radiomics nomograms, combining the radiomics score (Radscore) derived from R2* mapping and clinical variables, were used for staging significant and advanced fibrosis, and cirrhosis. Performance of the model was evaluated using the AUC. The utility and clinical benefits were evaluated using the continuous net reclassification index (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). RESULTS The Radscore calculated by 12 radiomics features and independent factors (laminin and platelet) of advanced fibrosis were used to construct the radiomics nomograms. In the test cohort, the AUCs of the radiomics nomograms for staging significant fibrosis, advanced fibrosis, and cirrhosis were 0.738 (95% confidence interval [CI]: 0.604-0.872), 0.879 (95% CI: 0.779-0.98), and 0.952 (95% CI: 0.878-1), respectively. NRI, IDI, and DCA confirmed that radiomics nomograms demonstrated varying degrees of clinical benefit and improvement for advanced fibrosis and cirrhosis, but not for significant fibrosis. CONCLUSIONS Radiomics nomograms combined with R2* mapping-based Radscore, laminin, and platelet have value in staging advanced fibrosis and cirrhosis but limited value for staging significant fibrosis. KEY POINTS • Laminin and platelets were independent predictors of advanced fibrosis. • Radiomics analysis based on R2* mapping was beneficial for evaluating advanced fibrosis and cirrhosis. • It was difficult to distinguish significant fibrosis using a radiomics nomogram, which is possibly due to the complex pathological microenvironment of chronic liver diseases.
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Premature Macrophage Activation by Stored Red Blood Cell Transfusion Halts Liver Regeneration Post-Partial Hepatectomy in Rats. Cells 2022; 11:cells11213522. [DOI: 10.3390/cells11213522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Liver resection is a common treatment for various conditions and often requires blood transfusions to compensate for operative blood loss. As partial hepatectomy (PHx) is frequently performed in patients with a pre-damaged liver, avoiding further injury is of paramount clinical importance. Our aim was to study the impact of red blood cell (RBC) resuscitation on liver regeneration. We assessed the impact of RBC storage time on liver regeneration following 50% PHx in rats and explored possible contributing molecular mechanisms using immunohistochemistry, RNA-Seq, and macrophage depletion. The liver was successfully regenerated after PHx when rats were transfused with fresh RBCs (F-RBCs). However, in rats resuscitated with stored RBCs (S-RBCs), the regeneration process was disrupted, as detected by delayed hepatocyte proliferation and lack of hypertrophy. The delayed regeneration was associated with elevated numbers of hemorrhage-activated liver macrophages (Mhem) secreting HO-1. Depletion of macrophages prior to PHx and transfusion improved the regeneration process. Gene expression profiling revealed alterations in numerous genes belonging to critical pathways, including cell cycle and DNA replication, and genes associated with immune cell activation, such as chemokine signaling and platelet activation and adhesion. Our results implicate activated macrophages in delayed liver regeneration following S-RBC transfusion via HO-1 and PAI-1 overexpression.
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Lesner NP, Wang X, Chen Z, Frank A, Menezes CJ, House S, Shelton SD, Lemoff A, McFadden DG, Wansapura J, DeBerardinis RJ, Mishra P. Differential requirements for mitochondrial electron transport chain components in the adult murine liver. eLife 2022; 11:e80919. [PMID: 36154948 PMCID: PMC9648974 DOI: 10.7554/elife.80919] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Mitochondrial electron transport chain (ETC) dysfunction due to mutations in the nuclear or mitochondrial genome is a common cause of metabolic disease in humans and displays striking tissue specificity depending on the affected gene. The mechanisms underlying tissue-specific phenotypes are not understood. Complex I (cI) is classically considered the entry point for electrons into the ETC, and in vitro experiments indicate that cI is required for basal respiration and maintenance of the NAD+/NADH ratio, an indicator of cellular redox status. This finding has largely not been tested in vivo. Here, we report that mitochondrial complex I is dispensable for homeostasis of the adult mouse liver; animals with hepatocyte-specific loss of cI function display no overt phenotypes or signs of liver damage, and maintain liver function, redox and oxygen status. Further analysis of cI-deficient livers did not reveal significant proteomic or metabolic changes, indicating little to no compensation is required in the setting of complex I loss. In contrast, complex IV (cIV) dysfunction in adult hepatocytes results in decreased liver function, impaired oxygen handling, steatosis, and liver damage, accompanied by significant metabolomic and proteomic perturbations. Our results support a model whereby complex I loss is tolerated in the mouse liver because hepatocytes use alternative electron donors to fuel the mitochondrial ETC.
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Affiliation(s)
- Nicholas P Lesner
- Children's Medical Center Research Institute, University of Texas Southwestern Medical CenterDallasUnited States
| | - Xun Wang
- Children's Medical Center Research Institute, University of Texas Southwestern Medical CenterDallasUnited States
| | - Zhenkang Chen
- Children's Medical Center Research Institute, University of Texas Southwestern Medical CenterDallasUnited States
| | - Anderson Frank
- Department of Biochemistry, University of Texas Southwestern Medical CenterDallasUnited States
| | - Cameron J Menezes
- Children's Medical Center Research Institute, University of Texas Southwestern Medical CenterDallasUnited States
| | - Sara House
- Children's Medical Center Research Institute, University of Texas Southwestern Medical CenterDallasUnited States
| | - Spencer D Shelton
- Children's Medical Center Research Institute, University of Texas Southwestern Medical CenterDallasUnited States
| | - Andrew Lemoff
- Department of Biochemistry, University of Texas Southwestern Medical CenterDallasUnited States
| | - David G McFadden
- Department of Biochemistry, University of Texas Southwestern Medical CenterDallasUnited States
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical CenterDallasUnited States
| | - Janaka Wansapura
- Advanced Imaging Research Center, University of Texas Southwestern Medical CenterDallasUnited States
| | - Ralph J DeBerardinis
- Children's Medical Center Research Institute, University of Texas Southwestern Medical CenterDallasUnited States
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical CenterDallasUnited States
- Department of Pediatrics, University of Texas Southwestern Medical CenterDallasUnited States
- Howard Hughes Medical Institute, University of Texas Southwestern Medical CenterDallasUnited States
| | - Prashant Mishra
- Children's Medical Center Research Institute, University of Texas Southwestern Medical CenterDallasUnited States
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical CenterDallasUnited States
- Department of Pediatrics, University of Texas Southwestern Medical CenterDallasUnited States
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Ginosar Y, Bromberg Z, Nachmanson N, Ariel I, Skarzinski G, Hagai L, Elchalal U, Shapiro J, Abramovitch R. Chronic hypoxia in pregnant mice impairs the placental and fetal vascular response to acute hypercapnia in BOLD-MRI hemodynamic response imaging. Placenta 2021; 110:29-38. [PMID: 34116499 DOI: 10.1016/j.placenta.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Brief hypercapnic challenge causes acute placental hypoperfusion with fetal brain sparing on BOLD-MRI. We hypothesize that this non-invasive imaging strategy can distinguish between normal pregnancy and chronic placental hypoperfusion (using the maternal hypoxia model). METHODS Eighteen pregnant female ICR mice were randomized to three groups: normoxia, late-onset hypoxia (12%O2;E13.5-17.5) and early-onset hypoxia (12%O2;E10.5-17.5). On E17.5, animals were imaged in a 4.7-T Bruker-Biospec MRI scanner. Fast coronal True-FISP was performed to identify organs of interest (placenta and fetal heart, liver and brain). BOLD-MRI was performed at baseline and during a 4-min hypercapnic challenge (5%CO2). %-change in placental and fetal signal was analyzed from T2*-weighted gradient echo MR images. Following MRI, fetuses and placentas were harvested, weighed and immuno-stained. RESULTS In normoxic mice, hypercapnia caused reduction in BOLD-MRI signal in placenta (-44% ± 7%; p < 0.0001), fetal liver (-32% ± 7%; p < 0.0001) and fetal heart (-54% ± 12%; p < 0.002), with relative fetal brain sparing (-12% ± 5%; p < 0.0001). These changes were markedly attenuated in both hypoxia groups. Baseline fetal brain/placenta SI ratio was highest in normoxic mice (1.14 ± 0.017) and reduced with increasing duration of hypoxia (late-onset hypoxia: 1.00 ± 0.026; early-onset hypoxia: 0.91 ± 0.016; p = 0.02). Both hypoxic groups exhibited fetal growth restriction with prominent placental glycogen-containing cells, particularly in early-onset hypoxia. There was increased fetal neuro- and intestinal-apoptosis in early-onset hypoxia only. CONCLUSIONS BOLD-MRI with brief hypercapnic challenge distinguished between normoxia and both hypoxia groups, while fetal neuroapoptosis was only observed after early-onset hypoxia. This suggests that BOLD-MRI with hypercapnic challenge can identify chronic fetal asphyxia before the onset of irreversible brain injury.
