Free fatty acid flux measured using [1-11C]palmitate positron emission tomography and [U-13C]palmitate in humans

Detecting altered hepatic lipid oxidation by MRI in an animal model of MASLD

Metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence is increasing annually and affects over a third of US adults. MASLD can progress to metabolic dysfunction-associated steatohepatitis (MASH), characterized by severe hepatocyte injury, inflammation, and eventual advanced fibrosis or cirrhosis. MASH is predicted to become the primary cause of liver transplant by 2030. Although the etiology of MASLD/MASH is incompletely understood, dysregulated fatty acid oxidation is implicated in disease pathogenesis. Here, we develop a method for estimating hepatic β-oxidation from the metabolism of [D15]octanoate to deuterated water and detection with deuterium magnetic resonance methods. Perfused livers from a mouse model of MASLD reveal dysregulated hepatic β-oxidation, findings that corroborate in vivo imaging. The high-fat-diet-induced MASLD mouse studies indicate that decreased β-oxidative efficiency in the fatty liver could serve as an indicator of MASLD progression. Furthermore, our method provides a clinically translatable imaging approach for determining hepatic β-oxidation efficiency.

Noninvasive quantification of nonhuman primate dynamic 18F-FDG PET imaging

¹⁸F-FDG uptake rate constant K_i is the main physiology parameter measured in dynamic PET studies. A model-independent graphical analysis using Patlak plot with plasma input function (PIF) is a standard approach used to estimate K_i . The PIF is the ¹⁸F-FDG time activity curve (TAC) in plasma that is obtained by serial arterial blood sampling. The purpose of the study is to evaluate a Patlak plot-based optimization approach with reduced blood samples for noninvasive quantification of dynamic ¹⁸F-FDG PET imaging. Eight 60 min rhesus monkey brain dynamic ¹⁸F-FDG PET scans with arterial blood samples were collected. The measured PIF (mPIF) was determined by arterial blood samples. TACs of seven cerebral regions of interest were generated from each study. With a given number of blood samples, the population-based PIF (pPIF) was determined by either interpolation or extrapolation method using scale calibrated population mean of normalized PIF. The optimal sampling scheme with given blood sample size was determined by maximizing the correlations between the K_i estimated from pPIF and those obtained by mPIF. A leave-two-out cross-validation method was used for evaluation. The linear correlations between the K_i estimates from pPIF with optimal sampling schemes and those from mPIF were: K_i (pPIF 1 sample at 40 min) = 1.015 K_i (mPIF) - 0.000, R ² = 0.974; K_i (pPIF 2 samples at 35 and 50 min) = 1.052 K_i (mPIF) - 0.001, R ² = 0.976; K_i (pPIF 3 samples at 12, 40, and 50 min) = 1.030 K_i (mPIF) - 0.000, R ² = 0.985; and K_i (pPIF 4 samples at 10, 20, 40, and 50 min) = 1.016 K_i (mPIF)- 0.000, R ² = 0.993. As the sample size became greater or equal to 4, the K_i estimates from pPIF with the optimal protocol were almost identical to those from mPIF. The Patlak plot-based optimization approach is a reliable method to estimate PIF for noninvasive quantification of non-human primate dynamic ¹⁸F-FDG PET imaging and is potentially extendable to further translational human studies.

