Multiparameter monitoring of the awake brain under hyperbaric oxygenation

Mitochondrial function and brain Metabolic Score (BMS) in ischemic Stroke: Evaluation of "neuroprotectants" safety and efficacy

The initial and significant event developed in ischemic stroke is the sudden decrease in blood flow and oxygen supply to brain tissue, leading to dysfunction of the mitochondria. Many attempts were and are being made to develop new drugs and treatments that will save the ischemic brain, but the efficacy is not optimal and in many patients, irreversible damage to the brain will persist. We review a unique approach to evaluate mitochondrial function and microcirculatory hemodynamic in real time in vivo. Three out of four monitored physiological parameters are integrated into a new Brain Metabolic Score (BMS) calculated in real time and is correlated to Brain Oxygen Balance. The technology was adapted to various experimental as well as clinical situations for monitoring the brain in real time. The developed protocols could be used in testing the efficacy and safety of new drugs in experimental animals. Few models of brain monitoring during partial or complete ischemia were developed and used in naive animals or under brain activation protocols. It was found that mitochondrial function/dysfunction is the major and dominant parameter affecting the calculated Brain Metabolic Score. Using our monitoring system and protocols will provide direct information regarding the ability of the tested brain to provide enough oxygen consumed by the mitochondria in the "resting" or in the "activated" brain in vivo and in real-time. Preliminary studies, indicated that testing the efficacy and safety of new neuroprotectant drugs provided significant results to the R&D studies of ischemic stroke related to mitochondrial function.

Shedding light on mitochondrial function by real time monitoring of NADH fluorescence: II: human studies

Monitoring the mitochondrial function, alone or together with microcirculatory blood flow, volume and hemoglobin oxygenation in patients, is very rare. The integrity of microcirculation and mitochondrial activity is a key factor in keeping normal cellular activities. Many pathological conditions in patients are directly or indirectly related to dysfunction of the mitochondria. Evaluation of mitochondrial activity by measuring the autofluorescence of NADH has been the most practical approach since the 1950s. This review, which accompanies part I, presents the principles and technological aspects of various devices used in order to monitor mitochondrial NADH redox state and tissue viability in patients. In part I, the detailed technological aspects of NADH monitoring were described. Typical results accumulated in our studies since the mid-1990s are presented as well. We were able to apply the fiber optic based NADH fluorometry to several organs monitored in vivo in patients under various pathophysiological conditions.

Shedding light on mitochondrial function by real time monitoring of NADH fluorescence: I. Basic methodology and animal studies

Normal mitochondrial function in the process of metabolic energy production is a key factor in maintaining cellular activities. Many pathological conditions in animals, as well as in patients, are directly or indirectly related to dysfunction of the mitochondria. Monitoring the mitochondrial activity by measuring the autofluorescence of NADH has been the most practical approach since the 1950s. This review presents the principles and technological aspects, as well as typical results, accumulated in our laboratory since the early 1970s. We were able to apply the fiber-optic-based NADH fluorometry to many organs monitored in vivo under various pathophysiological conditions in animals. These studies were the basis for the development of clinical monitoring devices as presented in accompanying article. The encouraging experimental results in animals stimulated us to apply the same technology in patients after technological adaptations as described in the accompanying article. Our medical device was approved for clinical use by the FDA.

Effect of hyperbaric oxygenation on brain hemodynamics, hemoglobin oxygenation and mitochondrial NADH

To determine the HbO(2) oxygenation level at the microcirculation, we used the hyperbaric chamber. The effects of hyperbaric oxygenation (HBO) were tested on vitality parameters in the brain at various pressures. Microcirculatory hemoglobin oxygen saturation (HbO(2)), cerebral blood flow (CBF) and mitochondrial NADH redox state were assessed in the brain of awake restrained rats using a fiber optic probe. The hypothesis was that HBO may lead to maximal level in microcirculatory HbO(2) due to the amount of the dissolved O(2) to provide the O(2) consumed by the brain, and therefore no O(2) will be dissociated from the HbO(2). Awake rats were exposed progressively to 15 min normobaric hyperoxia, 100% O(2) (NH) and to 90 min hyperbaric hyperoxia (HH) from 1.75 to 6.0 absolute atmospheres (ATA). NH and HH gradually decreased the blood volume measured by tissue reflectance and NADH but increased HbO(2) in relation to pO(2) in the chamber up to a nearly maximum effect at 2.5 ATA. Two possible approximations were found to describe the relationship between NADH and HbO(2): linear or logarithmic. These findings show that the increase in brain microcirculatory HbO(2) is due to an increase in O(2) supply by dissolved O(2), reaching a maximum at 2.5 ATA. NADH is oxidized (decreased signal) in parallel to the HbO(2) increase, showing maximal tissue oxygenation and cellular mitochondrial NADH oxidation at 2.5 ATA. In conclusion, in the normoxic brain, the level of microcirculatory HbO(2) is about 50% as compared to the maximal level recorded at 2.5 ATA and the minimal level measured during anoxia.