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Affiliation(s)
- Yehuda Ginosar
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel; Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA; The Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel.
| | - Zohar Bromberg
- The Goldyne Savad Institute of Gene Therapy and MRI Laboratory, Human Biology Research Center, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel; The Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Nathalie Nachmanson
- The Goldyne Savad Institute of Gene Therapy and MRI Laboratory, Human Biology Research Center, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel; The Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Ilana Ariel
- Perinatal Pathology Unit, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Galina Skarzinski
- Perinatal Pathology Unit, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Lital Hagai
- Medical Student, Hebrew University-Hadassah Medical School, Ein Karem, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Joel Shapiro
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Rinat Abramovitch
- The Goldyne Savad Institute of Gene Therapy and MRI Laboratory, Human Biology Research Center, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel; The Wohl Institute for Translational Medicine, Hadassah Hebrew University Medical Center, Ein Karem, And the Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Using IVIM-MRI and R2⁎ Mapping to Differentiate Early Stage Liver Fibrosis in a Rat Model of Radiation-Induced Liver Fibrosis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4673814. [PMID: 30627558 PMCID: PMC6304485 DOI: 10.1155/2018/4673814] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/09/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022]
Abstract
Rationale and Objectives To investigate the utility of intravoxel incoherent motion MRI (IVIM-MRI) and R2⁎ mapping in diagnosing early stage liver fibrosis in a radiation-induced rat model. Materials and Methods Thirty rats were randomly divided into three groups with 10 rats in each group. Liver fibrosis was induced by exposure of right lobe of liver in each animal to 20 Gy of radiation. MRI examination was conducted at baseline, one month, two months, and three months after radiation using T1WI, T2WI, IVIM-DWI, and R2⁎ sequences. The pathological examination included hematoxylin eosin, masson trichrome, and prussian blue staining. D, D⁎, f, and R2⁎ values were measured in both left and right lobes for quantitative analysis. Results Regarding the surviving 23 rats, eight rats were diagnosed with stage F0, ten with stage F1, and five with stage F2 liver fibrosis using METAVIR Scores. The D values of right lobes decreased (P<0.05), and R2⁎ values increased (P<0.01) significantly as fibrosis levels increased. But there was no statistical difference in D⁎ (P=0.970) and f values (P=0.079). R2⁎ value showed a strong positive correlation (r=0.819, P<0.001), while D value showed a negative correlation with fibrosis stages (r=-0.424, P<0.001). D⁎ (r=0.029, P=0.744) and f values (r=-0.055, P=0.536) were poorly correlated with fibrosis levels. Conclusion IVIM-MRI and R2⁎ mapping are useful techniques for evaluating the severity of liver fibrosis in a radiation-induced rat model, and R2⁎ value is the most sensitive parameter in detecting early stage fibrosis.
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Cox EF, Palaniyappan N, Aithal GP, Guha IN, Francis ST. Using MRI to study the alterations in liver blood flow, perfusion, and oxygenation in response to physiological stress challenges: Meal, hyperoxia, and hypercapnia. J Magn Reson Imaging 2018; 49:1577-1586. [PMID: 30353969 DOI: 10.1002/jmri.26341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Noninvasive assessment of dynamic changes in liver blood flow, perfusion, and oxygenation using MRI may allow detection of subtle hemodynamic alterations in cirrhosis. PURPOSE To assess the feasibility of measuring dynamic liver blood flow, perfusion, and T2 * alterations in response to meal, hypercapnia, and hyperoxia challenges. STUDY TYPE Prospective. SUBJECTS Ten healthy volunteers (HV) and 10 patients with compensated cirrhosis (CC). FIELD STRENGTH/SEQUENCE 3T; phase contrast, arterial spin labeling, and T 2 * mapping. ASSESSMENT Dynamic changes in portal vein and hepatic artery blood flow (using phase contrast MRI), liver perfusion (using arterial spin labeling), and blood oxygenation ( T 2 * mapping) following a meal challenge (660 kcal), hyperoxia (target PET O2 of 500 mmHg), and hypercapnia (target increase PET CO2 of ∼6 mmHg). STATISTICAL TESTS Tests between baseline and each challenge were performed using a paired two-tailed t-test (parametric) or Wilcoxon-signed-ranks test (nonparametric). Repeatability and reproducibility were determined by the coefficient of variation (CoV). RESULTS Portal vein velocity increased following the meal (70 ± 9%, P < 0.001) and hypercapnic (7 (5-11)%, P = 0.029) challenge, while hepatic artery flow decreased (-30 ± 18%, P = 0.005) following the meal challenge in HV. In CC patients, portal vein velocity increased (37 ± 13%, P = 0.012) without the decrease in hepatic artery flow following the meal. In both groups, the meal increased liver perfusion (HV: 82 ± 50%, P < 0.0001; CC: 27 (16-42)%, P = 0.011) with faster arrival time of blood (HV: -54 (-56-30)%, P = 0.074; CC: -42 ± 32%, P = 0.005). In HVs, T 2 * increased after the meal and in response to hyperoxia, with a decrease in hypercapnia (6 ± 8% P = 0.052; 3 ± 5%, P = 0.075; -5 ± 6%, P = 0.073, respectively), but no change in CC patients. Baseline between-session CoV <15% for blood flow and <10% for T 2 * measures. DATA CONCLUSION Dynamic changes in liver perfusion, blood flow, and oxygenation following a meal, hyperoxic, and hypercapnic challenges can be measured using noninvasive MRI and potentially be used to stratify patients with cirrhosis. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1577-1586.
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Affiliation(s)
- Eleanor F Cox
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham, UK
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Naaventhan Palaniyappan
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Guruprasad P Aithal
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - I Neil Guha
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham, UK
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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Yuan F, Song B, Huang Z, Liu X, Xia C. Glucose as a stimulation agent in the BOLD functional magnetic resonance imaging for liver cirrhosis and hepatocellular carcinoma: a feasibility study. Abdom Radiol (NY) 2018; 43:607-612. [PMID: 28730273 DOI: 10.1007/s00261-017-1264-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To explore the role of glucose as a stimulation agent in the blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) for liver cirrhosis and hepatocellular carcinoma (HCC). MATERIALS AND METHODS Twenty HCC patients with cirrhosis and 10 healthy volunteers were recruited. BOLD fMRI was performed for all participants prior to and 30 min after oral administration of glucose to measure the T2* values of normal liver parenchyma, HCC liver parenchyma, HCC center, and HCC edge. Variations of the T2*(△T2*) before and after administration were calculated. RESULTS Data from 16 patients and 10 healthy volunteers were reported. Before and after oral administration of glucose, T2* values of the normal liver parenchyma, HCC liver parenchyma, and HCC center were statistically different (p < 0.01), while no statistical difference was found in T2* value of the HCC edge (p = 0.35). △T2* values of the normal liver parenchyma, HCC liver parenchyma, HCC center, and HCC edge were 2.8 ± 1.1 ms, -1.3 ± 1.2 ms, -2.1 ± 1.8 ms, and 0.8 ± 3.2 ms before and after administration, respectively. △T2* value was statistically different in the liver parenchyma between healthy volunteers and HCC patients and between HCC center and HCC edge (both p < 0.01). CONCLUSION Use of glucose as the stimulation agent in BOLD fMRI may facilitate the assessment of liver function for patients with liver cirrhosis. The potential of △T2* to correlate with severity of liver cirrhosis, as well as to evaluate hepatic artery perfusion and bioactivity of HCC center should be further investigated.
