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Koleini N, Meddeb M, Zhao L, Keykhaei M, Kwon S, Farshidfar F, Hahn VS, Pearce EL, Sharma K, Kass DA. Landscape of glycolytic metabolites and their regulating proteins in myocardium from human heart failure with preserved ejection fraction. Eur J Heart Fail 2024. [PMID: 39119952 DOI: 10.1002/ejhf.3389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/13/2024] [Accepted: 07/04/2024] [Indexed: 08/10/2024] Open
Abstract
AIMS Heart failure (HF) with preserved ejection fraction (HFpEF) reflects half of all clinical HF yet has few therapies. Obesity and diabetes are now common comorbidities which have focused attention towards underlying myocardial metabolic defects. The profile of a major metabolic pathway, glycolytic intermediates and their regulating enzymes and ancillary pathways, remains unknown. METHODS AND RESULTS Endomyocardial biopsies from HFpEF (n = 37) and non-failing controls (n = 21) were assayed by non-targeted or targeted metabolomics and immunoblot to determine glycolytic and ancillary pathway metabolites and protein expression of their regulating enzymes. Glucose and GLUT1 expression were higher in HFpEF, but prominent glycolytic metabolites: glucose-6-phosphate, fructose-1,6-biphosphate (F1,6bP), and 3-phosphoglycerate were reduced by -78%, -91%, and -73%, respectively, versus controls. Expression of their corresponding synthesizing enzymes hexokinase, phospho-fructokinase, and phosphoglycerate kinase were also significantly lower (all p < 0.0005). Pentose phosphate and hexosamine biosynthetic pathway metabolites were reduced while glycogen content increased. Despite proximal reduction in key glycolytic intermediates, pyruvate increased but mitochondrial pyruvate transporter (MPC1) expression was reduced. Pyruvate dehydrogenase converting pyruvate to acetyl-CoA was more activated but some Krebs cycle intermediates were reduced. This HFpEF glycolytic profile persisted after adjusting for body mass index (BMI), diabetes, age, and sex, or in subgroup analysis with controls and HFpEF matched for BMI and diabetes/insulin history. In HFpEF, BMI but not glycated haemoglobin negatively correlated with F1,6bP (p = 7e-5, r = -0.61) and phosphoenolpyruvate (p = 0.006, r = -0.46). CONCLUSIONS Human HFpEF myocardium exhibits reduced glycolytic and ancillary pathway intermediates and expression of their synthesizing proteins. This combines features reported in HF with reduced ejection fraction and obesity/diabetes that likely exacerbate metabolic inflexibility.
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Affiliation(s)
- Navid Koleini
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mariam Meddeb
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Liang Zhao
- Department of Chemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, and Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Complete Omics Inc, Baltimore, MD, USA
| | - Mohammad Keykhaei
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seoyoung Kwon
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Farnaz Farshidfar
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Virginia S Hahn
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erika L Pearce
- Department of Chemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, and Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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2
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Blazey T, Shaw A, von Morze C. A vendor-neutral EPI sequence for hyperpolarized 13C MRI. Magn Reson Med 2024; 92:772-781. [PMID: 38525658 DOI: 10.1002/mrm.30090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/02/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE To develop a flexible, vendor-neutral EPI sequence for hyperpolarized 13C metabolic imaging. METHODS An open-source EPI sequence consisting of a metabolite-specific spectral-spatial RF excitation pulse and a customizable EPI readout was created using the Pulseq framework. To explore the flexibility of our sequence, we tested several versions of the sequence including a symmetric 3D readout with different spatial resolutions for each metabolite (1.0 cm3 and 1.5 cm3). A multichamber phantom constructed with a Shepp-Logan geometry, containing two chambers filled with either natural abundance 13C compounds or hyperpolarized (HP) [1-13C]pyruvate, was used to test each sequence. For experiments involving HP [1-13C]pyruvate, a single chamber was prefilled with nicotinamide adenine dinucleotide hydride and lactate dehydrogenase to facilitate the conversion of [1-13C]pyruvate to [1-13C]lactate. All experiments were performed on a Siemens Prisma 3T scanner. RESULTS All the sequence variations localized natural-abundance 13C ethylene glycol and methanol to the appropriate compartment of the multichamber phantom. [1-13C]pyruvate was detectable in both chambers following the injection of HP [1-13C]pyruvate, whereas [1-13C]lactate was only found in the chamber containing nicotinamide adenine dinucleotide hydride and lactate dehydrogenase. The conversion rate from [1-13C]pyruvate to [1-13C]lactate (kPL) was 0.01 s-1 (95% confidence interval [0.00, 0.02]). CONCLUSION We have developed and tested a vendor-neutral EPI sequence for imaging HP 13C agents. We have made all of our sequence creation and image reconstruction code freely available online for other investigators to use.
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Affiliation(s)
- Tyler Blazey
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
| | - Ashley Shaw
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
| | - Cornelius von Morze
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
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3
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Huynh MT, Erfani Z, Al Nemri S, Chirayil S, Kovacs Z, Park JM. Enhanced Solubility and Polarization of 13C-Fumarate with Meglumine Allows for In Vivo Detection of Gluconeogenic Metabolism in Kidneys. ACS APPLIED MATERIALS & INTERFACES 2024; 16:37435-37444. [PMID: 38984763 PMCID: PMC11272437 DOI: 10.1021/acsami.4c03163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Hyperpolarized 13C-labeled fumarate probes tissue necrosis via the production of 13C-malate. Despite its promises in detecting tumor necrosis and kidney injuries, its clinical translation has been limited, primarily due to the low solubility in conventional glassing solvents. In this study, we introduce a new formulation of fumarate for dissolution dynamic nuclear polarization (DNP) by using meglumine as a counterion, a nonmetabolizable derivative of sorbitol. We have found that meglumine fumarate vitrifies by itself with enhanced water solubility (4.8 M), which is expected to overcome the solubility-restricted maximum concentration of hyperpolarized fumarate after dissolution. The achievable liquid-state polarization level of meglumine-fumarate is more than doubled (29.4 ± 1.3%) as compared to conventional dimethyl sulfoxide (DMSO)-mixed fumarate (13.5 ± 2.4%). In vivo comparison of DMSO- and meglumine-prepared 50-mM hyperpolarized [1,4-13C2]fumarate shows that the signal sensitivity in rat kidneys increases by 10-fold. As a result, [1,4-13C2]aspartate and [13C]bicarbonate in addition to [1,4-13C2]malate can be detected in healthy rat kidneys in vivo using hyperpolarized meglumine [1,4-13C2]fumarate. In particular, the appearance of [13C]bicarbonate indicates that hyperpolarized meglumine [1,4-13C2]fumarate can be used to investigate phosphoenolpyruvate carboxykinase, a key regulatory enzyme in gluconeogenesis.
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Affiliation(s)
- Mai T Huynh
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Zohreh Erfani
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Sarah Al Nemri
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Sara Chirayil
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Zoltan Kovacs
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Jae Mo Park
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
- Department of Biomedical Engineering, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
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4
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Lewis AJM, Dodd MS, Sourdon J, Lygate CA, Clarke K, Neubauer S, Tyler DJ, Rider OJ. Hyperpolarized 13C and 31P MRS detects differences in cardiac energetics, metabolism, and function in obesity, and responses following treatment. NMR IN BIOMEDICINE 2024:e5206. [PMID: 38994722 DOI: 10.1002/nbm.5206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 07/13/2024]
Abstract
Obesity is associated with important changes in cardiac energetics and function, and an increased risk of adverse cardiovascular outcomes. Multi-nuclear MRS and MRI techniques have the potential to provide a comprehensive non-invasive assessment of cardiac metabolic perturbation in obesity. A rat model of obesity was created by high-fat diet feeding. This model was characterized using in vivo hyperpolarized [1-13C]pyruvate and [2-13C]pyruvate MRS, echocardiography and perfused heart 31P MRS. Two groups of obese rats were subsequently treated with either caloric restriction or the glucagon-like peptide-1 analogue/agonist liraglutide, prior to reassessment. The model recapitulated cardiovascular consequences of human obesity, including mild left ventricular hypertrophy, and diastolic, but not systolic, dysfunction. Hyperpolarized 13C and 31P MRS demonstrated that obesity was associated with reduced myocardial pyruvate dehydrogenase flux, altered cardiac tricarboxylic acid (TCA) cycle metabolism, and impaired myocardial energetic status (lower phosphocreatine to adenosine triphosphate ratio and impaired cardiac ΔG~ATP). Both caloric restriction and liraglutide treatment were associated with normalization of metabolic changes, alongside improvement in cardiac diastolic function. In this model of obesity, hyperpolarized 13C and 31P MRS demonstrated abnormalities in cardiac metabolism at multiple levels, including myocardial substrate selection, TCA cycle, and high-energy phosphorus metabolism. Metabolic changes were linked with impairment of diastolic function and were reversed in concert following either caloric restriction or liraglutide treatment. With hyperpolarized 13C and 31P techniques now available for human use, the findings support a role for multi-nuclear MRS in the development of new therapies for obesity.
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Affiliation(s)
- Andrew J M Lewis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Michael S Dodd
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Centre for Health and Life Sciences, Coventry University, Coventry, UK
| | - Joevin Sourdon
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Craig A Lygate
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Damian J Tyler
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Oliver J Rider
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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5
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Qu J, Wang Y, Wang Q. Cuproptosis: potential new direction in diabetes research and treatment. Front Endocrinol (Lausanne) 2024; 15:1344729. [PMID: 38904034 PMCID: PMC11188452 DOI: 10.3389/fendo.2024.1344729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Cuproptosis, a recently discovered form of cell death, stems from an overabundance of copper ions infiltrating mitochondria. These ions directly engage lipoylated proteins, prompting their oligomerization and subsequent loss of iron-sulfur clusters. This sequence induces proteotoxic stress, ultimately culminating in cell death. Type 2 diabetes, a chronic metabolic disorder resulting from a complex interplay of genetic and environmental factors, has not yet been fully understood in terms of its etiology and pathogenesis. Intricately, it is linked to various modalities of cell death, including mitochondrial autophagy, apoptosis, pyroptosis, and ferroptosis. Studies have discovered impaired copper metabolism in individuals with Type 2 diabetes, hinting at a unique role for copper homeostasis in the progression of the disease. To this end, the present research aims to delineate the potential correlation between cuproptosis and Type 2 diabetes by exhaustively reviewing the existing literature. By synthesizing relevant research on cuproptosis, the paper intends to lay the groundwork for a thorough exploration of the pathogenesis of Type 2 diabetes and the development of targeted therapeutic interventions. The ultimate objective is to facilitate a deeper understanding of Type 2 diabetes and to identify novel therapeutic strategies associated with cuproptosis.