Mitochondrial function in vivo evaluated by NADH fluorescence: from animal models to human studies

Normal mitochondrial function is a critical factor in maintaining cellular homeostasis in various organs of the body. Due to the involvement of mitochondrial dysfunction in many pathological states, the real-time in vivo monitoring of the mitochondrial metabolic state is crucially important. This type of monitoring in animal models as well as in patients provides real-time data that can help interpret experimental results or optimize patient treatment. The goals of the present review are the following: 1) to provide an historical overview of NADH fluorescence monitoring and its physiological significance; 2) to present the solid scientific ground underlying NADH fluorescence measurements based on published materials; 3) to provide the reader with basic information on the methodologies used in the past and the current state of the art fluorometers; and 4) to clarify the various factors affecting monitored signals, including artifacts. The large numbers of publications by different groups testify to the valuable information gathered in various experimental conditions. The monitoring of NADH levels in the tissue provides the most important information on the metabolic state of the mitochondria in terms of energy production and intracellular oxygen levels. Although NADH signals are not calibrated in absolute units, their trend monitoring is important for the interpretation of physiological or pathological situations. To understand tissue function better, the multiparametric approach has been developed where NADH serves as the key parameter. The development of new light sources in UV and visible spectra has led to the development of small compact units applicable in clinical conditions for better diagnosis of patients.

Modeling brain energy metabolism and function: a multiparametric monitoring approach

Mathematical modeling of brain function is an important tool needed for a better understanding of experimental results and clinical situations. In the present study, we are constructing and testing a mathematical model capable of simulating changes in brain energy metabolism that develop in real time under various pathophysiological conditions. The model incorporates the following parameters: cerebral blood flow, partial oxygen pressure, mitochondrial NADH redox state, and extracellular potassium. Accordingly, all the model variables are only time dependent (;point-model' approach). Numerical runs demonstrate the ability of the model to mimic pathological conditions, such as complete and partial ischemia, cortical spreading depression under normoxic and partial ischemic conditions. They also show that, when properly tuned, a model of this type permits the monitoring of only one or two crucial variables and the computation of the remaining variables in real time during clinical or experimental procedures.

Effects of euthanasia on brain physiological activities monitored in real-time

Animal experimentation is terminated by the euthanasia procedure in order to avoid pain and minimize suffering. Very little is known about the real time physiological changes taking place in the brain of animals during the euthanasia. Since there is no way to evaluate the suffering of animals under euthanasia, it is assumed that objective physiological changes taking place could serve as a good way to compare various types of euthanasia procedures. In the present study we compared the effect of euthanasia induced by i. v. injection of concentrated KCL to that of Taxan T-61 (a standard mixture used by veterinarians). The responses of the cat brain were evaluated by monitoring the hemodynamic (CBF), metabolic (NADH redox state), electrical (EcoG) and extracellular ion levels, as an indicator to the ionic homeostasis.