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Affiliation(s)
- Fang Yuan
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
| | - Zixing Huang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xijiao Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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Ginosar Y, Gielchinsky Y, Nachmansson N, Hagai L, Shapiro J, Elchalal U, Abramovitch R. BOLD-MRI demonstrates acute placental and fetal organ hypoperfusion with fetal brain sparing during hypercapnia. Placenta 2017; 63:53-60. [PMID: 29061514 DOI: 10.1016/j.placenta.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/04/2017] [Accepted: 09/08/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION We evaluated changes in placental and fetal hemodynamics in rodents during acute hypercapnia using BOLD-MRI and Doppler ultrasound. METHODS Animals were anesthetized with pentobarbital and, in consecutive 4-min periods, breathed: air, 21%O2:5%CO2, and 95%O2:5%CO2. BOLD-MRI Pregnant ICR mice (n = 6; E17.5) were scanned in a 4.7-T Bruker Biospec spectrometer. Placenta and fetal liver, heart and brain were identified on True-FISP images. Percent change in signal intensity (SI) were analyzed every 30 s from T2*-weighted GE images (TR/TE = 147/10 ms). Doppler: Pregnant Wistar rats (n = 6; E18-20) were anesthetized with pentobarbital and received abdominal Doppler ultrasound. Umbilical artery pulsatility index (PI) and fetal heart rate were assessed at baseline and after two minutes of both hypercapnic challenges. RESULTS BOLD-MRI: Normoxic-hypercapnia caused immediate marked reduction in SI in placenta (-44% ± 5.5; p < 0.001), fetal liver (-32% ± 6.4; p < 0.001) and fetal heart (-53% ± 9.9; p < 0.001) but only minor changes in fetal brain (-13% ± 3.4; p < 0.01), suggesting fetal brain sparing. Doppler: Normoxic-hypercapnia caused a marked increase in umbilical artery PI (+27.4% ± 7.2; p < 0.001) and a reduction in fetal heart rate (-48 bpm; 95%CI -9.3 to -87.0; p = 0.02), suggesting acute fetal asphyxia. CONCLUSIONS Brief maternal hypercapnic challenge caused BOLD-MRI changes consistent with acute placental and fetal hypoperfusion with fetal brain sparing. The same challenge caused increased umbilical artery PI and fetal bradycardia on Doppler ultrasound, suggestive for acute fetal asphyxia. BOLD-MRI may be a suitable noninvasive imaging strategy to assess placental and fetal organ hemodynamics.
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Affiliation(s)
- Yehuda Ginosar
- Mother and Child Anesthesia Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 91120, Israel; Division of Obstetric Anesthesia, Department of Anesthesiology, Washington University School of Medicine, 660 South Euclid - Campus Box 8054 St. Louis, MO 63110-1093, USA.
| | - Yuval Gielchinsky
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 91120, Israel.
| | - Nathalie Nachmansson
- The Goldyne Savad Institute of Gene Therapy, MRI Laboratory, Human Biology Research Center, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 91120, Israel.
| | - Lital Hagai
- Hebrew University-Hadassah Medical School, POB 12000, Ein Kerem, Jerusalem 91120, Israel.
| | - Joel Shapiro
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 91120, Israel.
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 91120, Israel.
| | - Rinat Abramovitch
- The Goldyne Savad Institute of Gene Therapy, MRI Laboratory, Human Biology Research Center, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 91120, Israel.
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Matot I, Nachmansson N, Duev O, Schulz S, Schroeder-Stein K, Frede S, Abramovitch R. Impaired liver regeneration after hepatectomy and bleeding is associated with a shift from hepatocyte proliferation to hypertrophy. FASEB J 2017; 31:5283-5295. [PMID: 28790176 PMCID: PMC5690394 DOI: 10.1096/fj.201700153r] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/25/2017] [Indexed: 12/13/2022]
Abstract
Extensive liver resections are common, and bleeding is frequent in these operations. Impaired regeneration after partial hepatectomy (PHx) may contribute to liver failure. We thus assessed the impact of acute bleeding on the liver regeneration progress after PHx and explored possible contributing molecular mechanisms. In rats, the regeneration progress was delayed and attenuated with PHx and bleeding and was not restored with colloid resuscitation. Livers restored their initial volume by postoperative day (POD) 2 after PHx through hepatocyte proliferation vs. POD 4 in the PHx and bleeding group, primarily by hepatocyte hypertrophy. With bleeding, hepatocyte proliferation was hindered in two mechanisms: by inhibiting cells from starting proliferation and by causing hindrance in G1/S progression. Liver hypoxia was prominent, with significant prolonged up-regulation of hypoxia-inducible factors (HIF) and HIF-targeted genes only in the PHx and bleeding group. Gene expression profiling revealed alterations in numerous genes that belong to critical pathways, including cell cycle, DNA replication, PI3K-Akt, purine, and pyrimidine metabolism. Because liver surgery is frequently performed in patients with a predamaged liver, an improper regenerative process after PHx and bleeding might lead to decompensation. The results hint at specific pathways to target in order to improve liver regeneration during PHx and bleeding.—Matot, I., Nachmansson, N., Duev, O., Schulz, S., Schroeder-Stein, K., Frede, S., Abramovitch, R. Impaired liver regeneration after hepatectomy and bleeding is associated with a shift from hepatocyte proliferation to hypertrophy.
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Affiliation(s)
- Idit Matot
- Division of Anesthesiology, Intensive Care, and Pain, Tel-Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nathalie Nachmansson
- The Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Omri Duev
- The Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Susanne Schulz
- Clinic of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Katrin Schroeder-Stein
- Clinic of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Stilla Frede
- Clinic of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Rinat Abramovitch
- The Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel;
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A non-invasive magnetic resonance imaging approach for assessment of real-time microcirculation dynamics. Sci Rep 2017; 7:7468. [PMID: 28784990 PMCID: PMC5547069 DOI: 10.1038/s41598-017-06983-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/21/2017] [Indexed: 11/17/2022] Open
Abstract
We present a novel, non-invasive magnetic resonance imaging (MRI) technique to assess real-time dynamic vasomodulation of the microvascular bed. Unlike existing perfusion imaging techniques, our method is sensitive only to blood volume and not flow velocity. Using graded gas challenges and a long-life, blood-pool T1-reducing agent gadofosveset, we can sensitively assess microvascular volume response in the liver, kidney cortex, and paraspinal muscle to vasoactive stimuli (i.e. hypercapnia, hypoxia, and hypercapnic hypoxia). Healthy adult rats were imaged on a 3 Tesla scanner and cycled through 10-minute gas intervals to elicit vasoconstriction followed by vasodilatation. Quantitative T1 relaxation time mapping was performed dynamically; heart rate and blood oxygen saturation were continuously monitored. Laser Doppler perfusion measurements confirmed MRI findings: dynamic changes in T1 corresponded with perfusion changes to graded gas challenges. Our new technique uncovered differential microvascular response to gas stimuli in different organs: for example, mild hypercapnia vasodilates the kidney cortex but constricts muscle vasculature. Finally, we present a gas challenge protocol that produces a consistent vasoactive response and can be used to assess vasomodulatory capacity. Our imaging approach to monitor real-time vasomodulation may be extended to other imaging modalities and is valuable for investigating diseases where microvascular health is compromised.
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Fähling M, Mathia S, Scheidl J, Abramovitch R, Milman Z, Paliege A, Peters H, Persson PB, Heyman SN, Rosenberger C. Cyclosporin a induces renal episodic hypoxia. Acta Physiol (Oxf) 2017; 219:625-639. [PMID: 27690155 DOI: 10.1111/apha.12811] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/29/2016] [Accepted: 09/21/2016] [Indexed: 01/20/2023]
Abstract
AIM Cyclosporin A (CsA) causes renal toxicity. The underlying mechanisms are incompletely understood, but may involve renal hypoxia and hypoxia-inducible factors (Hifs). We sought for hypoxia and Hif in mouse kidneys with CsA-induced toxicity, assessed their time course, Hif-mediated responses and the impact of interventional Hif upregulation. METHODS Mice received CsA or its solvent cremophore for up to 6 weeks. Low salt diet (Na+ ↓) was given in combination with CsA to enhance toxicity. We assessed fine morphology, renal function, blood oxygen level-dependent magnetic resonance imaging under room air and following changes in breathing gas composition which correlate with vascular reactivity, pimonidazole adducts (which indicate O2 tensions below 10 mmHg), Hif-α proteins, as well as expression of Hif target genes. Stable Hif upregulation was achieved by inducible, Pax8-rtTA-based knockout of von Hippel-Lindau protein (Vhl-KO), which is crucial for Hif-α degradation. RESULTS Cyclosporin A transiently increased renal deoxyhaemoglobin (R2*). Augmented vascular reactivity was observed at 2 h, but decreased at 24 h after CsA treatment. Na+ ↓/CsA provoked chronic renal failure with tubular degeneration and interstitial fibrosis. Nephron segments at risk for injury accumulated pimonidazole adducts, as well as Hif-α proteins. Remarkably, Hif target gene expression remained unchanged, while factor-inhibiting Hif (Fih) was enhanced. Na+ ↓/CsA/Vhl-KO aggravated morpho-functional outcome of chronic renal CsA toxicity. CONCLUSIONS Cyclosporin A provokes episodic hypoxia in nephron segments most susceptible to chronic CsA toxicity. Fih is upregulated and likely blocks further Hif activity. Continuous tubular Hif upregulation via Vhl-KO worsens the outcome of chronic CsA-induced renal toxicity.