Renal hemodynamics and fatty acid uptake: effects of obesity and weight loss

Human studies of renal hemodynamics and metabolism in obesity are insufficient. We hypothesized that renal perfusion and renal free fatty acid (FFA) uptake are higher in subjects with morbid obesity compared with lean subjects and that they both decrease after bariatric surgery. Cortical and medullary hemodynamics and metabolism were measured in 23 morbidly obese women and 15 age- and sex-matched nonobese controls by PET scanning of [¹⁵O]-H₂O (perfusion) and 14(R,S)-[¹⁸F]fluoro-6-thia-heptadecanoate (FFA uptake). Kidney volume and radiodensity were measured by computed tomography, cardiac output by MRI. Obese subjects were re-studied 6 mo after bariatric surgery. Obese subjects had higher renal volume but lower radiodensity, suggesting accumulation of water and/or lipid. Both cardiac output and estimated glomerular filtration rate (eGFR) were increased by ~25% in the obese. Total renal blood flow was higher in the obese [885 (317) (expressed as median and interquartile range) vs. 749 (300) (expressed as means and SD) ml/min of controls, P = 0.049]. In both groups, regional blood perfusion was higher in the cortex than medulla; in either region, FFA uptake was ~50% higher in the obese as a consequence of higher circulating FFA levels. Following weight loss (26 ± 8 kg), total renal blood flow was reduced (P = 0.006). Renal volume, eGFR, cortical and medullary FFA uptake were decreased but not fully normalized. Obesity is associated with renal structural, hemodynamic, and metabolic changes. Six months after bariatric surgery, the hemodynamic changes are reversed and the structural changes are improved. On the contrary, renal FFA uptake remains increased, driven by high substrate availability.

Imaging of cancer lipid metabolism in response to therapy

Lipids represent a diverse array of molecules essential to the cell's structure, defense, energy, and communication. Lipid metabolism can often become dysregulated during tumor development. During cancer therapy, targeted inhibition of cell proliferation can likewise cause widespread and drastic changes in lipid composition. Molecular imaging techniques have been developed to monitor altered lipid profiles as a biomarker for cancer diagnosis and treatment response. For decades, MRS has been the dominant non-invasive technique for studying lipid metabolite levels. Recent insights into the oncogenic transformations driving changes in lipid metabolism have revealed new mechanisms and signaling molecules that can be exploited using optical imaging, mass spectrometry imaging, and positron emission tomography. These novel imaging modalities have provided researchers with a diverse toolbox to examine changes in lipids in response to a wide array of anticancer strategies including chemotherapy, radiation therapy, signal transduction inhibitors, gene therapy, immunotherapy, or a combination of these strategies. The understanding of lipid metabolism in response to cancer therapy continues to evolve as each therapeutic method emerges, and this review seeks to summarize the current field and areas of unmet needs.

Subcutaneous adipose tissue free fatty acid uptake measured using positron emission tomography and adipose biopsies in humans

Positron emission tomography (PET) radiopharmaceuticals can noninvasively measure free fatty acid (FFA) uptake into adipose tissue. We studied 29 volunteers to test whether abdominal and femoral subcutaneous adipose tissue FFA uptake measured using [1-¹¹C]palmitate PET agrees with FFA storage rates measured using an intravenous bolus of [1-¹⁴C]palmitate and adipose biopsies. The dynamic left ventricular cavity PET images combined with blood sample radioactivity corrected for the ¹¹CO₂ content were used to create the blood time activity curve (TAC), and the constant (K_i) was determined using Patlak analysis of the TACs generated for regions of interest in abdominal subcutaneous fat. These data were used to calculate palmitate uptake rates in abdominal subcutaneous adipose tissue (µmol·kg^-1·min^-1). Immediately after the dynamic imaging, a static image of the thigh was taken to measure the standardized uptake value (SUV) in thigh adipose tissue, which was scaled to each participant's abdominal adipose tissue SUV to calculate thigh adipose palmitate uptake rates. Abdominal adipose palmitate uptake using PET [1-¹¹C]palmitate was correlated with, but significantly (P < 0.001) greater than, FFA storage measured using [1-¹⁴C]palmitate and adipose biopsy. Thigh adipose palmitate measured using PET calculation was positively correlated (R² = 0.44, P < 0.0001) with and not different from the biopsy approach. The relative differences between PET measured abdominal subcutaneous adipose tissue palmitate uptake and biopsy-measured palmitate storage were positively correlated (P = 0.03) with abdominal subcutaneous fat. We conclude that abdominal adipose tissue FFA uptake measured using PET does not equate to adipose FFA storage measured using biopsy techniques.