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Affiliation(s)
| | | | - Qiuyue Wang
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, Liaoning, China
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6
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Larson PEZ, Bernard JML, Bankson JA, Bøgh N, Bok RA, Chen AP, Cunningham CH, Gordon J, Hövener JB, Laustsen C, Mayer D, McLean MA, Schilling F, Slater J, Vanderheyden JL, von Morze C, Vigneron DB, Xu D. Current methods for hyperpolarized [1- 13C]pyruvate MRI human studies. Magn Reson Med 2024; 91:2204-2228. [PMID: 38441968 PMCID: PMC10997462 DOI: 10.1002/mrm.29875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/12/2023] [Accepted: 09/06/2023] [Indexed: 03/07/2024]
Abstract
MRI with hyperpolarized (HP) 13C agents, also known as HP 13C MRI, can measure processes such as localized metabolism that is altered in numerous cancers, liver, heart, kidney diseases, and more. It has been translated into human studies during the past 10 years, with recent rapid growth in studies largely based on increasing availability of HP agent preparation methods suitable for use in humans. This paper aims to capture the current successful practices for HP MRI human studies with [1-13C]pyruvate-by far the most commonly used agent, which sits at a key metabolic junction in glycolysis. The paper is divided into four major topic areas: (1) HP 13C-pyruvate preparation; (2) MRI system setup and calibrations; (3) data acquisition and image reconstruction; and (4) data analysis and quantification. In each area, we identified the key components for a successful study, summarized both published studies and current practices, and discuss evidence gaps, strengths, and limitations. This paper is the output of the "HP 13C MRI Consensus Group" as well as the ISMRM Hyperpolarized Media MR and Hyperpolarized Methods and Equipment study groups. It further aims to provide a comprehensive reference for future consensus, building as the field continues to advance human studies with this metabolic imaging modality.
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Affiliation(s)
- Peder EZ Larson
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering,
University of California, San Francisco and University of California, Berkeley, CA
94143, USA
| | - Jenna ML Bernard
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | - James A Bankson
- Department of Imaging Physics, MD Anderson Medical Center,
Houston, TX, USA
| | - Nikolaj Bøgh
- The MR Research Center, Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
| | - Robert A Bok
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | | | - Charles H Cunningham
- Physical Sciences, Sunnybrook Research Institute, Toronto,
Ontario, Canada
- Department of Medical Biophysics, University of Toronto,
Toronto, Ontario, Canada
| | - Jeremy Gordon
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North
Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University
Medical Center Schleswig-Holstein (UKSH), Kiel University, Am Botanischen Garten 14,
24118, Kiel, Germany
| | - Christoffer Laustsen
- The MR Research Center, Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
| | - Dirk Mayer
- Department of Diagnostic Radiology and Nuclear Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
- Greenebaum Cancer Center, University of Maryland School
of Medicine, Baltimore, MD, USA
| | - Mary A McLean
- Department of Radiology, University of Cambridge,
Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of
Cambridge, Li Ka Shing Center, Cambridge, United Kingdom
| | - Franz Schilling
- Department of Nuclear Medicine, School of Medicine,
Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich,
Germany
| | - James Slater
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | | | | | - Daniel B Vigneron
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering,
University of California, San Francisco and University of California, Berkeley, CA
94143, USA
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering,
University of California, San Francisco and University of California, Berkeley, CA
94143, USA
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7
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Frijia F, Flori A, Giovannetti G, Barison A, Menichetti L, Santarelli MF, Positano V. MRI Application and Challenges of Hyperpolarized Carbon-13 Pyruvate in Translational and Clinical Cardiovascular Studies: A Literature Review. Diagnostics (Basel) 2024; 14:1035. [PMID: 38786333 PMCID: PMC11120300 DOI: 10.3390/diagnostics14101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Cardiovascular disease shows, or may even be caused by, changes in metabolism. Hyperpolarized magnetic resonance spectroscopy and imaging is a technique that could assess the role of different aspects of metabolism in heart disease, allowing real-time metabolic flux assessment in vivo. In this review, we introduce the main hyperpolarization techniques. Then, we summarize the use of dedicated radiofrequency 13C coils, and report a state of the art of 13C data acquisition. Finally, this review provides an overview of the pre-clinical and clinical studies on cardiac metabolism in the healthy and diseased heart. We furthermore show what advances have been made to translate this technique into the clinic in the near future and what technical challenges still remain, such as exploring other metabolic substrates.
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Affiliation(s)
- Francesca Frijia
- Bioengineering Unit, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (A.F.); (V.P.)
| | - Alessandra Flori
- Bioengineering Unit, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (A.F.); (V.P.)
| | - Giulio Giovannetti
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (G.G.); (L.M.); (M.F.S.)
| | - Andrea Barison
- Cardiology and Cardiovascular Medicine Unit, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy;
| | - Luca Menichetti
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (G.G.); (L.M.); (M.F.S.)
| | - Maria Filomena Santarelli
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (G.G.); (L.M.); (M.F.S.)
| | - Vincenzo Positano
- Bioengineering Unit, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (A.F.); (V.P.)
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8
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Berg-Hansen K, Gopalasingam N, Christensen KH, Ladefoged B, Andersen MJ, Poulsen SH, Borlaug BA, Nielsen R, Møller N, Wiggers H. Cardiovascular Effects of Oral Ketone Ester Treatment in Patients With Heart Failure With Reduced Ejection Fraction: A Randomized, Controlled, Double-Blind Trial. Circulation 2024; 149:1474-1489. [PMID: 38533643 PMCID: PMC11081479 DOI: 10.1161/circulationaha.123.067971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Heart failure triggers a shift in myocardial metabolic substrate utilization, favoring the ketone body 3-hydroxybutyrate as energy source. We hypothesized that 14-day treatment with ketone ester (KE) would improve resting and exercise hemodynamics and exercise capacity in patients with heart failure with reduced ejection fraction. METHODS In a randomized, double-blind cross-over study, nondiabetic patients with heart failure with reduced ejection fraction received 14-day KE and 14-day isocaloric non-KE comparator regimens of 4 daily doses separated by a 14-day washout period. After each treatment period, participants underwent right heart catheterization, echocardiography, and blood sampling at plasma trough levels and after dosing. Participants underwent an exercise hemodynamic assessment after a second dosing. The primary end point was resting cardiac output (CO). Secondary end points included resting and exercise pulmonary capillary wedge pressure and peak exercise CO and metabolic equivalents. RESULTS We included 24 patients with heart failure with reduced ejection fraction (17 men; 65±9 years of age; all White). Resting CO at trough levels was higher after KE compared with isocaloric comparator (5.2±1.1 L/min versus 5.0±1.1 L/min; difference, 0.3 L/min [95% CI, 0.1-0.5), and pulmonary capillary wedge pressure was lower (8±3 mm Hg versus 11±3 mm Hg; difference, -2 mm Hg [95% CI, -4 to -1]). These changes were amplified after KE dosing. Across all exercise intensities, KE treatment was associated with lower mean exercise pulmonary capillary wedge pressure (-3 mm Hg [95% CI, -5 to -1] ) and higher mean CO (0.5 L/min [95% CI, 0.1-0.8]), significantly different at low to moderate steady-state exercise but not at peak. Metabolic equivalents remained similar between treatments. In exploratory analyses, KE treatment was associated with 18% lower NT-proBNP (N-terminal pro-B-type natriuretic peptide; difference, -98 ng/L [95% CI, -185 to -23]), higher left ventricular ejection fraction (37±5 versus 34±5%; P=0.01), and lower left atrial and ventricular volumes. CONCLUSIONS KE treatment for 14 days was associated with higher CO at rest and lower filling pressures, cardiac volumes, and NT-proBNP levels compared with isocaloric comparator. These changes persisted during exercise and were achieved on top of optimal medical therapy. Sustained modulation of circulating ketone bodies is a potential treatment principle in patients with heart failure with reduced ejection fraction. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05161650.
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Affiliation(s)
- Kristoffer Berg-Hansen
- Department of Cardiology (K.B.-H., N.G., K.H.C., B.L., M.J.A., S.H.P., R.N., H.W.), Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark (K.B.-H., N.G., K.H.C., B.L., S.H.P., N.M., H.W.)
| | - Nigopan Gopalasingam
- Department of Cardiology (K.B.-H., N.G., K.H.C., B.L., M.J.A., S.H.P., R.N., H.W.), Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark (K.B.-H., N.G., K.H.C., B.L., S.H.P., N.M., H.W.)
| | - Kristian Hylleberg Christensen
- Department of Cardiology (K.B.-H., N.G., K.H.C., B.L., M.J.A., S.H.P., R.N., H.W.), Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark (K.B.-H., N.G., K.H.C., B.L., S.H.P., N.M., H.W.)
| | - Bertil Ladefoged
- Department of Cardiology (K.B.-H., N.G., K.H.C., B.L., M.J.A., S.H.P., R.N., H.W.), Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark (K.B.-H., N.G., K.H.C., B.L., S.H.P., N.M., H.W.)
| | - Mads Jønsson Andersen
- Department of Cardiology (K.B.-H., N.G., K.H.C., B.L., M.J.A., S.H.P., R.N., H.W.), Aarhus University Hospital, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology (K.B.-H., N.G., K.H.C., B.L., M.J.A., S.H.P., R.N., H.W.), Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark (K.B.-H., N.G., K.H.C., B.L., S.H.P., N.M., H.W.)
| | - Barry A. Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, MN (B.A.B.)
| | - Roni Nielsen
- Department of Cardiology (K.B.-H., N.G., K.H.C., B.L., M.J.A., S.H.P., R.N., H.W.), Aarhus University Hospital, Denmark
| | - Niels Møller
- Department of Endocrinology and Metabolism (N.M.), Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark (K.B.-H., N.G., K.H.C., B.L., S.H.P., N.M., H.W.)
| | - Henrik Wiggers
- Department of Cardiology (K.B.-H., N.G., K.H.C., B.L., M.J.A., S.H.P., R.N., H.W.), Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark (K.B.-H., N.G., K.H.C., B.L., S.H.P., N.M., H.W.)