Can the Indo-1 fluorescence approach measure brain intracellular calcium in vivo? A multiparametric study of cerebrocortical anoxia and ischemia

Indo-1 fluorescence was used to monitor intracellular calcium levels in the cat brain in vivo, using the approach proposed by Uematsu et al. [Uematsu D., Greenberg J. H., Reivich M., Karp A. In vivo measurement of cytosolic free calcium during cerebral ischemia and reperfusion. Ann Neurol 1988; 24: 420-428]. In addition, extracellular calcium and potassium levels, NADH redox state, electrocorticogram (ECoG), DC potential and relative cerebral blood flow were monitored simultaneously. Changes in the Indo-1 fluorescence ratio F400/F506 were monitored during anoxia, reversible ischemia and irreversible ischemia. Although these perturbations resulted in the expected changes in extracellular calcium and potassium levels, NADH redox state, ECoG and other physiological parameters, they did not result in significant increases in the F400/F506 ratio. The apparent insensitivity of the in vivo Indo-1 approach is due to the difficulty in obtaining accurate fluorescence signals from Indo-1 in the brain. Two reasons for this difficulty appear to be problems in loading Indo-1 into the brain, and problems in correcting Indo-1 fluorescence signals for changes in NADH fluorescence and changes in absorption of intrinsic chromophores. Under the conditions of our in vivo cat experiments, Indo-1 fluorescence is not a viable approach for measuring changes in cerebral intracellular calcium levels.

Cortical spreading depression recorded from the human brain using a multiparametric monitoring system

The number of parameters (i.e., EEG or ICP-intracranial pressure) routinely monitored under clinical situations is limited. The brain function analyzer described in this paper enables simultaneous, continuous on-line monitoring of cerebral blood flow (CBF) and volume (CBV), intramitochondrial NADH redox state, extracellular K+ concentrations, DC potential, electrocorticography and ICP from the cerebral cortex. Brain function of 14 patients with severe head injury (GCS < or = 8), who were hospitalized in the neurosurgical or general intensive care unit was monitored using this analyzer. Leao cortical spreading depression (SD) has been reported in many experimental animals but not in the human cerebral cortex. In one of the patients monitored, spreading depression was observed. This is the first time that spontaneous repetitive cortical SD cycles have been recorded from the cerebral cortex of a patient suffering from severe head injury. Typical SD cycles appeared 4-5 h after the beginning of monitoring this patient. During the first 3-4 cycles the responses of this patient were very similar to the responses to SD recorded in normoxic experimental animals. Electrocorticography was depressed whereas extracellular K+ levels increased. The metabolic response to spreading depression was characterized by oxidation of intramitochondrial NADH concomitant to a large increase in CBF. During brain death, an ischemic depolarization, characterized by decrease in CBF and an irreversible increase in extracellular K+, was recorded.

Multiparameter monitoring and analysis of in vivo ischemic and hypoxic heart

We describe a unique in vivo technique which addresses the multifactorial function of the heart, i.e., simultaneous measurement of myocardial ion transport (two mini-electrode systems to measure K+e and Ca2+e), energy metabolism (NADH fluorescence to measure NADH redox state), and coronary flow (laser-Doppler perfusion) using a multiprobe assembly (MPA) which contains transducers for all measurements. The MPA (which is 6 mm in diameter) was applied to the external surface of the heart in an open chest dog model. To test MPA function, myocardial ischemia was produced by application of a balloon occluder to the left anterior descending coronary (LAD) artery, and hypoxia was produced by changing the inspired O2-N2 ratio until the PaO2 was 20-30 torr. The MPA simultaneously monitored changes in ion flux, heart metabolism, and tissue perfusion during pathophysiological intervention.

Continuous multiparametric monitoring of brain activities following fluid-percussion injury in rats: preliminary results

Severe head injury can result in a high mortality rate or irreversible brain damage. One technique used to induce traumatic brain injury (TBI) is exposure of the brain to fluid percussion pressure while monitoring the increase in intracranial pressure (ICP). Since brain injury is a multifactorial, pathological, time-dependent state, the multiparametric monitoring approach was adopted for studying fluid percussion effects on the rat brain. A multiprobe assembly (MPA) connected to the brain in vivo (right hemisphere) enabled the simultaneous monitoring of CBF, NADH redox state, extracellular K+, Ca2+, H+ levels as well as DC potential, ECoG and ICP. The animal was connected to the monitoring system and exposed to TBI after a recuperation period of at least 3 hours after the end of the operation. Two typical responses to TBI were recorded in our preliminary experiments. When severe injury was induced, ischemic depolarization (ID) developed, whereas mild or moderate injury led to repetitive spreading depression (SD) cycles. The relationship between the ID and SD observed under TBI is important to the understanding of the mechanism of brain injury. ICP before injury was between 2-6 mm Hg and increased to 20-22 mm Hg 2-3 minutes after the ID. After severe head injury, ICP remained high and in some cases increased to critical values causing death of these animals. Some animals developed seizures at various stages after the TBI. Hyperbaric oxygenation was used as a therapeutic tool to treat severely injured animals. These preliminary results suggest that it is feasible and practical to use the MPA approach for monitoring the brain after TBI.