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Affiliation(s)
- M. Fähling
- Vegetative Physiologie; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Mathia
- Vegetative Physiologie; Charité - Universitätsmedizin Berlin; Berlin Germany
- Nephrology and Renal Transplantation; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - J. Scheidl
- Gastroenterology; Krankenhaus Westend; Berlin Germany
| | - R. Abramovitch
- The Goldyne Savad Institute of Gene Therapy; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Z. Milman
- The Goldyne Savad Institute of Gene Therapy; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - A. Paliege
- Nephrology and Renal Transplantation; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H. Peters
- Nephrology and Renal Transplantation; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - P. B. Persson
- Vegetative Physiologie; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. N. Heyman
- Medicine; Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - C. Rosenberger
- Nephrology and Renal Transplantation; Charité - Universitätsmedizin Berlin; Berlin Germany
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12
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Wang C, Zhao K, Zhang R, Jiang L, Wang R, Zhang X, Wang H, Jin L, Zhang J, Wang X, Fang J. Evaluation of renal oxygenation change under the influence of carbogen breathing using a dynamic R 2 , R 2 ' and R 2 * quantification approach. NMR IN BIOMEDICINE 2016; 29:1601-1607. [PMID: 27670144 DOI: 10.1002/nbm.3625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/03/2016] [Accepted: 08/22/2016] [Indexed: 06/06/2023]
Abstract
The purpose of this study is to demonstrate the feasibility of dynamic renal R2 /R2 '/R2 * measurements based on a method, denoted psMASE-ME, in which a periodic 180° pulse-shifting multi-echo asymmetric spin echo (psMASE) sequence, combined with a moving estimation (ME) strategy, is adopted. Following approval by the institutional animal care and use committee, a block design of respiratory challenge with interleaved air and carbogen (97% O2 , 3% CO2 ) breathing was employed in nine rabbits. Parametrical R2 /R2 '/R2 * maps were computed and average R2 /R2 '/R2 * values were measured in regions of interest in the renal medulla and cortex. Bland-Altman plots showed good agreement between the proposed method and reference standards of multi-echo spin echo and multi-echo gradient echo sequences. Renal R2 , R2 ' and R2 * decreased significantly from 16.2 ± 4.4 s-1 , 9.8 ± 5.2 s-1 and 25.9 ± 5.0 s-1 to 14.9 ± 4.4 s-1 (p < 0.05), 8.5 ± 4.1 s-1 (p < 0.05) and 23.4 ± 4.8 s-1 (p < 0.05) in the cortex when switching the gas mixture from room air to carbogen. In the renal medulla, R2 , R2 ' and R2 * also decreased significantly from 12.9 ± 4.7 s-1 , 15.1 ± 5.8 s-1 and 27.9 ± 5.3 s-1 to 11.8 ± 4.5 s-1 (p < 0.05), 14.2 ± 4.2 s-1 (p < 0.05) and 25.8 ± 5.1 s-1 (p < 0.05). No statistically significant differences in relative R2 , R2 ' and R2 * changes were observed between the cortex and medulla (p = 0.72 for R2 , p = 0.39 for R2 ' and p = 0.61 for R2 *). The psMASE-ME method for dynamic renal R2 /R2 '/R2 * measurements, together with the respiratory challenge, has potential use in the evaluation of renal oxygenation in many renal diseases.
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Affiliation(s)
- Chengyan Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Kai Zhao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Rui Zhang
- College of Engineering, Peking University, Beijing, China
| | - Li Jiang
- Philips Healthcare, Suzhou, Jiangsu, China
| | - Rui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - He Wang
- Philips Healthcare, Suzhou, Jiangsu, China
| | - Lixin Jin
- Philips Healthcare, Suzhou, Jiangsu, China
| | - Jue Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.
- College of Engineering, Peking University, Beijing, China.
| | - Xiaoying Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.
- Department of Radiology, Peking University First Hospital, Beijing, China.
| | - Jing Fang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- College of Engineering, Peking University, Beijing, China
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13
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Patterson AJ, Priest AN, Bowden DJ, Wallace TE, Patterson I, Graves MJ, Lomas DJ. Quantitative BOLD imaging at 3T: Temporal changes in hepatocellular carcinoma and fibrosis following oxygen challenge. J Magn Reson Imaging 2016; 44:739-44. [PMID: 26892734 PMCID: PMC5042181 DOI: 10.1002/jmri.25189] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/25/2016] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the utility of oxygen challenge and report on temporal changes in blood oxygenation level-dependent (BOLD) contrast in normal liver, hepatocellular carcinoma (HCC) and background fibrosis. MATERIALS AND METHODS Eleven volunteers (nine male and two female, mean age 33.5, range 27-41 years) and 10 patients (nine male and one female, mean age 68.9, range 56-87 years) with hepatocellular carcinoma on a background of diffuse liver disease were recruited. Imaging was performed on a 3T system using a multiphase, multiecho, fast gradient echo sequence. Oxygen was administered via a Hudson mask after 2 minutes of free-breathing. Paired t-tests were performed to determine if the mean pre- and post-O2 differences were statistically significant. RESULTS In patients with liver fibrosis (n = 8) the change in T2* following O2 administration was elevated (0.88 ± 0.582 msec, range 0.03-1.69 msec) and the difference was significant (P = 0.004). The magnitude of the BOLD response in patients with HCC (n = 10) was larger, however the response was more variable (1.07 ± 1.458 msec, range -0.93-3.26 msec), and the difference was borderline significant (P = 0.046). The BOLD response in the volunteer cohort was not significant (P = 0.121, 0.59 ± 1.162 msec, range -0.81-2.44 msec). CONCLUSION This work demonstrates that the BOLD response following oxygen challenge within cirrhotic liver is consistent with a breakdown in vascular autoregulatory mechanisms. Similarly, the elevated BOLD response within HCC is consistent with the abnormal capillary vasculature within tumors and the arterialization of the blood supply. Our results suggest that oxygen challenge may prove a viable BOLD contrast mechanism in the liver. J. Magn. Reson. Imaging 2016;44:739-744.
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Affiliation(s)
- Andrew J Patterson
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Andrew N Priest
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - David J Bowden
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Tess E Wallace
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Ilse Patterson
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Martin J Graves
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - David J Lomas
- Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
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14
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Ganesh T, Estrada M, Duffin J, Cheng HL. T2* and T1 assessment of abdominal tissue response to graded hypoxia and hypercapnia using a controlled gas mixing circuit for small animals. J Magn Reson Imaging 2016; 44:305-16. [PMID: 26872559 DOI: 10.1002/jmri.25169] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/12/2016] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To characterize T2* and T1 relaxation time response to a wide spectrum of gas challenges in extracranial tissues of healthy rats. MATERIALS AND METHODS A range of graded gas mixtures (hyperoxia, hypercapnia, hypoxia, and hypercapnic hypoxia) were delivered through a controlled gas-mixing circuit to mechanically ventilated and intubated rats. Quantitative magnetic resonance imaging (MRI) was performed on a 3T clinical scanner; T2* and T1 maps were computed to determine tissue response in the liver, kidney cortex, and paraspinal muscles. Heart rate and blood oxygen saturation (SaO2 ) were measured through a rodent oximeter and physiological monitor. RESULTS T2* decreases consistent with lowered SaO2 measurements were observed for hypercapnia and hypoxia, but decreases were significant only in liver and kidney cortex (P < 0.05) for >10% CO2 and <15% O2 , with the new gas stimulus, hypercapnic hypoxia, producing the greatest T2* decrease. Hyperoxia-related T2* increases were accompanied by negligible increases in SaO2 . T1 generally increased, if at all, in the liver and decreased in the kidney. Significance was observed (P < 0.05) only in kidney for >90% O2 and >5% CO2 . CONCLUSION T2* and T1 provide complementary roles for evaluating extracranial tissue response to a broad range of gas challenges. Based on both measured and known physiological responses, our results are consistent with T2* as a sensitive marker of blood oxygen saturation and T1 as a weak marker of blood volume changes. J. Magn. Reson. Imaging 2016;44:305-316.