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9
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Lai YC, Hsieh CY, Juan YH, Lu KY, Lee HJ, Ng SH, Wan YL, Lin G. Hyperpolarized Carbon-13 Magnetic Resonance Imaging: Technical Considerations and Clinical Applications. Korean J Radiol 2024; 25:459-472. [PMID: 38685736 PMCID: PMC11058429 DOI: 10.3348/kjr.2024.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/17/2024] [Accepted: 02/27/2024] [Indexed: 05/02/2024] Open
Abstract
Hyperpolarized (HP) carbon-13 (13C) MRI represents an innovative approach for noninvasive, real-time assessment of dynamic metabolic flux, with potential integration into routine clinical MRI. The use of [1-13C]pyruvate as a probe and its conversion to [1-13C]lactate constitute an extensively explored metabolic pathway. This review comprehensively outlines the establishment of HP 13C-MRI, covering multidisciplinary team collaboration, hardware prerequisites, probe preparation, hyperpolarization techniques, imaging acquisition, and data analysis. This article discusses the clinical applications of HP 13C-MRI across various anatomical domains, including the brain, heart, skeletal muscle, breast, liver, kidney, pancreas, and prostate. Each section highlights the specific applications and findings pertinent to these regions, emphasizing the potential versatility of HP 13C-MRI in diverse clinical contexts. This review serves as a comprehensive update, bridging technical aspects with clinical applications and offering insights into the ongoing advancements in HP 13C-MRI.
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Affiliation(s)
- Ying-Chieh Lai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ching-Yi Hsieh
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Research Center for Radiation Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsiang Juan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Ying Lu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hsien-Ju Lee
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Research Center for Radiation Medicine, Chang Gung University, Taoyuan, Taiwan.
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10
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Heather LC, Gopal K, Srnic N, Ussher JR. Redefining Diabetic Cardiomyopathy: Perturbations in Substrate Metabolism at the Heart of Its Pathology. Diabetes 2024; 73:659-670. [PMID: 38387045 PMCID: PMC11043056 DOI: 10.2337/dbi23-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Abstract
Cardiovascular disease represents the leading cause of death in people with diabetes, most notably from macrovascular diseases such as myocardial infarction or heart failure. Diabetes also increases the risk of a specific form of cardiomyopathy, referred to as diabetic cardiomyopathy (DbCM), originally defined as ventricular dysfunction in the absence of underlying coronary artery disease and/or hypertension. Herein, we provide an overview on the key mediators of DbCM, with an emphasis on the role for perturbations in cardiac substrate metabolism. We discuss key mechanisms regulating metabolic dysfunction in DbCM, with additional focus on the role of metabolites as signaling molecules within the diabetic heart. Furthermore, we discuss the preclinical approaches to target these perturbations to alleviate DbCM. With several advancements in our understanding, we propose the following as a new definition for, or approach to classify, DbCM: "diastolic dysfunction in the presence of altered myocardial metabolism in a person with diabetes but absence of other known causes of cardiomyopathy and/or hypertension." However, we recognize that no definition can fully explain the complexity of why some individuals with DbCM exhibit diastolic dysfunction, whereas others develop systolic dysfunction. Due to DbCM sharing pathological features with heart failure with preserved ejection fraction (HFpEF), the latter of which is more prevalent in the population with diabetes, it is imperative to determine whether effective management of DbCM decreases HFpEF prevalence. ARTICLE HIGHLIGHTS
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Affiliation(s)
- Lisa C. Heather
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, U.K
| | - Keshav Gopal
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Nikola Srnic
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, U.K
| | - John R. Ussher
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Research Institute, University of Alberta, Edmonton, Alberta, Canada
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Nakamura M. Lipotoxicity as a therapeutic target in obesity and diabetic cardiomyopathy. JOURNAL OF PHARMACY & PHARMACEUTICAL SCIENCES : A PUBLICATION OF THE CANADIAN SOCIETY FOR PHARMACEUTICAL SCIENCES, SOCIETE CANADIENNE DES SCIENCES PHARMACEUTIQUES 2024; 27:12568. [PMID: 38706718 PMCID: PMC11066298 DOI: 10.3389/jpps.2024.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/09/2024] [Indexed: 05/07/2024]
Abstract
Unhealthy sources of fats, ultra-processed foods with added sugars, and a sedentary lifestyle make humans more susceptible to developing overweight and obesity. While lipids constitute an integral component of the organism, excessive and abnormal lipid accumulation that exceeds the storage capacity of lipid droplets disrupts the intracellular composition of fatty acids and results in the release of deleterious lipid species, thereby giving rise to a pathological state termed lipotoxicity. This condition induces endoplasmic reticulum stress, mitochondrial dysfunction, inflammatory responses, and cell death. Recent advances in omics technologies and analytical methodologies and clinical research have provided novel insights into the mechanisms of lipotoxicity, including gut dysbiosis, epigenetic and epitranscriptomic modifications, dysfunction of lipid droplets, post-translational modifications, and altered membrane lipid composition. In this review, we discuss the recent knowledge on the mechanisms underlying the development of lipotoxicity and lipotoxic cardiometabolic disease in obesity, with a particular focus on lipotoxic and diabetic cardiomyopathy.
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Affiliation(s)
- Michinari Nakamura
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, United States
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12
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Chaumeil MM, Bankson JA, Brindle KM, Epstein S, Gallagher FA, Grashei M, Guglielmetti C, Kaggie JD, Keshari KR, Knecht S, Laustsen C, Schmidt AB, Vigneron D, Yen YF, Schilling F. New Horizons in Hyperpolarized 13C MRI. Mol Imaging Biol 2024; 26:222-232. [PMID: 38147265 PMCID: PMC10972948 DOI: 10.1007/s11307-023-01888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/27/2023]
Abstract
Hyperpolarization techniques significantly enhance the sensitivity of magnetic resonance (MR) and thus present fascinating new directions for research and applications with in vivo MR imaging and spectroscopy (MRI/S). Hyperpolarized 13C MRI/S, in particular, enables real-time non-invasive assessment of metabolic processes and holds great promise for a diverse range of clinical applications spanning fields like oncology, neurology, and cardiology, with a potential for improving early diagnosis of disease, patient stratification, and therapy response assessment. Despite its potential, technical challenges remain for achieving clinical translation. This paper provides an overview of the discussions that took place at the international workshop "New Horizons in Hyperpolarized 13C MRI," in March 2023 at the Bavarian Academy of Sciences and Humanities, Munich, Germany. The workshop covered new developments, as well as future directions, in topics including polarization techniques (particularly focusing on parahydrogen-based methods), novel probes, considerations related to data acquisition and analysis, and emerging clinical applications in oncology and other fields.
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Affiliation(s)
- Myriam M Chaumeil
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA.
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | - James A Bankson
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kevin M Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | | | - Ferdia A Gallagher
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Martin Grashei
- Department of Nuclear Medicine, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Caroline Guglielmetti
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Joshua D Kaggie
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Kayvan R Keshari
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Weill Cornell Graduate School, New York City, NY, USA
| | | | - Christoffer Laustsen
- The MR Research Centre, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
| | - Andreas B Schmidt
- Partner Site Freiburg and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5a, 79106, Freiburg, Germany
- Department of Chemistry, Integrative Biosciences (Ibio), Karmanos Cancer Institute (KCI), Wayne State University, Detroit, MI, 48202, USA
| | - Daniel Vigneron
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Yi-Fen Yen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Franz Schilling
- Department of Nuclear Medicine, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
- Partner Site Freiburg and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Chen HY, Gordon JW, Dwork N, Chung BT, Riselli A, Sivalokanathan S, Bok RA, Slater JB, Vigneron DB, Abraham MR, Larson PEZ. Probing human heart TCA cycle metabolism and response to glucose load using hyperpolarized [2- 13 C]pyruvate MRS. NMR IN BIOMEDICINE 2024; 37:e5074. [PMID: 38054254 DOI: 10.1002/nbm.5074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION The healthy heart has remarkable metabolic flexibility that permits rapid switching between mitochondrial glucose oxidation and fatty acid oxidation to generate ATP. Loss of metabolic flexibility has been implicated in the genesis of contractile dysfunction seen in cardiomyopathy. Metabolic flexibility has been imaged in experimental models, using hyperpolarized (HP) [2-13 C]pyruvate MRI, which enables interrogation of metabolites that reflect tricarboxylic acid (TCA) cycle flux in cardiac myocytes. This study aimed to develop methods, demonstrate feasibility for [2-13 C]pyruvate MRI in the human heart for the first time, and assess cardiac metabolic flexibility. METHODS Good manufacturing practice [2-13 C]pyruvic acid was polarized in a 5 T polarizer for 2.5-3 h. Following dissolution, quality control parameters of HP pyruvate met all safety and sterility criteria for pharmacy release, prior to administration to study subjects. Three healthy subjects each received two HP injections and MR scans, first under fasting conditions, followed by oral glucose load. A 5 cm axial slab-selective spectroscopy approach was prescribed over the left ventricle and acquired at 3 s intervals on a 3 T clinical MRI scanner. RESULTS The study protocol, which included HP substrate injection, MR scanning, and oral glucose load, was performed safely without adverse events. Key downstream metabolites of [2-13 C]pyruvate metabolism in cardiac myocytes include the glycolytic derivative [2-13 C]lactate, TCA-associated metabolite [5-13 C]glutamate, and [1-13 C]acetylcarnitine, catalyzed by carnitine acetyltransferase (CAT). After glucose load, 13 C-labeling of lactate, glutamate, and acetylcarnitine from 13 C-pyruvate increased by an average of 39.3%, 29.5%, and 114% respectively in the three subjects, which could result from increases in lactate dehydrogenase, pyruvate dehydrogenase, and CAT enzyme activity as well as TCA cycle flux (glucose oxidation). CONCLUSIONS HP [2-13 C]pyruvate imaging is safe and permits noninvasive assessment of TCA cycle intermediates and the acetyl buffer, acetylcarnitine, which is not possible using HP [1-13 C]pyruvate. Cardiac metabolite measurement in the fasting/fed states provides information on cardiac metabolic flexibility and the acetylcarnitine pool.