Metabolic regulation of in vivo myocardial contractile function: multiparameter analysis

To gain insight into the mechanisms of myocardial regulation as it relates to the interaction of mechanical and metabolic function and perfusion, intact animal models were instrumented for routine physiological measurements of mechanical function and for measurements of metabolism (31P NMR, NADH fluorescence (redox state)) and perfusion (2H NMR and Laser doppler techniques). These techniques were applied to canine and cat models of volume and/or pressure loading, hypoxia, ischemia and cardiomyopathic states. Data generated using these techniques indicate that myocardial bioenergetic function is quite stable under most loading conditions as long as the heart is not ischemic. In addition, these data indicate that there is no universal regulator and that different biochemical regulators appear to mediate stable function under different physiological and pathophysiological conditions: for example; during hypoxia, NADH redox state appears to play a regulatory role; and in pressure loading, ADP, phosphorylation potential and free energy of ATP hydrolysis as well as NADH redox state appear to be regulatory.

Combined intracerebral microdialysis and electrophysiological recording: methodology and applications

A microdialysis probe is described that can simultaneously monitor indices of electrical activity, ionic homeostasis and changes in the composition of the extracellular fluid at the same brain site in anaesthetised laboratory animals. The probe is no larger than its conventional counterpart and avoids tissue injury problems due to implantation of separate recording electrodes. Examples are given of its application to the study of changes following probe implantation, cerebral ischaemia and local high K(+)-induced depolarisation.

Multiparametric evaluation of brain functions in the Mongolian gerbil in vivo

We have developed the multiprobe assembly (MPA) by which metabolic, ionic and electrical activities can be monitored from the surface of the brain. In the present study we included optical fibers for the monitoring of intracapillary hemoglobin oxygenation by use of the Erlangen Microlight Guide Spectrophotometer (EMPHO-I) from the surface of the gerbil brain. The newly developed MPA provides simultaneous information about oxygen delivery (oxydeoxy Hb), tissue pO2 level, as well as the intracellular oxygen balance (intramitochondrial redox state). The ionic homeostasis was evaluated by monitoring extracellular K+ and Ca2+ activities reflecting the permeability changes of cation channels as well as the activities of Na+,K(+)-ATPase and other ion linked transport processes. The electrical activities were monitored by a bipolar electrocortical surface probe and DC steady potential. The subjects of the present study were Mongolian gerbils (Meriones unguiculatus) anesthetized and operated according to our routine techniques. After 30 min of recovery from the operation each gerbil was exposed to a short anoxia, graded hypoxia, ischemia as well as spreading depression. The results can be summarized as follows: 1. A clear correlation was recorded between the changes in oxydeoxy Hb spectra, tissue pO2 level and oxidation-reduction state of intramitochondrial NADH under oxygen deficiency situations (hypoxia, ischemia). 2. Blood volume changes under various perturbations monitored by various probes (366 reflectance and EMPHO-I) correlated very well with each other. 3. The degree of inhibition of Na+,K(+)-ATPase induced by oxygen deficiency could be interpreted by changes in extracellular levels of K+ measured by the surface mini-electrode. 4. Brain stimulation induced by spreading depression mechanism led to transient changes in ionic homeostasis and increase in energy requirements. The major HbO2 response was an increase in oxygenation due to the large CBF increase as monitored by the laser Doppler flowmeter. 5. Changes in oxy-deoxy Hb under fast scanning of 500-600 nm during 2-3 seconds of bilateral carotid arterial occlusion provided an indirect index for tissue O2 consumption.