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Affiliation(s)
- Tameshwar Ganesh
- Translational Biology & Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Canada.,Physiology & Experimental Medicine, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Marvin Estrada
- Lab Animal Services, Hospital for Sick Children, Toronto, Canada
| | - James Duffin
- Department of Anesthesia, University of Toronto, Canada
| | - Hai Ling Cheng
- Translational Biology & Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Canada.,Physiology & Experimental Medicine, Hospital for Sick Children Research Institute, Toronto, Canada.,The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Canada.,Institute of Biomaterials & Biomedical Engineering, University of Toronto, Canada
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15
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Laufer S, Mazuz A, Nachmansson N, Fellig Y, Corn BW, Bokstein F, Bashat DB, Abramovitch R. Monitoring brain tumor vascular heamodynamic following anti-angiogenic therapy with advanced magnetic resonance imaging in mice. PLoS One 2014; 9:e115093. [PMID: 25506833 PMCID: PMC4266643 DOI: 10.1371/journal.pone.0115093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/18/2014] [Indexed: 11/18/2022] Open
Abstract
Advanced MR imaging methods have an essential role in classification, grading, follow-up and therapeutic management in patients with brain tumors. With the introduction of new therapeutic options, the challenge for better tissue characterization and diagnosis increase, calling for new reliable non-invasive imaging methods. In the current study we evaluated the added value of a combined protocol of blood oxygen level dependent (BOLD) imaging during hyperoxic challenge (termed hemodynamic response imaging (HRI)) in an orthotopic mouse model for glioblastoma under anti-angiogenic treatment with B20-4.1.1, an anti-VEGF antibody. In glioblastoma tumors, the elevated HRI indicated progressive angiogenesis as further confirmed by histology. In the current glioblastoma model, B20-treatment caused delayed tumor progression with no significant changes in HRI yet with slightly reduced tumor vascularity as indicated by histology. Furthermore, fewer apoptotic cells and higher proliferation index were detected in the B20-treated tumors compared to control-treated tumors. In conclusion, HRI provides an easy, safe and contrast agent free method for the assessment of the brain hemodynamic function, an additionally important clinical information.
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Affiliation(s)
- Shlomi Laufer
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- MRI/MRS lab HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ahinoam Mazuz
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- MRI/MRS lab HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Nathalie Nachmansson
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- MRI/MRS lab HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yakov Fellig
- Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Felix Bokstein
- Neuro-Oncology Service. Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dafna Ben Bashat
- The Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Abramovitch
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- MRI/MRS lab HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- * E-mail:
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16
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Milman Z, Axelrod JH, Heyman SN, Nachmansson N, Abramovitch R. Assessment with unenhanced MRI techniques of renal morphology and hemodynamic changes during acute kidney injury and chronic kidney disease in mice. Am J Nephrol 2014; 39:268-78. [PMID: 24662013 DOI: 10.1159/000360093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 01/25/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND/AIMS Changes in renal oxygenation and perfusion have been identified as common pathways to the development and progression of renal disease. Recently, the sensitivity of hemodynamic response imaging (HRI) was demonstrated; this is a functional magnetic resonance imaging (MRI) method combined with transient hypercapnia and hyperoxia for the evaluation of renal perfusion and vascular reactivity. The aim of this study was to utilize HRI for the noninvasive evaluation of changes in renal hemodynamics and morphology during acute, chronic and acute-on-chronic renal failures. METHODS Renal-HRI maps and true fast imaging with steady-state precession (True-FISP) images were used to evaluate renal perfusion, morphology and corticomedullary differentiation (CMD). MR images were acquired on two mouse models of kidney injury: adenine-induced chronic kidney disease (CKD) and rhabdomyolysis-induced acute kidney injury (AKI). Serum urea was measured from these mice in order to determine renal function. RESULTS Renal-HRI maps revealed a blunted response to hypercapnia and hyperoxia with evolving kidney dysfunction in both models, reflecting hampered renal vascular reactivity and perfusion. True-FISP images showed a high sensitivity to renal morphological changes, with different patterns characterizing each model. Calculated data obtained from HRI and True-FISP during the evolution of renal failure and upon recovery, with and without protective intervention, closely correlated with the degree of renal impairment. CONCLUSIONS This study suggests the potential combined usage of two noninvasive MRI methods, HRI and True-FISP, for the assessment of renal dysfunction without the potential risk associated with contrast-agents administration. HRI may also serve as a research tool in experimental settings, revealing the hemodynamic changes associated with kidney dysfunction.
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Affiliation(s)
- Zohar Milman
- The Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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17
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Komar-Stossel C, Gross E, Dery E, Corchia N, Meir K, Fried I, Abramovitch R. TL-118 and gemcitabine drug combination display therapeutic efficacy in a MYCN amplified orthotopic neuroblastoma murine model--evaluation by MRI. PLoS One 2014; 9:e90224. [PMID: 24603724 PMCID: PMC3946152 DOI: 10.1371/journal.pone.0090224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/31/2014] [Indexed: 02/07/2023] Open
Abstract
Neuroblastoma (NB) is the most common extra-cranial pediatric solid tumor with up to 50% of NB patients classified as having high-risk disease with poor long-term survival rates. The poor clinical outcome and aggressiveness of high-risk NB strongly correlates with enhanced angiogenesis, suggesting anti-angiogenic agents as attractive additions to the currently insufficient therapeutics. TL-118, a novel drug combination has been recently developed to inhibit tumor angiogenesis. In the current study, we used the SK-N-BE (2) cell line to generate orthotopic NB tumors in order to study the combinational therapeutic potential of TL-118 with either Gemcitabine (40 mg/kg; IP) or Retinoic acid (40 mg/kg; IP). We show that TL-118 treatment (n = 9) significantly inhibited tumor growth, increased cell apoptosis, reduced proliferation and extended mouse survival. Moreover, the reciprocal effect of TL-118 and Gemcitabine treatment (n = 10) demonstrated improved anti-tumor activity. The synergistic effect of these drugs in combination was more effective than either TL or Gemcitabine alone (n = 9), via significantly reduced cell proliferation (p<0.005), increased apoptosis (p<0.05) and significantly prolonged survival (2-fold; p<0.00001). To conclude, we demonstrate that the novel drug combination TL-118 has the ability to suppress the growth of an aggressive NB tumor. The promising results with TL-118 in this aggressive animal model may imply that this drug combination has therapeutic potential in the clinical setting.
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Affiliation(s)
- Chani Komar-Stossel
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel; MRI/MRS lab HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Eitan Gross
- Pediatric Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Elia Dery
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel; MRI/MRS lab HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Nathalie Corchia
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel; MRI/MRS lab HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Karen Meir
- Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Iris Fried
- Pediatric Hemato-Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Rinat Abramovitch
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel; MRI/MRS lab HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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18
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Edrei Y, Freiman M, Sklair-Levy M, Tsarfaty G, Gross E, Joskowicz L, Abramovitch R. Quantitative functional MRI biomarkers improved early detection of colorectal liver metastases. J Magn Reson Imaging 2013; 39:1246-53. [PMID: 24006217 DOI: 10.1002/jmri.24270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 05/16/2013] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To implement and evaluate the performance of a computerized statistical tool designed for robust and quantitative analysis of hemodynamic response imaging (HRI) -derived maps for the early identification of colorectal liver metastases (CRLM). MATERIALS AND METHODS CRLM-bearing mice were scanned during the early stage of tumor growth and subsequently during the advanced-stage. Three experienced radiologists marked various suspected-foci on the early stage anatomical images and classified each as either highly certain or as suspected tumors. The statistical model construction was based on HRI maps (functional-MRI combined with hypercapnia and hyperoxia) using a supervised learning paradigm which was further trained either with the advanced-stage sets (late training; LT) or with the early stage sets (early training; ET). For each group of foci, the classifier results were compared with the ground-truth. RESULTS The ET-based classification significantly improved the manual classification of the highly certain foci (P < 0.05) and was superior compared with the LT-based classification (P < 0.05). Additionally, the ET-based classification, offered high sensitivity (57-63%), accompanied with high positive predictive value (>94%) and high specificity (>98%) for suspected-foci. CONCLUSION The ET-based classifier can strengthen the radiologist's classification of highly certain foci. Additionally, it can aid in classifying suspected-foci, thus enabling earlier intervention which can often be lifesaving.