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Affiliation(s)
- Hsin-Yu Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Nicholas Dwork
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Brian T Chung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Andrew Riselli
- School of Pharmacy, University of California, San Francisco, California, USA
| | | | - Robert A Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - James B Slater
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Daniel B Vigneron
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - M Roselle Abraham
- Division of Cardiology, University of California, San Francisco, California, USA
| | - Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
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14
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Liu X, Cui D, Xu D, Bok R, Wang ZJ, Vigneron DB, Larson PEZ, Gordon JW. Dynamic T 2 * relaxometry of hyperpolarized [1- 13 C]pyruvate MRI in the human brain and kidneys. Magn Reson Med 2024; 91:1030-1042. [PMID: 38013217 PMCID: PMC10872504 DOI: 10.1002/mrm.29942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE This study aimed to quantifyT 2 * $$ {T}_2^{\ast } $$ for hyperpolarized [1-13 C]pyruvate and metabolites in the healthy human brain and renal cell carcinoma (RCC) patients at 3 T. METHODS DynamicT 2 * $$ {T}_2^{\ast } $$ values were measured with a metabolite-specific multi-echo spiral sequence. The dynamicT 2 * $$ {T}_2^{\ast } $$ of [1-13 C]pyruvate, [1-13 C]lactate, and 13 C-bicarbonate was estimated in regions of interest in the whole brain, sinus vein, gray matter, and white matter in healthy volunteers, as well as in kidney tumors and the contralateral healthy kidneys in a separate group of RCC patients.T 2 * $$ {T}_2^{\ast } $$ was fit using a mono-exponential function; and metabolism was quantified using pyruvate-to-lactate conversion rate maps and lactate-to-pyruvate ratio maps, which were compared with and without an estimatedT 2 * $$ {T}_2^{\ast } $$ correction. RESULTS TheT 2 * $$ {T}_2^{\ast } $$ of pyruvate was shown to vary during the acquisition, whereas theT 2 * $$ {T}_2^{\ast } $$ of lactate and bicarbonate were relatively constant through time and across the organs studied. TheT 2 * $$ {T}_2^{\ast } $$ of lactate was similar in gray matter (29.75 ± 1.04 ms), white matter (32.89 ± 0.9 ms), healthy kidney (34.61 ± 4.07 ms), and kidney tumor (33.01 ± 2.31 ms); and theT 2 * $$ {T}_2^{\ast } $$ of bicarbonate was different between whole-brain (108.17 ± 14.05 ms) and healthy kidney (58.45 ± 6.63 ms). TheT 2 * $$ {T}_2^{\ast } $$ of pyruvate had similar trends in both brain and RCC studies, reducing from 75.56 ± 2.23 ms to 22.24 ± 1.24 ms in the brain and reducing from 122.72 ± 9.86 ms to 57.38 ± 7.65 ms in the kidneys. CONCLUSION Multi-echo dynamic imaging can quantifyT 2 * $$ {T}_2^{\ast } $$ and metabolism in a single integrated acquisition. Clear differences were observed in theT 2 * $$ {T}_2^{\ast } $$ of metabolites and in their behavior throughout the timecourse.
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Affiliation(s)
- Xiaoxi Liu
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Di Cui
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Duan Xu
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Robert Bok
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Zhen J Wang
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Daniel B Vigneron
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, California, USA
| | - Peder E Z Larson
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, California, USA
| | - Jeremy W Gordon
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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15
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Henry JA, Couch LS, Rider OJ. Myocardial Metabolism in Heart Failure with Preserved Ejection Fraction. J Clin Med 2024; 13:1195. [PMID: 38592048 PMCID: PMC10931709 DOI: 10.3390/jcm13051195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent and now accounts for half of all heart failure cases. This rise is largely attributed to growing rates of obesity, hypertension, and diabetes. Despite its prevalence, the pathophysiological mechanisms of HFpEF are not fully understood. The heart, being the most energy-demanding organ, appears to have a compromised bioenergetic capacity in heart failure, affecting all phenotypes and aetiologies. While metabolic disturbances in heart failure with reduced ejection fraction (HFrEF) have been extensively studied, similar insights into HFpEF are limited. This review collates evidence from both animal and human studies, highlighting metabolic dysregulations associated with HFpEF and its risk factors, such as obesity, hypertension, and diabetes. We discuss how changes in substrate utilisation, oxidative phosphorylation, and energy transport contribute to HFpEF. By delving into these pathological shifts in myocardial energy production, we aim to reveal novel therapeutic opportunities. Potential strategies include modulating energy substrates, improving metabolic efficiency, and enhancing critical metabolic pathways. Understanding these aspects could be key to developing more effective treatments for HFpEF.
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Affiliation(s)
- John Aaron Henry
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK (O.J.R.)
- Department of Cardiology, Jersey General Hospital, Gloucester Street, St. Helier JE1 3QS, Jersey, UK
| | - Liam S. Couch
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK (O.J.R.)
| | - Oliver J. Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK (O.J.R.)
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Sun Q, Wagg CS, Güven B, Wei K, de Oliveira AA, Silver H, Zhang L, Vergara A, Chen B, Wong N, Wang F, Dyck JRB, Oudit GY, Lopaschuk GD. Stimulating cardiac glucose oxidation lessens the severity of heart failure in aged female mice. Basic Res Cardiol 2024; 119:133-150. [PMID: 38148348 DOI: 10.1007/s00395-023-01020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/28/2023]
Abstract
Heart failure is a prevalent disease worldwide. While it is well accepted that heart failure involves changes in myocardial energetics, what alterations that occur in fatty acid oxidation and glucose oxidation in the failing heart remains controversial. The goal of the study are to define the energy metabolic profile in heart failure induced by obesity and hypertension in aged female mice, and to attempt to lessen the severity of heart failure by stimulating myocardial glucose oxidation. 13-Month-old C57BL/6 female mice were subjected to 10 weeks of a 60% high-fat diet (HFD) with 0.5 g/L of Nω-nitro-L-arginine methyl ester (L-NAME) administered via drinking water to induce obesity and hypertension. Isolated working hearts were perfused with radiolabeled energy substrates to directly measure rates of myocardial glucose oxidation and fatty acid oxidation. Additionally, a series of mice subjected to the obesity and hypertension protocol were treated with a pyruvate dehydrogenase kinase inhibitor (PDKi) to stimulate cardiac glucose oxidation. Aged female mice subjected to the obesity and hypertension protocol had increased body weight, glucose intolerance, elevated blood pressure, cardiac hypertrophy, systolic dysfunction, and decreased survival. While fatty acid oxidation rates were not altered in the failing hearts, insulin-stimulated glucose oxidation rates were markedly impaired. PDKi treatment increased cardiac glucose oxidation in heart failure mice, which was accompanied with improved systolic function and decreased cardiac hypertrophy. The primary energy metabolic change in heart failure induced by obesity and hypertension in aged female mice is a dramatic decrease in glucose oxidation. Stimulating glucose oxidation can lessen the severity of heart failure and exert overall functional benefits.
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Affiliation(s)
- Qiuyu Sun
- Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2S2, Canada
| | - Cory S Wagg
- Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2S2, Canada
| | - Berna Güven
- Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2S2, Canada
| | - Kaleigh Wei
- Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2S2, Canada
| | - Amanda A de Oliveira
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Heidi Silver
- Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2S2, Canada
| | - Liyan Zhang
- Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2S2, Canada
| | - Ander Vergara
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Brandon Chen
- Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2S2, Canada
| | - Nathan Wong
- Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2S2, Canada
| | - Faqi Wang
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2S2, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Gary D Lopaschuk
- Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada.
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.
- Department of Pediatrics, University of Alberta, Edmonton, AB, T6G 2S2, Canada.
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17
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Wodtke P, Grashei M, Schilling F. Quo Vadis Hyperpolarized 13C MRI? Z Med Phys 2023:S0939-3889(23)00120-4. [PMID: 38160135 DOI: 10.1016/j.zemedi.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 01/03/2024]
Abstract
Over the last two decades, hyperpolarized 13C MRI has gained significance in both preclinical and clinical studies, hereby relying on technologies like PHIP-SAH (ParaHydrogen-Induced Polarization-Side Arm Hydrogenation), SABRE (Signal Amplification by Reversible Exchange), and dDNP (dissolution Dynamic Nuclear Polarization), with dDNP being applied in humans. A clinical dDNP polarizer has enabled studies across 24 sites, despite challenges like high cost and slow polarization. Parahydrogen-based techniques like SABRE and PHIP offer faster, more cost-efficient alternatives but require molecule-specific optimization. The focus has been on imaging metabolism of hyperpolarized probes, which requires long T1, high polarization and rapid contrast generation. Efforts to establish novel probes, improve acquisition techniques and enhance data analysis methods including artificial intelligence are ongoing. Potential clinical value of hyperpolarized 13C MRI was demonstrated primarily for treatment response assessment in oncology, but also in cardiology, nephrology, hepatology and CNS characterization. In this review on biomedical hyperpolarized 13C MRI, we summarize important and recent advances in polarization techniques, probe development, acquisition and analysis methods as well as clinical trials. Starting from those we try to sketch a trajectory where the field of biomedical hyperpolarized 13C MRI might go.
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Affiliation(s)
- Pascal Wodtke
- Department of Nuclear Medicine, TUM School of Medicine and Health, Klinikum rechts der Isar of Technical University of Munich, 81675 Munich, Germany; Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge UK
| | - Martin Grashei
- Department of Nuclear Medicine, TUM School of Medicine and Health, Klinikum rechts der Isar of Technical University of Munich, 81675 Munich, Germany
| | - Franz Schilling
- Department of Nuclear Medicine, TUM School of Medicine and Health, Klinikum rechts der Isar of Technical University of Munich, 81675 Munich, Germany; Munich Institute of Biomedical Engineering, Technical University of Munich, 85748 Garching, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany.
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Larson PEZ, Tang S, Liu X, Sinha A, Dwork N, Sivalokanathan S, Liu J, Bok R, Ordovas KG, Slater J, Gordon JW, Abraham MR. Regional quantification of cardiac metabolism with hyperpolarized [1- 13C]-pyruvate CMR evaluated in an oral glucose challenge. J Cardiovasc Magn Reson 2023; 25:77. [PMID: 38093285 PMCID: PMC10720165 DOI: 10.1186/s12968-023-00972-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 10/19/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The heart has metabolic flexibility, which is influenced by fed/fasting states, and pathologies such as myocardial ischemia and hypertrophic cardiomyopathy (HCM). Hyperpolarized (HP) 13C-pyruvate MRI is a promising new tool for non-invasive quantification of myocardial glycolytic and Krebs cycle flux. However, human studies of HP 13C-MRI have yet to demonstrate regional quantification of metabolism, which is important in regional ischemia and HCM patients with asymmetric septal/apical hypertrophy. METHODS We developed and applied methods for whole-heart imaging of 13C-pyruvate, 13C-lactate and 13C-bicarbonate, following intravenous administration of [1-13C]-pyruvate. The image acquisition used an autonomous scanning method including bolus tracking, real-time magnetic field calibrations and metabolite-specific imaging. For quantification of metabolism, we evaluated 13C metabolite images, ratio metrics, and pharmacokinetic modeling to provide measurements of myocardial lactate dehydrogenase (LDH) and pyruvate dehydrogenase (PDH) mediated metabolic conversion in 5 healthy volunteers (fasting & 30 min following oral glucose load). RESULTS We demonstrate whole heart coverage for dynamic measurement of pyruvate-to-lactate conversion via LDH and pyruvate-to-bicarbonate conversion via PDH at a resolution of 6 × 6 × 21 mm3 (13C-pyruvate) and 12 × 12 × 21 mm3 (13C-lactate, 13C-bicarbonate). 13C-pyruvate and 13C-lactate were detected simultaneously in the RV blood pool, immediately after intravenous injection, reflecting LDH activity in blood. In healthy volunteers, myocardial 13C-pyruvate-SNR, 13C-lactate-SNR, 13C-bicarbonate-SNR, 13C-lactate/pyruvate ratio, 13C-pyruvate-to-lactate conversion rate, kPL, and 13C-pyruvate-to-bicarbonate conversion rate, kPB, all had statistically significant increases following oral glucose challenge. kPB, reflecting PDH activity and pyruvate entering the Krebs Cycle, had the highest correlation with blood glucose levels and was statistically significant. CONCLUSIONS We demonstrate first-in-human regional quantifications of cardiac metabolism by HP 13C-pyruvate MRI that aims to reflect LDH and PDH activity.