Effects of age on the metabolic, ionic and electrical responses to anoxia in the newborn dog brain in vivo

The interrelation between brain energy metabolism, electrical activity and ion homeostasis developing under experimental anoxia in animals of different ages is of significant value in the understanding of brain damage occurring under similar conditions of clinical neuropathology. The purpose of the present study was to compare brain energy states and extracellular ion homeostasis during anoxia in newborn puppies of various ages. We have developed and used a multiparametric monitoring device by which various functions of the brain can be recorded in a real-time mode from a 5 mm diameter area on the surface of the cortex. Intracellular oxygen balance was evaluated in newborn puppies of various ages by monitoring the intramitochondrial NADH redox state using a fluorescence technique. The electrical activity was measured by recording the spontaneous ECoG (electrocorticogram) and DC (direct current) steady potential. Ion homeostasis was evaluated using surface potassium and calcium mini-electrodes. Newborn puppies were anesthetized, the dura mater was removed and the multiprobe assembly was placed on the brain and cemented to the skull. Five groups of puppies (0-1, 2-7, 8-14, 15-21 days and 3-24 weeks) were exposed to 5 minutes of complete O2 deprivation (100% nitrogen exposure) and were monitored during the recovery period until all parameters returned to baseline values. The results may be summarized as follows: 1. Resting baseline levels of extracellular K+ were in the same range as described for other young and adult mammals (2.9 +/- 0.05 mM). 2. Extracellular Ca2+ levels were higher than those published for other mammals (1.6 +/- 0.07 mM). 3. During 5 minutes of anoxia, a significant increase in K+ levels was recorded. This increase was not accompanied by measurable changes in extracellular Ca2+. 4. The effect of age on the length of time to the elevation of the extracellular K+ concentration and on the rate of K+ accumulation from the onset of the anoxic condition was significant, i.e., the younger the animal the longer the time and the lower the rate. 5. The rate of energy depletion was age dependent as indicated by the rate of NADH accumulation during anoxia. However, no significant effect of age on the basal aerobic metabolism was found as measured by the maximum percent increase of NADH during anoxia.(ABSTRACT TRUNCATED AT 400 WORDS)

Level of ischemia and brain functions in the Mongolian gerbil in vivo

The Mongolian gerbil (Meriones unguiculatus) provides a very useful animal model to study the effects of ischemia on brain functions. In this model it is possible to induce two levels of ischemia in the same animal. Thus, monitoring the brain in vivo in real-time will provide meaningful information regarding the development of ischemic injury as well as the follow-up during the recirculation period. The aims of the study were as follows: (1) To elucidate the mechanism behind the development of ischemic depolarization under unilateral and bilateral carotid artery occlusion. (2) To exclude the possibility that removal of the dura mater will affect the results. (3) To correlate the kinetics of the recovery processes to the level of ischemia. We tested the correlation between energy depletion level (evaluated by intramitochondrial NADH redox state) and the development of ischemic depolarization (ID) and vasospasm (evaluated by extracellular K+, DC potential and 366 nm reflectance changes, respectively) under partial and complete ischemia (induced by unilateral or bilateral carotid artery occlusion) using the multiparametric monitoring system (MPA). In 12 out of 32 gerbils monitored by the MPA, the dura mater remained intact, while in the other 20, it was removed very gently before connecting the MPA to the brain. Two types of responses to unilateral carotid artery occlusion were recorded and the gerbils were divided into groups according to the development of the ID. In a third group of 5 gerbils we tested the effect of 1-5 min of bilateral occlusion on the various parameters monitored.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain NADH redox state monitored in vivo by fiber optic surface fluorometry

A new approach for the evaluation of brain energy metabolism in awake animals became possible as UV transmitting optical fibers became available. A variety of surface fiber optic fluorometers / reflectometers which were developed during the past decade enabled the monitoring of intramitochondrial NADH redox state in unanesthetized animals. The bundle of flexible fibers was connected to the brain via a cemented light guide holder implanted epidurally. The two signals obtained, 366 nm reflectance and 450 nm fluorescence, are subjected to various artifacts not connected to the intramitochondrial NADH redox state. In our system, the effects of movement artifacts and changes in blood oxygenation are negligible while the effects of tissue absorption or blood volume changes are considerable and could be minimized by subtraction of the two signals (1:1 ratio) providing the corrected fluorescence signal. The brain was exposed to various physiological and pathological conditions which resulted in the increase or decrease in the level of NADH. Under anoxia, hypoxia and ischemia, oxygen availability decreased and the metabolic state of the brain became more reduced (state 4-5 transition). When the brain was activated by seizures, spreading depression of hyperbaric oxygenation NADH became more oxidized (state 4-3 transition).