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Affiliation(s)
- Yifat Edrei
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Abstract
OBJECTIVE Blood loss and transfusion are frequent among patients undergoing liver surgery. Concerns have been raised about the safety and efficacy of transfusing stored blood. The influence of transfusing fresh vs. stored blood on the liver has not been studied to date. We tested the hypothesis that transfusion of stored, but not fresh blood, adversely affects liver outcome in vivo following acute hemorrhage. Additionally, possible mechanisms linking adverse liver outcome with increased storage duration were evaluated. DESIGN Prospective, controlled, animal study. SETTING University research laboratory. SUBJECTS Adult male Sprague-Dawley rats INTERVENTIONS Anesthetized rats were randomized to control, hemorrhagic and shock group (acute bleeding; HSG), or hemorrhagic and blood resuscitation groups (BR) (with fresh blood [BR-d0], blood stored for 4 [BR-d4] or 7 [BR-d7] days, or packed RBCs stored for 7 days [packed RBC-d7]). MEASUREMENTS AND MAIN RESULTS Administration of blood or packed RBC stored for 7 days exacerbated liver injury as reflected by liver necrosis and enhanced apoptosis (p < 0.001). Functional MRI analysis of the liver demonstrated significant improvement in liver perfusion with fresh blood (% change in functional MRI signal intensity due to hyperoxia was 16% ± 3% in BR-d0 vs. 4% ± 3% in hemorrhagic group, p < 0.001) but not with stored blood (12% ± 2% and 9% ± 5% for BR-d4 and BR-d7, respectively). Analysis of stored blood showed reduction in RBC deformability at 7 days of storage, reflecting a five-fold increase in the number of undeformable cells. CONCLUSION Liver injury is exacerbated by the transfusion of stored blood, primarily due to the change in the rheological properties of RBC. This data call for clinical studies in patients undergoing liver resection or transplantation.
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Milman Z, Heyman SN, Corchia N, Edrei Y, Axelrod JH, Rosenberger C, Tsarfati G, Abramovitch R. Hemodynamic response magnetic resonance imaging: application for renal hemodynamic characterization. Nephrol Dial Transplant 2013; 28:1150-6. [PMID: 23291364 DOI: 10.1093/ndt/gfs541] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The clinical use of iodinated radiocontrast agents or gadolinium for renal perfusion imaging is limited in the presence of renal dysfunction. We have previously demonstrated the feasibility of hemodynamic response imaging (HRI), a functional magnetic resonance imaging (MRI) method combined with hypercapnia and hypercapnic-hyperoxia, for monitoring changes in liver perfusion and hemodynamics. The aim of the present study was to evaluate the utility of HRI for monitoring changes in renal perfusion and hemodynamics. METHODS Renal HRI maps were acquired during graded hypercapnia (95% air + 5% CO2) and hypercapnic-hyperoxia (95% O2 + 5% CO2) in control mice. The utility of HRI for monitoring changes in renal perfusion and oxygenation was evaluated using pharmacological inhibition of nitric oxide synthase and cycloxygenase as well as in rhabdomyolysis-induced acute kidney injury (AKI) in mice. HRI results were further interpreted using Doppler ultrasound (US). RESULTS Renal HRI maps revealed pronounced signal-intensity changes in response to both hypercapnia and hypercapnic-hyperoxia, reflecting intense vascular reactivity. These changes were significantly attenuated following the pharmacological intervention and during AKI, corresponding with hampered perfusion dynamics, as confirmed by Doppler US. CONCLUSIONS The applicability of the non-invasive HRI method suggests its potential use for the evaluation of renal perfusion and vascular reactivity, excluding the need for contrast-agent administration.
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Affiliation(s)
- Zohar Milman
- The Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Improved efficacy of a novel anti-angiogenic drug combination (TL-118) against colorectal-cancer liver metastases; MRI monitoring in mice. Br J Cancer 2012; 107:658-66. [PMID: 22805330 PMCID: PMC3419965 DOI: 10.1038/bjc.2012.322] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The poor prognosis of patients with colorectal-cancer liver metastases (CRLM) and the insufficiency of available treatments have raised the need for alternative curative strategies. We aimed to assess the therapeutic potential of TL-118, a new anti-angiogenic drug combination, for CRLM treatment, in a mouse model. METHODS The therapeutic potential of TL-118 was evaluated and compared with B20-4.1.1 (B20; anti-VEGF antibody) and rapamycin in CRLM-bearing mice. Tumour progression and the vascular changes were monitored by MRI. Additionally, mice survival, cell proliferation, apoptosis and vessel density were evaluated. RESULTS This study demonstrated an unequivocal advantage to TL-118 therapy by significantly prolonging survival (threefold) and reducing metastasis perfusion and vessel density (ninefold). The underlying mechanism for TL-118-treatment success was associated with hepatic perfusion attenuation resulting from reduced nitric-oxide (NO) serum levels as elucidated by using hemodynamic response imaging (HRI, a functional MRI combined with hypercapnia and hyperoxia). Further, systemic hepatic perfusion reduction during the initial treatment phase by adding NO inhibitor has proven to be essential for reaching maximal therapeutic effects for both TL-118 and B20. CONCLUSION TL-118 harbours a potential clinical benefit to CLRM patients. Moreover, the reduction of hepatic perfusion at early stages of anti-angiogenic therapies by adding NO inhibitor is crucial for achieving maximal anti-tumour effects.
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Cheng HLM. Effect of hyperoxia and hypercapnia on tissue oxygen and perfusion response in the normal liver and kidney. PLoS One 2012; 7:e40485. [PMID: 22792349 PMCID: PMC3391313 DOI: 10.1371/journal.pone.0040485] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 06/08/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Inhalation of air with altered levels of oxygen and carbon dioxide to manipulate tissue oxygenation and perfusion has both therapeutic and diagnostic value. These physiological responses can be measured non-invasively with magnetic resonance (MR) relaxation times. However, interpreting MR measurements is not straight-forward in extra-cranial organs where gas challenge studies have only begun to emerge. Inconsistent results have been reported on MR, likely because different organs respond differently. The objective of this study was to elucidate organ-specific physiological responses to gas challenge underlying MR measurements by investigating oxygenation and perfusion changes in the normal liver and kidney cortex. MATERIALS AND METHODS Gas challenges (100% O(2), 10% CO(2), and carbogen [90% O(2)+10% CO(2)]) interleaved with room air was delivered to rabbits to investigate their effect on tissue oxygenation and perfusion. Real-time fiber-optic measurements of absolute oxygen and relative blood flow were made in the liver and kidney cortex. RESULTS Only the liver demonstrated a vasodilatory response to CO(2). Perfusion changes to other gases were minimal in both organs. Tissue oxygenation measurements showed the liver responding only when CO(2) was present and the kidney only when O(2) was present. CONCLUSION This study reveals distinct physiological response mechanisms to gas challenge in the liver and kidney. The detailed characterization of organ-specific responses is critical to improving our understanding and interpretation of MR measurements in various body organs, and will help broaden the application of MR for non-invasive studies of gas challenges.
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Affiliation(s)
- Hai-Ling Margaret Cheng
- Physiology & Experimental Medicine, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
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Sørensen A, Holm D, Pedersen M, Tietze A, Stausbøl-Grøn B, Duus L, Uldbjerg N. Left-right difference in fetal liver oxygenation during hypoxia estimated by BOLD MRI in a fetal sheep model. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:665-672. [PMID: 21557372 DOI: 10.1002/uog.9044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The purpose of this study was to measure differences in oxygenation between the left and right sides of the fetal liver during varying oxygenation levels. METHODS Eight ewes carrying singleton fetuses at gestational age 125 days (term, 145 days) were included in the study. Under anesthesia the ewes were ventilated with gas containing different levels of oxygen, thereby subjecting the fetuses to hyperoxia (mean ± SD maternal arterial partial pressure of oxygen (pO2), 23.2 ± 8.2 kPa) and hypoxia (mean maternal arterial pO2, 7.1 ± 0.5 kPa). Changes in oxygenation within the fetal liver were assessed by blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI). RESULTS During hyperoxia there was no difference between the BOLD signal in the left and right sides of the fetal liver; mean change in BOLD (ΔBOLD)(hyperox), -0.9 ± 3.7%. During hypoxia, however, the decrease in the BOLD signal was more pronounced in the right side as compared with the left side, thereby creating a significant increase in the left-right difference in the BOLD signal; mean ΔBOLD(hypox), 5.2 ± 2.2% (P = 0.002, paired t-test). The left-right difference was directly proportional to the degree of hypoxia (R2 = 0.86, P = 0.007). CONCLUSIONS To our knowledge, this is the first study demonstrating differences in oxygenation between the left and right sides of the fetal liver during hypoxia, a difference that can be explained by increased ductus venosus shunting. Thus, the BOLD MRI technique is a promising non-invasive tool that might be useful for the future monitoring of the human fetus.