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Affiliation(s)
- Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA.
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, CA, USA.
| | - Shuyu Tang
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, CA, USA
- Vista.ai, Palo Alto, CA, USA
| | - Xiaoxi Liu
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - Avantika Sinha
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - Nicholas Dwork
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
- Departments of Bioinformatics and Radiology, University of Colorado School of Medicine, Denver, CO, USA
| | - Sanjay Sivalokanathan
- Division of Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jing Liu
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - Robert Bok
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - Karen G Ordovas
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - James Slater
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - M Roselle Abraham
- Cardiology Division, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
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MacCulloch K, Browning A, Bedoya DOG, McBride SJ, Abdulmojeed MB, Dedesma C, Goodson BM, Rosen MS, Chekmenev EY, Yen YF, TomHon P, Theis T. Facile hyperpolarization chemistry for molecular imaging and metabolic tracking of [1- 13C]pyruvate in vivo. JOURNAL OF MAGNETIC RESONANCE OPEN 2023; 16-17:100129. [PMID: 38090022 PMCID: PMC10715622 DOI: 10.1016/j.jmro.2023.100129] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Hyperpolarization chemistry based on reversible exchange of parahydrogen, also known as Signal Amplification By Reversible Exchange (SABRE), is a particularly simple approach to attain high levels of nuclear spin hyperpolarization, which can enhance NMR and MRI signals by many orders of magnitude. SABRE has received significant attention in the scientific community since its inception because of its relative experimental simplicity and its broad applicability to a wide range of molecules, however in vivo detection of molecular probes hyperpolarized by SABRE has remained elusive. Here we describe a first demonstration of SABRE-hyperpolarized contrast detected in vivo, specifically using hyperpolarized [1-13C]pyruvate. Biocompatible formulations of hyperpolarized [1-13C]pyruvate in, both, methanol-water mixtures, and ethanol-water mixtures followed by dilution with saline and catalyst filtration were prepared and injected into healthy Sprague Dawley and Wistar rats. Effective hyperpolarization-catalyst removal was performed with silica filters without major losses in hyperpolarization. Metabolic conversion of pyruvate to lactate, alanine, and bicarbonate was detected in vivo. Pyruvate-hydrate was also observed as minor byproduct. Measurements were performed on the liver and kidney at 4.7 T via time-resolved spectroscopy and chemical-shift-resolved MRI. In addition, whole-body metabolic measurements were obtained using a cryogen-free 1.5 T MRI system, illustrating the utility of combining lower-cost MRI systems with simple, low-cost hyperpolarization chemistry to develop safe, and scalable molecular imaging.
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Affiliation(s)
- Keilian MacCulloch
- Department of Chemistry, North Carolina State University, Raleigh, NC, 27695,USA
| | - Austin Browning
- Department of Chemistry, North Carolina State University, Raleigh, NC, 27695,USA
| | - David O. Guarin Bedoya
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Stephen J. McBride
- Department of Chemistry, North Carolina State University, Raleigh, NC, 27695,USA
| | | | - Carlos Dedesma
- Vizma Life Sciences Inc., Chapel Hill, NC, 27514, United States
| | - Boyd M. Goodson
- School of Chemical & Biomolecular Sciences and Materials Technology Center, Southern Illinois University, Carbondale, IL, 62901, USA
| | - Matthew S. Rosen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Eduard Y. Chekmenev
- Department of Chemistry, Integrative Bio-sciences (Ibio), Karmanos Cancer Institute (KCI), Wayne State University, Detroit, MI 48202, USA
- Russian Academy of Sciences, 119991 Moscow, Russia
| | - Yi-Fen Yen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Patrick TomHon
- Vizma Life Sciences Inc., Chapel Hill, NC, 27514, United States
| | - Thomas Theis
- Department of Chemistry, North Carolina State University, Raleigh, NC, 27695,USA
- Department of Physics, North Carolina State University, Raleigh, NC 27606, USA
- Joint UNC & NC State Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27606, USA
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Lakhani A, Kang DH, Kang YE, Park JO. Toward Systems-Level Metabolic Analysis in Endocrine Disorders and Cancer. Endocrinol Metab (Seoul) 2023; 38:619-630. [PMID: 37989266 PMCID: PMC10764991 DOI: 10.3803/enm.2023.1814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023] Open
Abstract
Metabolism is a dynamic network of biochemical reactions that support systemic homeostasis amidst changing nutritional, environmental, and physical activity factors. The circulatory system facilitates metabolite exchange among organs, while the endocrine system finely tunes metabolism through hormone release. Endocrine disorders like obesity, diabetes, and Cushing's syndrome disrupt this balance, contributing to systemic inflammation and global health burdens. They accompany metabolic changes on multiple levels from molecular interactions to individual organs to the whole body. Understanding how metabolic fluxes relate to endocrine disorders illuminates the underlying dysregulation. Cancer is increasingly considered a systemic disorder because it not only affects cells in localized tumors but also the whole body, especially in metastasis. In tumorigenesis, cancer-specific mutations and nutrient availability in the tumor microenvironment reprogram cellular metabolism to meet increased energy and biosynthesis needs. Cancer cachexia results in metabolic changes to other organs like muscle, adipose tissue, and liver. This review explores the interplay between the endocrine system and systems-level metabolism in health and disease. We highlight metabolic fluxes in conditions like obesity, diabetes, Cushing's syndrome, and cancers. Recent advances in metabolomics, fluxomics, and systems biology promise new insights into dynamic metabolism, offering potential biomarkers, therapeutic targets, and personalized medicine.
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Affiliation(s)
- Aliya Lakhani
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Da Hyun Kang
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yea Eun Kang
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Junyoung O. Park
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, CA, USA
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Larson PE, Bernard JM, Bankson JA, Bøgh N, Bok RA, Chen AP, Cunningham CH, Gordon J, Hövener JB, Laustsen C, Mayer D, McLean MA, Schilling F, Slater J, Vanderheyden JL, von Morze C, Vigneron DB, Xu D, Group THCMC. Current Methods for Hyperpolarized [1-13C]pyruvate MRI Human Studies. ARXIV 2023:arXiv:2309.04040v2. [PMID: 37731660 PMCID: PMC10508833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
MRI with hyperpolarized (HP) 13C agents, also known as HP 13C MRI, can measure processes such as localized metabolism that is altered in numerous cancers, liver, heart, kidney diseases, and more. It has been translated into human studies during the past 10 years, with recent rapid growth in studies largely based on increasing availability of hyperpolarized agent preparation methods suitable for use in humans. This paper aims to capture the current successful practices for HP MRI human studies with [1-13C]pyruvate - by far the most commonly used agent, which sits at a key metabolic junction in glycolysis. The paper is divided into four major topic areas: (1) HP 13C-pyruvate preparation, (2) MRI system setup and calibrations, (3) data acquisition and image reconstruction, and (4) data analysis and quantification. In each area, we identified the key components for a successful study, summarized both published studies and current practices, and discuss evidence gaps, strengths, and limitations. This paper is the output of the HP 13C MRI Consensus Group as well as the ISMRM Hyperpolarized Media MR and Hyperpolarized Methods & Equipment study groups. It further aims to provide a comprehensive reference for future consensus building as the field continues to advance human studies with this metabolic imaging modality.
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Li AL, Lian L, Chen XN, Cai WH, Fan XB, Fan YJ, Li TT, Xie YY, Zhang JP. The role of mitochondria in myocardial damage caused by energy metabolism disorders: From mechanisms to therapeutics. Free Radic Biol Med 2023; 208:236-251. [PMID: 37567516 DOI: 10.1016/j.freeradbiomed.2023.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
Myocardial damage is the most serious pathological consequence of cardiovascular diseases and an important reason for their high mortality. In recent years, because of the high prevalence of systemic energy metabolism disorders (e.g., obesity, diabetes mellitus, and metabolic syndrome), complications of myocardial damage caused by these disorders have attracted widespread attention. Energy metabolism disorders are independent of traditional injury-related risk factors, such as ischemia, hypoxia, trauma, and infection. An imbalance of myocardial metabolic flexibility and myocardial energy depletion are usually the initial changes of myocardial injury caused by energy metabolism disorders, and abnormal morphology and functional destruction of the mitochondria are their important features. Specifically, mitochondria are the centers of energy metabolism, and recent evidence has shown that decreased mitochondrial function, caused by an imbalance in mitochondrial quality control, may play a key role in myocardial injury caused by energy metabolism disorders. Under chronic energy stress, mitochondria undergo pathological fission, while mitophagy, mitochondrial fusion, and biogenesis are inhibited, and mitochondrial protein balance and transfer are disturbed, resulting in the accumulation of nonfunctional and damaged mitochondria. Consequently, damaged mitochondria lead to myocardial energy depletion and the accumulation of large amounts of reactive oxygen species, further aggravating the imbalance in mitochondrial quality control and forming a vicious cycle. In addition, impaired mitochondria coordinate calcium homeostasis imbalance, and epigenetic alterations participate in the pathogenesis of myocardial damage. These pathological changes induce rapid progression of myocardial damage, eventually leading to heart failure or sudden cardiac death. To intervene more specifically in the myocardial damage caused by metabolic disorders, we need to understand the specific role of mitochondria in this context in detail. Accordingly, promising therapeutic strategies have been proposed. We also summarize the existing therapeutic strategies to provide a reference for clinical treatment and developing new therapies.