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Affiliation(s)
- A Sørensen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aalborg, Denmark.
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Guo Y, Jin N, Klein R, Nicolai J, Yang GY, Omary RA, Larson AC. Gas challenge-blood oxygen level-dependent (GC-BOLD) MRI in the rat Novikoff hepatoma model. Magn Reson Imaging 2011; 30:133-8. [PMID: 22055749 DOI: 10.1016/j.mri.2011.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 07/09/2011] [Accepted: 09/23/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the study was to investigate the relationship between gas challenge-blood oxygen level-dependent (GC-BOLD) response angiogenesis and tumor size in rat Novikoff hepatoma model. MATERIALS AND METHODS Twenty adult male Sprague-Dawley rats (weighting 301-325 g) were used for our Animal Care and Use Committee-approved experiments. N1-S1 Novikoff hepatomas were grown in 14 rats with sizes ranging from 0.42 to 2.81 cm. All experiments were performed at 3.0 T using a custom-built rodent receiver coil. A multiple gradient-echo sequence was used for R2* measurements, first during room air (78% N(2)/20% O(2)) breathing and then after 10 min of carbogen (95% O(2)/5% CO(2)) breathing. After image acquisition, rats were euthanized, and the tumors were harvested for histological evaluation. RESULTS The R2* change between air and carbogen breathing for small hepatomas was positive; R2* changes changed to negative values for larger hepatomas. We found a significant positive correlation between tumor R2* change and tumor microvessel density (MVD) (r=0.798, P=.001) and a significant inverse correlation between tumor R2* change and tumor size (r=-0.840, P<.0001). CONCLUSIONS GC-BOLD magnetic resonance imaging measurements are well correlated to MVD levels and tumor size in the N1-S1 Novikoff hepatoma model; GC-BOLD measurements may serve as noninvasive biomarkers for evaluating angiogenesis and disease progression and/or therapy response.
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Affiliation(s)
- Yang Guo
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
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25
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Sela Y, Freiman M, Dery E, Edrei Y, Safadi R, Pappo O, Joskowicz L, Abramovitch R. fMRI-Based Hierarchical SVM Model for the Classification and Grading of Liver Fibrosis. IEEE Trans Biomed Eng 2011; 58:2574-81. [DOI: 10.1109/tbme.2011.2159501] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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26
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Winter JD, Estrada M, Cheng HLM. Normal tissue quantitative T1 and T2* MRI relaxation time responses to hypercapnic and hyperoxic gases. Acad Radiol 2011; 18:1159-67. [PMID: 21704536 DOI: 10.1016/j.acra.2011.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 04/19/2011] [Accepted: 04/29/2011] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Longitudinal (T(1)) and effective transverse (T(2)*) magnetic resonance (MR) relaxation times provide noninvasive measures of tissue oxygenation. The objective for this study was to quantify independent effects of inhaled O(2) and CO(2) on normal tissue T(1) and T(2)* in rabbit liver, kidney, and paraspinal muscle. MATERIALS AND METHODS Three gas challenges (100% O(2), 10% CO(2) [balance air], and carbogen [90% O(2) + 10% CO(2)]) were delivered to the rabbits in random order to isolate the effects of inspired O(2) and CO(2). During each challenge, quantitative T(1) and T(2)* maps were collected on a 1.5 Tesla MR imaging. Mean changes in T(1) (ΔT(1)) and T(2)* (ΔT(2)*) were calculated from regions of interest in each organ. RESULTS Greatest ΔT(1) and ΔT(2)* changes were observed in liver for 10% CO(2) and in kidney for 100% O(2). ΔT(1) and ΔT(2)* generally followed predicted patterns when transitioning from air breathing: lower T(1)/higher T(2)* with inspired O(2), higher T(1)/lower T(2)* with inspired CO(2), and variable T(1)/T(2)* changes in the presence of both (ie, carbogen). New observations also emerged: 1) between-gas-challenge transitions revealed the greatest significance in ΔT(2)* for the liver and kidney resulting from the isolation of independent O(2) and CO(2) effects; 2) ΔT(2)* provided the best sensitivity and detected both tissue oxygenation and blood volume modulation; and 3) ΔT(1) sensitivity was restricted mainly to tissue oxygenation in the absence of counteracting vasodilatation. CONCLUSION Robust use of MR relaxation times as noninvasive biomarkers requires an understanding of their relative sensitivity to organ-specific physiological responses.
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Edrei Y, Gross E, Corchia N, Tsarfaty G, Galun E, Pappo O, Abramovitch R. Vascular profile characterization of liver tumors by magnetic resonance imaging using hemodynamic response imaging in mice. Neoplasia 2011; 13:244-53. [PMID: 21390187 PMCID: PMC3050867 DOI: 10.1593/neo.101354] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/02/2010] [Accepted: 12/08/2010] [Indexed: 12/12/2022]
Abstract
Recently, we have demonstrated the feasibility of using hemodynamic response imaging (HRI), a functional magnetic resonance imaging (MRI) method combined with hypercapnia and hyperoxia, for monitoring vascular changes during liver pathologies without the need of contrast material. In this study, we evaluated HRI ability to assess changes in liver tumor vasculature during tumor establishment, progression, and antiangiogenic therapy. Colorectal adenocarcinoma cells were injected intrasplenically to model colorectal liver metastasis (CRLM) and the Mdr2 knockout mice were used to model primary hepatic tumors. Hepatic perfusion parameters were evaluated using the HRI protocol and were compared with contrast-enhanced (CE) MRI. The hypovascularity and the increased arterial blood supply in well-defined CRLM were demonstrated by HRI. In CRLM-bearing mice, the entire liver perfusion was attenuated as the HRI maps were significantly reduced by 35%. This study demonstrates that the HRI method showed enhanced sensitivity for small CRLM (1-2 mm) detection compared with CE-MRI (82% versus 38%, respectively). In addition, HRI could demonstrate the vasculature alteration during CRLM progression (arborized vessels), which was further confirmed by histology. Moreover, HRI revealed the vascular changes induced by rapamycin treatment. Finally, HRI facilitates primary hepatic tumor characterization with good correlation to the pathologic differentiation. The HRI method is highly sensitive to subtle hemodynamic changes induced by CRLM and, hence, can function as an imaging tool for understanding the hemodynamic changes occurring during CRLM establishment, progression, and antiangiogenic treatment. In addition, this method facilitated the differentiation between different types of hepatic lesions based on their vascular profile noninvasively.