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Affiliation(s)
- Ao-Lin Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Lu Lian
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Xin-Nong Chen
- Department of Traditional Chinese Medicine, Tianjin First Central Hospital, Tianjin, 300190, China
| | - Wen-Hui Cai
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Xin-Biao Fan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Ya-Jie Fan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Ting-Ting Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China; Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Ying-Yu Xie
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Jun-Ping Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300183, China.
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Larson PEZ, Tang S, Liu X, Sinha A, Dwork N, Sivalokanathan S, Liu J, Bok R, Ordovas KG, Slater J, Gordon JW, Abraham MR. Regional quantification of cardiac metabolism with hyperpolarized [1- 13C]-pyruvate MRI evaluated in an oral glucose challenge. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.16.23297052. [PMID: 37904936 PMCID: PMC10615005 DOI: 10.1101/2023.10.16.23297052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Background The heart has metabolic flexibility, which is influenced by fed/fasting states, and pathologies such as myocardial ischemia and hypertrophic cardiomyopathy (HCM). Hyperpolarized (HP) 13C-pyruvate MRI is a promising new tool for non-invasive quantification of myocardial glycolytic and Krebs cycle flux. However, human studies of HP 13C-MRI have yet to demonstrate regional quantification of metabolism, which is important in regional ischemia and HCM patients with asymmetric septal/apical hypertrophy. Methods We developed and applied methods for whole-heart imaging of 13C-pyruvate, 13C-lactate and 13C-bicarbonate, following intravenous administration of [1-13C]-pyruvate. The image acquisition used an autonomous scanning method including bolus tracking, real-time magnetic field calibrations and metabolite-specific imaging. For quantification of metabolism, we evaluated 13C metabolite images, ratio metrics, and pharmacokinetic modeling to provide measurements of myocardial lactate dehydrogenase (LDH) and pyruvate dehydrogenase (PDH) mediated metabolic conversion in 5 healthy volunteers (fasting & 30 min following oral glucose load). Results We demonstrate whole heart coverage for dynamic measurement of pyruvate-to-lactate conversion via LDH and pyruvate-to-bicarbonate conversion via PDH at a resolution of 6×6×21 mm3 (13C-pyruvate) and 12×12×21 mm3 (13C-lactate, 13C-bicarbonate) . 13C-pyruvate and 13C-lactate were detected simultaneously in the RV blood pool, immediately after intravenous injection, reflecting LDH activity in blood. In healthy volunteers, myocardial 13C-pyruvate-SNR, 13C-lactate-SNR, 13C-bicarbonate-SNR, 13C-lactate/pyruvate ratio, 13C-pyruvate-to-lactate conversion rate, kPL, and 13C-pyruvate-to-bicarbonate conversion rate, kPB, all had statistically significant increases following oral glucose challenge. kPB, reflecting PDH activity and pyruvate entering the Krebs Cycle, had the highest correlation with blood glucose levels and was statistically significant. Conclusions We demonstrate first-in-human regional quantifications of cardiac metabolism by HP 13C-pyruvate MRI that aims to reflect LDH and PDH activity.
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Affiliation(s)
- Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California, USA
| | - Shuyu Tang
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California, USA
- Vista.ai, Palo Alto, CA, USA
| | - Xiaoxi Liu
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - Avantika Sinha
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - Nicholas Dwork
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
- Departments of Bioinformatics and Radiology, University of Colorado School of Medicine, Denver, CO, USA
| | - Sanjay Sivalokanathan
- Department of Medicine - Division of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jing Liu
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - Robert Bok
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - Karen G Ordovas
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - James Slater
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - M Roselle Abraham
- Department of Medicine - Cardiology Division, University of California - San Francisco, San Francisco, California, USA
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24
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Chen HY, Gordon JW, Dwork N, Chung BT, Riselli A, Sivalokanathan S, Bok RA, Slater JB, Vigneron DB, Abraham MR, Larson PE. Probing Human Heart TCA Cycle Metabolism and Response to Glucose Load using Hyperpolarized [2- 13C]Pyruvate MR Spectroscopy. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.16.23297053. [PMID: 37905131 PMCID: PMC10615004 DOI: 10.1101/2023.10.16.23297053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Introduction The normal heart has remarkable metabolic flexibility that permits rapid switching between mitochondrial glucose oxidation and fatty acid (FA) oxidation to generate ATP. Loss of metabolic flexibility has been implicated in the genesis of contractile dysfunction seen in cardiomyopathy. Metabolic flexibility has been imaged in experimental models, using hyperpolarized (HP) [2-13C]pyruvate MRI, which enables interrogation of metabolites that reflect tricarboxylic acid (TCA) cycle flux in cardiac myocytes. This study aimed to develop methods, demonstrate feasibility for [2-13C]pyruvate MRI in the human heart for the first time, and assess cardiac metabolic flexibility. Methods Good Manufacturing Practice [2-13C]pyruvic acid was polarized in a 5T polarizer for 2.5-3 hours. Following dissolution, QC parameters of HP pyruvate met all safety and sterility criteria for pharmacy release, prior to administration to study subjects. Three healthy subjects each received two HP injections and MR scans, first under fasting conditions, followed by oral glucose load. A 5cm axial slab-selective spectroscopy approach was prescribed over the left ventricle and acquired at 3s intervals on a 3T clinical MRI scanner. Results The study protocol which included HP substrate injection, MR scanning and oral glucose load, was performed safely without adverse events. Key downstream metabolites of [2-13C]pyruvate metabolism in cardiac myocytes include the glycolytic derivative [2-13C]lactate, TCA-associated metabolite [5-13C]glutamate, and [1-13C]acetylcarnitine, catalyzed by carnitine acetyltransferase (CAT). After glucose load, 13C-labeling of lactate, glutamate, and acetylcarnitine from 13C-pyruvate increased by 39.3%, 29.5%, and 114%, respectively in the three subjects, that could result from increases in lactate dehydrogenase (LDH), pyruvate dehydrogenase (PDH), and CAT enzyme activity as well as TCA cycle flux (glucose oxidation). Conclusions HP [2-13C]pyruvate imaging is safe and permits non-invasive assessment of TCA cycle intermediates and the acetyl buffer, acetylcarnitine, which is not possible using HP [1-13C]pyruvate. Cardiac metabolite measurement in the fasting/fed states provides information on cardiac metabolic flexibility and the acetylcarnitine pool.
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Affiliation(s)
- Hsin-Yu Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - Jeremy W. Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - Nicholas Dwork
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - Brian T. Chung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - Andrew Riselli
- School of Pharmacy, University of California, San Francisco, United States
| | | | - Robert A. Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - James B. Slater
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - Daniel B. Vigneron
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - M. Roselle Abraham
- Division of Cardiology, University of California, San Francisco, United States
| | - Peder E.Z. Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
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Jex N, Greenwood JP, Cubbon RM, Rider OJ, Chowdhary A, Thirunavukarasu S, Kotha S, Giannoudi M, McGrane A, Maccannell A, Conning-Rowland M, Straw S, Procter H, Papaspyros S, Evans B, Javangula K, Ferrara A, Elmahdy W, Kaul P, Xue H, Swoboda P, Kellman P, Valkovič L, Roberts L, Beech D, Kearney MT, Plein S, Dweck MR, Levelt E. Association Between Type 2 Diabetes and Changes in Myocardial Structure, Contractile Function, Energetics, and Blood Flow Before and After Aortic Valve Replacement in Patients With Severe Aortic Stenosis. Circulation 2023; 148:1138-1153. [PMID: 37746744 PMCID: PMC10558154 DOI: 10.1161/circulationaha.122.063444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 08/15/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is associated with an increased risk of left ventricular dysfunction after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). Persistent impairments in myocardial energetics and myocardial blood flow (MBF) may underpin this observation. Using phosphorus magnetic resonance spectroscopy and cardiovascular magnetic resonance, this study tested the hypothesis that patients with severe AS and T2D (AS-T2D) would have impaired myocardial energetics as reflected by the phosphocreatine to ATP ratio (PCr/ATP) and vasodilator stress MBF compared with patients with AS without T2D (AS-noT2D), and that these differences would persist after AVR. METHODS Ninety-five patients with severe AS without coronary artery disease awaiting AVR (30 AS-T2D and 65 AS-noT2D) were recruited (mean, 71 years of age [95% CI, 69, 73]; 34 [37%] women). Thirty demographically matched healthy volunteers (HVs) and 30 patients with T2D without AS (T2D controls) were controls. One month before and 6 months after AVR, cardiac PCr/ATP, adenosine stress MBF, global longitudinal strain, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and 6-minute walk distance were assessed in patients with AS. T2D controls underwent identical assessments at baseline and 6-month follow-up. HVs were assessed once and did not undergo 6-minute walk testing. RESULTS Compared with HVs, patients with AS (AS-T2D and AS-noT2D combined) showed impairment in PCr/ATP (mean [95% CI]; HVs, 2.15 [1.89, 2.34]; AS, 1.66 [1.56, 1.75]; P<0.0001) and vasodilator stress MBF (HVs, 2.11 mL min g [1.89, 2.34]; AS, 1.54 mL min g [1.41, 1.66]; P<0.0001) before AVR. Before AVR, within the AS group, patients with AS-T2D had worse PCr/ATP (AS-noT2D, 1.74 [1.62, 1.86]; AS-T2D, 1.44 [1.32, 1.56]; P=0.002) and vasodilator stress MBF (AS-noT2D, 1.67 mL min g [1.5, 1.84]; AS-T2D, 1.25 mL min g [1.22, 1.38]; P=0.001) compared with patients with AS-noT2D. Before AVR, patients with AS-T2D also had worse PCr/ATP (AS-T2D, 1.44 [1.30, 1.60]; T2D controls, 1.66 [1.56, 1.75]; P=0.04) and vasodilator stress MBF (AS-T2D, 1.25 mL min g [1.10, 1.41]; T2D controls, 1.54 mL min g [1.41, 1.66]; P=0.001) compared with T2D controls at baseline. After AVR, PCr/ATP normalized in patients with AS-noT2D, whereas patients with AS-T2D showed no improvements (AS-noT2D, 2.11 [1.79, 2.43]; AS-T2D, 1.30 [1.07, 1.53]; P=0.0006). Vasodilator stress MBF improved in both AS groups after AVR, but this remained lower in patients with AS-T2D (AS-noT2D, 1.80 mL min g [1.59, 2.0]; AS-T2D, 1.48 mL min g [1.29, 1.66]; P=0.03). There were no longer differences in PCr/ATP (AS-T2D, 1.44 [1.30, 1.60]; T2D controls, 1.51 [1.34, 1.53]; P=0.12) or vasodilator stress MBF (AS-T2D, 1.48 mL min g [1.29, 1.66]; T2D controls, 1.60 mL min g [1.34, 1.86]; P=0.82) between patients with AS-T2D after AVR and T2D controls at follow-up. Whereas global longitudinal strain, 6-minute walk distance, and NT-proBNP all improved after AVR in patients with AS-noT2D, no improvement in these assessments was observed in patients with AS-T2D. CONCLUSIONS Among patients with severe AS, those with T2D demonstrate persistent abnormalities in myocardial PCr/ATP, vasodilator stress MBF, and cardiac contractile function after AVR; AVR effectively normalizes myocardial PCr/ATP, vasodilator stress MBF, and cardiac contractile function in patients without T2D.
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Affiliation(s)
- Nicholas Jex
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - John P. Greenwood
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Richard M. Cubbon
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Oliver J. Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), RDM Cardiovascular Medicine, University of Oxford, UK (O.J.R., L.V.)
| | - Amrit Chowdhary
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Sharmaine Thirunavukarasu
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Sindhoora Kotha
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Marilena Giannoudi
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Anna McGrane
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
| | - Amanda Maccannell
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
| | - Marcella Conning-Rowland
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
| | - Sam Straw
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Henry Procter
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Sotiris Papaspyros
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
| | - Betsy Evans
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Kalyana Javangula
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Antonella Ferrara
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Walid Elmahdy
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Pankaj Kaul
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD (H.X., P. Kellman)
| | - Peter Swoboda
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD (H.X., P. Kellman)
| | - Ladislav Valkovič
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), RDM Cardiovascular Medicine, University of Oxford, UK (O.J.R., L.V.)
- Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia (L.V.)
| | - Lee Roberts
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
| | - David Beech
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
| | - Mark T. Kearney
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Sven Plein
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
| | - Marc R. Dweck
- University of Edinburgh/BHF Centre for Cardiovascular Science, Edinburgh, UK (M.R.D.)
| | - Eylem Levelt
- University of Leeds, Multidisciplinary Cardiovascular Research Centre, and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., A. McGrane, A. Maccannell, M.C.-R., S.S., H.P., P.S., L.R., D.B., M.T.K., S.P., E.L.)
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, UK (N.J., J.P.G., R.M.C., A.C., S.T., S.K., M.G., S.S., H.P., S.P., B.E., K.J., A.F., W.E., P. Kaul, P.S., M.T.K., E.L.)
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Shaul D, Lev-Cohain N, Sapir G, Sosna J, Gomori JM, Joskowicz L, Katz-Brull R. Real-time influence of intracellular acidification and Na + /H + exchanger inhibition on in-cell pyruvate metabolism in the perfused mouse heart: A 31 P-NMR and hyperpolarized 13 C-NMR study. NMR IN BIOMEDICINE 2023; 36:e4993. [PMID: 37424280 DOI: 10.1002/nbm.4993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023]
Abstract
Disruption of acid-base balance is linked to various diseases and conditions. In the heart, intracellular acidification is associated with heart failure, maladaptive cardiac hypertrophy, and myocardial ischemia. Previously, we have reported that the ratio of the in-cell lactate dehydrogenase (LDH) to pyruvate dehydrogenase (PDH) activities is correlated with cardiac pH. To further characterize the basis for this correlation, these in-cell activities were investigated under induced intracellular acidification without and with Na+ /H+ exchanger (NHE1) inhibition by zoniporide. Male mouse hearts (n = 30) were isolated and perfused retrogradely. Intracellular acidification was performed in two ways: (1) with the NH4 Cl prepulse methodology; and (2) by combining the NH4 Cl prepulse with zoniporide. 31 P NMR spectroscopy was used to determine the intracellular cardiac pH and to quantify the adenosine triphosphate and phosphocreatine content. Hyperpolarized [1-13 C]pyruvate was obtained using dissolution dynamic nuclear polarization. 13 C NMR spectroscopy was used to monitor hyperpolarized [1-13 C]pyruvate metabolism and determine enzyme activities in real time at a temporal resolution of a few seconds using the product-selective saturating excitation approach. The intracellular acidification induced by the NH4 Cl prepulse led to reduced LDH and PDH activities (-16% and -39%, respectively). This finding is in line with previous evidence of reduced myocardial contraction and therefore reduced metabolic activity upon intracellular acidification. Concomitantly, the LDH/PDH activity ratio increased with the reduction in pH, as previously reported. Combining the NH4 Cl prepulse with zoniporide led to a greater reduction in LDH activity (-29%) and to increased PDH activity (+40%). These changes resulted in a surprising decrease in the LDH/PDH ratio, as opposed to previous predictions. Zoniporide alone (without intracellular acidification) did not change these enzyme activities. A possible explanation for the enzymatic changes observed during the combination of the NH4 Cl prepulse and NHE1 inhibition may be related to mitochondrial NHE1 inhibition, which likely negates the mitochondrial matrix acidification. This effect, combined with the increased acidity in the cytosol, would result in an enhanced H+ gradient across the mitochondrial membrane and a temporarily higher pyruvate transport into the mitochondria, thereby increasing the PDH activity at the expense of the cytosolic LDH activity. These findings demonstrate the complexity of in-cell cardiac metabolism and its dependence on intracellular acidification. This study demonstrates the capabilities and limitations of hyperpolarized [1-13 C]pyruvate in the characterization of intracellular acidification as regards cardiac pathologies.
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Affiliation(s)
- David Shaul
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Wohl Institute for Translational Medicine, Hadassah Medical Organization, Jerusalem, Israel
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gal Sapir
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Wohl Institute for Translational Medicine, Hadassah Medical Organization, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - J Moshe Gomori
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Wohl Institute for Translational Medicine, Hadassah Medical Organization, Jerusalem, Israel
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Pan J, Ng SM, Neubauer S, Rider OJ. Phenotyping heart failure by cardiac magnetic resonance imaging of cardiac macro- and microscopic structure: state of the art review. Eur Heart J Cardiovasc Imaging 2023; 24:1302-1317. [PMID: 37267310 PMCID: PMC10531211 DOI: 10.1093/ehjci/jead124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/04/2023] Open
Abstract
Heart failure demographics have evolved in past decades with the development of improved diagnostics, therapies, and prevention. Cardiac magnetic resonance (CMR) has developed in a similar timeframe to become the gold-standard non-invasive imaging modality for characterizing diseases causing heart failure. CMR techniques to assess cardiac morphology and function have progressed since their first use in the 1980s. Increasingly efficient acquisition protocols generate high spatial and temporal resolution images in less time. This has enabled new methods of characterizing cardiac systolic and diastolic function such as strain analysis, exercise real-time cine imaging and four-dimensional flow. A key strength of CMR is its ability to non-invasively interrogate the myocardial tissue composition. Gadolinium contrast agents revolutionized non-invasive cardiac imaging with the late gadolinium enhancement technique. Further advances enabled quantitative parametric mapping to increase sensitivity at detecting diffuse pathology. Novel methods such as diffusion tensor imaging and artificial intelligence-enhanced image generation are on the horizon. Magnetic resonance spectroscopy (MRS) provides a window into the molecular environment of the myocardium. Phosphorus (31P) spectroscopy can inform the status of cardiac energetics in health and disease. Proton (1H) spectroscopy complements this by measuring creatine and intramyocardial lipids. Hyperpolarized carbon (13C) spectroscopy is a novel method that could further our understanding of dynamic cardiac metabolism. CMR of other organs such as the lungs may add further depth into phenotypes of heart failure. The vast capabilities of CMR should be deployed and interpreted in context of current heart failure challenges.
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Affiliation(s)
- Jiliu Pan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Sher May Ng
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
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Liu X, Tang S, Cui D, Bok RA, Chen HY, Gordon JW, Wang ZJ, Larson PEZ. A metabolite specific 3D stack-of-spirals bSSFP sequence for improved bicarbonate imaging in hyperpolarized [1- 13C]Pyruvate MRI. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2023; 353:107518. [PMID: 37402333 PMCID: PMC10498937 DOI: 10.1016/j.jmr.2023.107518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023]
Abstract
13C-bicarbonate is a crucial measure of pyruvate oxidation and TCA cycle flux, but is challenging to measure due to its relatively low concentration and thus will greatly benefit from improved signal-to-noise ratio (SNR). To address this, we developed and investigated the feasibility of a 3D stack-of-spirals metabolite-specific balanced steady-state free precession (MS-bSSFP) sequence for improving the SNR and spatial resolution of dynamic 13C-bicarbonate imaging in hyperpolarized [1-13C]pyruvate studies. The bicarbonate MS-bSSFP sequence was evaluated by simulations, phantoms studies, preclinical studies on five rats, brain studies on two healthy volunteers and renal study on one renal cell carcinoma patient. The simulations and phantom results showed that the bicarbonate-specific pulse had minimal perturbation of other metabolites (<1%). In the animal studies, the MS-bSSFP sequence provided an approximately 2.6-3 × improvement in 13C-bicarbonate SNR compared to a metabolite-specific gradient echo (MS-GRE) sequence without altering the bicarbonate or pyruvate kinetics, and the shorter spiral readout in the MS-bSSFP approach reduced blurring. Using the SNR ratio between MS-bSSFP and MS-GRE, the T2 values of bicarbonate and lactate in the rat kidneys were estimated as 0.5 s and 1.1 s, respectively. The in-vivo feasibility of bicarbonate MS-bSSFP sequence was demonstrated in two human brain studies and one renal study. These studies demonstrate the potential of the sequence for in-vivo applications, laying the foundation for future studies to observe this relatively low concentration metabolite with high-quality images and improve measurements of pyruvate oxidation.
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Affiliation(s)
- Xiaoxi Liu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | | - Di Cui
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Robert A Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Hsin-Yu Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, San Francisco, CA, USA.