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Affiliation(s)
- Yifat Edrei
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- MRI/MRS Laboratory HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Eitan Gross
- Department of Pediatric Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Nathalie Corchia
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Galia Tsarfaty
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Eithan Galun
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Orit Pappo
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Rinat Abramovitch
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- MRI/MRS Laboratory HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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28
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Jin N, Deng J, Chadashvili T, Zhang Y, Guo Y, Zhang Z, Yang GY, Omary RA, Larson AC. Carbogen gas-challenge BOLD MR imaging in a rat model of diethylnitrosamine-induced liver fibrosis. Radiology 2010; 254:129-37. [PMID: 20032147 DOI: 10.1148/radiol.09090410] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the relationship between gas-challenge blood oxygen level-dependent (BOLD) magnetic resonance (MR) imaging measurements and hepatic disease progression in a rat model of diethylnitrosamine (DEN)-induced liver fibrosis. MATERIALS AND METHODS The institutional animal care and use committee approved all experiments. Liver fibrosis was induced in 27 male Wistar rats by means of weekly oral gavage with 5 mL of 1.5% DEN solution per kilogram of body weight for 3-11 weeks, which produced varying degrees of liver fibrosis. Eight rats developed nonsubstantial fibrosis; eight rats, substantial fibrosis; and 15 rats, cirrhosis. Four nontreated healthy rats served as controls. Multiple-gradient-echo MR images were acquired in the rats at steady-state normoxia and hyperoxia and then during dynamic gas challenges. The change in R2* (DeltaR2*) during the gas challenge and the ratio of number of activated voxels to total number of voxels in the liver were quantified. Masson trichrome staining of liver tissue was used to identify collagen tissue. Liver fibrosis was assessed by using a semiquantitative METAVIR scoring system and quantitative analysis of the percentage of liver fibrosis. Hepatic hemodynamic responses at BOLD MR imaging were compared across the fibrosis stages at independent-sample t test and linear regression analyses. RESULTS DeltaR2* was well correlated with gas-challenge interval. Mean DeltaR2* decreased during liver fibrosis progression, from 19.60 sec(-1) +/- 4.47 (standard deviation) in animals without substantial fibrosis to 14.02 sec(-1) +/- 2.88 and 6.26 sec(-1) +/- 7.40 in animals with substantial fibrosis and cirrhosis, respectively (P = .006 for rats without vs rats with substantial fibrosis, P = .001 for rats with substantial fibrosis vs rats with cirrhosis, P < .001 for rats without substantial fibrosis vs rats with cirrhosis). Mean DeltaR2* (r = -0.773) and liver activation (r = -0.691) were inversely correlated with liver fibrosis (P < .001). CONCLUSION Carbogen gas-challenge BOLD MR imaging can depict hepatic hemodynamic alterations during the progression of fibrosis and has the potential to serve as a noninvasive, nonenhanced imaging method for liver fibrosis diagnosis and staging.
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Affiliation(s)
- Ning Jin
- Department of Radiology, Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611, USA
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Beider K, Abraham M, Begin M, Wald H, Weiss ID, Wald O, Pikarsky E, Abramovitch R, Zeira E, Galun E, Nagler A, Peled A. Interaction between CXCR4 and CCL20 pathways regulates tumor growth. PLoS One 2009; 4:e5125. [PMID: 19340288 PMCID: PMC2659745 DOI: 10.1371/journal.pone.0005125] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 03/02/2009] [Indexed: 11/18/2022] Open
Abstract
The chemokine receptor CXCR4 and its ligand CXCL12 is overexpressed in the majority of tumors and is critically involved in the development and metastasis of these tumors. CXCR4 is expressed in malignant tumor cells whereas its ligand SDF-1 (CXCL12) is expressed mainly by cancer associated fibroblasts (CAF). Similarly to CXCR4, the chemokine CCL20 is overexpressed in variety of tumors; however its role and regulation in tumors is not fully clear. Here, we show that the chemokine receptor CXCR4 stimulates the production of the chemokine CCL20 and that CCL20 stimulates the proliferation and adhesion to collagen of various tumor cells. Furthermore, overexpression of CCL20 in tumor cells promotes growth and adhesion in vitro and increased tumor growth and invasiveness in vivo. Moreover, neutralizing antibodies to CCL20 inhibit the in vivo growth of tumors that either overexpress CXCR4 or CCL20 or naturally express CCL20. These results reveal a role for CCL20 in CXCR4-dependent and -independent tumor growth and suggest a therapeutic potential for CCL20 and CCR6 antagonists in the treatment of CXCR4- and CCL20-dependent malignancies.
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Affiliation(s)
- Katia Beider
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Michal Abraham
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Michal Begin
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Hanna Wald
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ido D. Weiss
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ori Wald
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Eli Pikarsky
- Department of Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Rinat Abramovitch
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
- MRI Lab, HBRC, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Evelyne Zeira
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Eithan Galun
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Arnon Nagler
- Bone Marrow Transplantation Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel
- * E-mail: (AN); (AP)
| | - Amnon Peled
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
- * E-mail: (AN); (AP)
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Abstract
This paper presents a machine-learning approach to the interactive classification of suspected liver metastases in fMRI images. The method uses fMRI-based statistical modeling to characterize colorectal hepatic metastases and follow their early hemodynamical changes. Changes in hepatic hemodynamics are evaluated from T2*-W fMRI images acquired during the breathing of air, air-CO2, and carbogen. A classification model is build to differentiate between tumors and healthy liver tissues. To validate our method, a model was built from 29 mice datasets, and used to classify suspicious regions in 16 new datasets of healthy subjects or subjects with metastases in earlier growth phases. Our experimental results on mice yielded an accuracy of 78% with high precision (88%). This suggests that the method can provide a useful aid for early detection of liver metastases.
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Barash H, Gross E, Edrei Y, Pappo O, Spira G, Vlodavsky I, Galun E, Matot I, Abramovitch R. Functional magnetic resonance imaging monitoring of pathological changes in rodent livers during hyperoxia and hypercapnia. Hepatology 2008; 48:1232-41. [PMID: 18629804 DOI: 10.1002/hep.22394] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
UNLABELLED Liver diseases and regeneration are associated with hemodynamic changes denoting pathological alterations. Determining and monitoring physiological and pathological liver changes is essential for diagnostic and therapeutic objectives. Our aim was to determine the feasibility of functional magnetic resonance imaging (fMRI) during hypercapnia and hyperoxia for monitoring liver pathology. Liver fMRI images were acquired in rodents following acute bleeding, partial hepatectomy, and fibrosis. Results were quantitated and confirmed by histology. Changes induced by hyperoxia and hypercapnia following hemorrhage significantly correlated with the percentage of blood loss, reflecting lower liver perfusion and diminished vessel responsiveness to gas saturation. Hepatectomy resulted in an early decline in signal intensity changes due to hyperoxia, suggesting a decrease in liver perfusion and blood content. Following hepatectomy, signal intensity changes due to hypercapnia increased, signifying a change in liver perfusion from a mainly portal to a more arterial source. Two weeks after induction of fibrosis, signal intensity changes due to hypercapnia became much lower and those due to hyperoxia were much higher than those in normal livers, reflecting the increased perfusion due to the inflammatory process as confirmed by histologic analysis. With fibrosis progression, signal intensity changes induced by hypercapnia and hyperoxia were gradually attenuated, indicating structural and functional alterations of the liver vasculature during fibrosis. CONCLUSION In various liver pathologies, fMRI response to hypercapnia and hyperoxia is sensitive to changes in liver hemodynamic status involved in hepatic damage or recovery; thus, this technique may offer an additional noninvasive diagnostic tool for evaluation and follow-up of liver diseases by means of examining perfusion-related alterations.
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Affiliation(s)
- Hila Barash
- The Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Matot I, Cohen K, Pappo O, Barash H, Abramovitch R. Liver response to hemorrhagic shock and subsequent resuscitation: MRI analysis. Shock 2008; 29:16-24. [PMID: 17621258 DOI: 10.1097/shk.0b013e3180556964] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The liver is a target for injury in low flow states. Markers of liver injury are either invasive or not rapidly responding. Magnetic resonance imaging (MRI) may offer a noninvasive alternative to evaluate liver injury due to reduced perfusion. Recently, we reported an MRI method (functional MRI [fMRI]) that enables us to follow liver perfusion by changing the enrichment of inspired gas (air, air-5% carbon dioxide, 95% oxygen-5% carbon dioxide). Rats were subjected to hemorrhagic shock (HS) (bleeding to a MAP of 25 mmHg) and randomized to no resuscitation or resuscitation with Ringer lactate (RL) or adrenaline infusion targeted to a MAP of 50 mmHg or baseline. Significantly decreased fMRI responses to hyperoxia and hypercapnia were observed immediately after HS. Liver enzymes levels, liver histology, and apoptosis assessments were normal immediately after hemorrhage, however, showed significant changes after 6 h. Functional MRI revealed that adrenaline, but not RL infusion, significantly (P < 0.01) improved liver perfusion. Similarly, liver injury, as assessed by liver enzyme levels, liver histology, and apoptosis, was attenuated to a greater extent with adrenaline resuscitation. No significant differences in liver perfusion and injury were noted between resuscitation to low (50 mmHg) versus high (baseline) MAP. This study shows that fMRI enables early assessment of changes in liver perfusion, resulting in liver injury or recovery, and therefore, it may be considered as a noninvasive, rapidly responding tool for following liver outcome subsequent to hemorrhage and resuscitation. Using fMRI, we showed that adrenaline may be preferable to RL as an initial measure to attenuate liver injury after HS.
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Affiliation(s)
- Idit Matot
- Department of Anesthesiology & Critical Care Medicine, Hadassah University Medical Center, the Hebrew University, Jerusalem, Israel.
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