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Bönner F, Jung C, Polzin A, Erkens R, Dannenberg L, Ipek R, Kaldirim M, Cramer M, Wischmann P, Zaharia OP, Meyer C, Flögel U, Levkau B, Gödecke A, Fischer J, Klöcker N, Krüger M, Roden M, Kelm M. SYSTEMI - systemic organ communication in STEMI: design and rationale of a cohort study of patients with ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2023; 23:232. [PMID: 37138228 PMCID: PMC10158247 DOI: 10.1186/s12872-023-03210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) still causes significant mortality and morbidity despite best-practice revascularization and adjunct medical strategies. Within the STEMI population, there is a spectrum of higher and lower risk patients with respect to major adverse cardiovascular and cerebral events (MACCE) or re-hospitalization due to heart failure. Myocardial and systemic metabolic disorders modulate patient risk in STEMI. Systematic cardiocirculatory and metabolic phenotyping to assess the bidirectional interaction of cardiac and systemic metabolism in myocardial ischemia is lacking. METHODS Systemic organ communication in STEMI (SYSTEMI) is an all-comer open-end prospective study in STEMI patients > 18 years of age to assess the interaction of cardiac and systemic metabolism in STEMI by systematically collecting data on a regional and systemic level. Primary endpoint will be myocardial function, left ventricular remodelling, myocardial texture and coronary patency at 6 month after STEMI. Secondary endpoint will be all-cause death, MACCE, and re-hospitalisation due to heart failure or revascularisation assessed 12 month after STEMI. The objective of SYSTEMI is to identify metabolic systemic and myocardial master switches that determine primary and secondary endpoints. In SYSTEMI 150-200 patients are expected to be recruited per year. Patient data will be collected at the index event, within 24 h, 5 days as well as 6 and 12 months after STEMI. Data acquisition will be performed in multilayer approaches. Myocardial function will be assessed by using serial cardiac imaging with cineventriculography, echocardiography and cardiovascular magnetic resonance. Myocardial metabolism will be analysed by multi-nuclei magnetic resonance spectroscopy. Systemic metabolism will be approached by serial liquid biopsies and analysed with respect to glucose and lipid metabolism as well as oxygen transport. In summary, SYSTEMI enables a comprehensive data analysis on the levels of organ structure and function alongside hemodynamic, genomic and transcriptomic information to assess cardiac and systemic metabolism. DISCUSSION SYSTEMI aims to identify novel metabolic patterns and master-switches in the interaction of cardiac and systemic metabolism to improve diagnostic and therapeutic algorithms in myocardial ischemia for patient-risk assessment and tailored therapy. TRIAL REGISTRATION Trial Registration Number: NCT03539133.
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Affiliation(s)
- Florian Bönner
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Amin Polzin
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Ralf Erkens
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Lisa Dannenberg
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Rojda Ipek
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Madlen Kaldirim
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Mareike Cramer
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Patricia Wischmann
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Oana-Patricia Zaharia
- Department of Endocrinology and Diabetology, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, Germany
| | - Christian Meyer
- Departmentn of Cardiology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Ulrich Flögel
- Experimental Cardiovascular Imaging, Department of Molecular Cardiology, Heinrich Heine University, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Bodo Levkau
- Institute for Molecular Medicine III, Heinrich Heine University, Düsseldorf, Germany
| | - Axel Gödecke
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
- Institute for Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf, Germany
| | - Jens Fischer
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
- Institute of Neural and Sensory Physiology, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nicolaj Klöcker
- Institute for Cardiovascular Physiology, Heinrich Heine University, Düsseldorf, Germany
| | - Martina Krüger
- Institute for Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- Department of Endocrinology and Diabetology, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany.
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Sejersen S, Rasmussen CW, Bøgh N, Kjaergaard U, Hansen ESS, Schulte RF, Laustsen C. Considering whole-body metabolism in hyperpolarized MRI through 13 C breath analysis-An alternative way to quantification and normalization? Magn Reson Med 2023; 90:664-672. [PMID: 37094025 DOI: 10.1002/mrm.29669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/12/2023] [Accepted: 03/27/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Hyperpolarized [1-13 C]pyruvate MRI is an emerging clinical tool for metabolic imaging. It has the potential for absolute quantitative metabolic imaging. However, the method itself is not quantitative, limiting comparison of images across both time and between individuals. Here, we propose a simple signal normalization to the whole-body oxidative metabolism to overcome this limitation. THEORY AND METHODS A simple extension of the model-free ratiometric analysis of hyperpolarized [1-13 C]pyruvate MRI is presented, using the expired 13 CO2 in breath for normalization. The proposed framework was investigated in two porcine cohorts (N = 11) subjected to local renal hypoperfusion defects and subsequent [1-13 C]pyruvate MRI. A breath sample was taken before the [1-13 C]pyruvate injection and 5 min after. The raw MR signal from both the healthy and intervened kidney in the two cohorts was normalized using the 13 CO2 in the expired air. RESULTS 13 CO2 content in the expired air was significantly different between the two cohorts. Normalization to this reduced the coefficients of variance in the aerobic metabolic sensitive pathways by 25% for the alanine/pyruvate ratio, and numerical changes were observed in the bicarbonate/pyruvate ratio. The lactate/pyruvate ratio was largely unaltered (<2%). CONCLUSION Our results indicate that normalizing the hyperpolarized 13 C-signal ratios by the 13 CO2 content in expired air can reduce variation as well as improve specificity of the method by normalizing the metabolic readout to the overall metabolic status of the individual. The method is a simple and cheap extension to the hyperpolarized 13 C exam.
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Affiliation(s)
- Steffen Sejersen
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Camilla W Rasmussen
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nikolaj Bøgh
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Uffe Kjaergaard
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Esben S S Hansen
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Christoffer Laustsen
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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31
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Burrage MK, Lewis AJ, Miller JJJ. Functional and Metabolic Imaging in Heart Failure with Preserved Ejection Fraction: Promises, Challenges, and Clinical Utility. Cardiovasc Drugs Ther 2023; 37:379-399. [PMID: 35881280 PMCID: PMC10014679 DOI: 10.1007/s10557-022-07355-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is recognised as an increasingly prevalent, morbid and burdensome condition with a poor outlook. Recent advances in both the understanding of HFpEF and the technological ability to image cardiac function and metabolism in humans have simultaneously shone a light on the molecular basis of this complex condition of diastolic dysfunction, and the inflammatory and metabolic changes that are associated with it, typically in the context of a complex patient. This review both makes the case for an integrated assessment of the condition, and highlights that metabolic alteration may be a measurable outcome for novel targeted forms of medical therapy. It furthermore highlights how recent technological advancements and advanced medical imaging techniques have enabled the characterisation of the metabolism and function of HFpEF within patients, at rest and during exercise.
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Affiliation(s)
- Matthew K Burrage
- Oxford Centre for Clinical Cardiovascular Magnetic Resonance Research (OCMR); Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Andrew J Lewis
- Oxford Centre for Clinical Cardiovascular Magnetic Resonance Research (OCMR); Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, UK
| | - Jack J J. Miller
- Oxford Centre for Clinical Cardiovascular Magnetic Resonance Research (OCMR); Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, UK
- The PET Research Centre and The MR Research Centre, Aarhus University, Aarhus, Denmark
- Department of Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, UK
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32
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Chen Ming Low J, Wright AJ, Hesse F, Cao J, Brindle KM. Metabolic imaging with deuterium labeled substrates. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2023; 134-135:39-51. [PMID: 37321757 DOI: 10.1016/j.pnmrs.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/12/2023] [Accepted: 02/07/2023] [Indexed: 06/17/2023]
Abstract
Deuterium metabolic imaging (DMI) is an emerging clinically-applicable technique for the non-invasive investigation of tissue metabolism. The generally short T1 values of 2H-labeled metabolites in vivo can compensate for the relatively low sensitivity of detection by allowing rapid signal acquisition in the absence of significant signal saturation. Studies with deuterated substrates, including [6,6'-2H2]glucose, [2H3]acetate, [2H9]choline and [2,3-2H2]fumarate have demonstrated the considerable potential of DMI for imaging tissue metabolism and cell death in vivo. The technique is evaluated here in comparison with established metabolic imaging techniques, including PET measurements of 2-deoxy-2-[18F]fluoro-d-glucose (FDG) uptake and 13C MR imaging of the metabolism of hyperpolarized 13C-labeled substrates.
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Affiliation(s)
- Jacob Chen Ming Low
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK.
| | - Alan J Wright
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK.
| | - Friederike Hesse
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK.
| | - Jianbo Cao
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK.
| | - Kevin M Brindle
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK.
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33
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Cannizzaro MT, Inserra MC, Passaniti G, Celona A, D'Angelo T, Romeo P, Basile A. Role of advanced cardiovascular imaging in chemotherapy-induced cardiotoxicity. Heliyon 2023; 9:e15226. [PMID: 37095987 PMCID: PMC10121465 DOI: 10.1016/j.heliyon.2023.e15226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
The development of cardiotoxicity induced by cancer treatments has emerged as a significant clinical problem, both in the short run, as it may influence drug administration in chemotherapeutic protocols, and in the long run, because it may determine adverse cardiovascular outcomes in survivors of various malignant diseases. Therefore, early detection of anticancer drug-related cardiotoxicity is an important clinical target to improve prevention of adverse effects and patient care. Today, echocardiography is the first-line cardiac imaging techniques used for identifying cardiotoxicity. Cardiac dysfunction, clinical and subclinical, is generally diagnosed by the reduction of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, myocardial injury detected by echocardiography is preceded by other alterations, such as myocardial perfusion and mitochondrial and metabolic dysfunction, that can only be recognized by second-level imaging techniques, like cardiac magnetic resonance (CMR) and nuclear imaging, which, using targeted radiotracers, may help to provide information on the specific mechanisms of cardiotoxicity. In this review, we focus on the current and emerging role of CMR, as a critical diagnostic tool of cardiotoxicity in the very early phase, due to its availability and because it allows the contemporary detection of functional alterations, tissue alterations (mainly performed using T1, T2 mapping with the evaluation of extracellular volume-ECV) and perfusional alteration (evaluated with rest-stress perfusion) and, in the next future, even metabolic changes. Moreover, in the subsequent future, the use of Artificial Intelligence and big data on imaging parameters (CT, CMR) and oncoming molecular imaging datasets, including differences for gender and countries, may help predict cardiovascular toxicity at its earliest stages, avoiding its progression, with precise tailoring of patients' diagnostic and therapeutic pathways.
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Affiliation(s)
| | | | | | | | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Ospital “Policlinico G. Martino”, Messina, Italy
| | - Placido Romeo
- Radiology Department of AO “San Marco”, A.U.O. Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Antonio Basile
- University of Catania, Department of Surgical and Medical Sciences and Advanced Technologies ‘G.F. Ingrassia’, Italy
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Sahin SI, Ji X, Agarwal S, Sinha A, Mali I, Gordon JW, Mattingly M, Subramaniam S, Kurhanewicz J, Larson PEZ, Sriram R. Metabolite-Specific Echo Planar Imaging for Preclinical Studies with Hyperpolarized 13C-Pyruvate MRI. Tomography 2023; 9:736-749. [PMID: 37104130 PMCID: PMC10143874 DOI: 10.3390/tomography9020059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023] Open
Abstract
Metabolite-specific echo-planar imaging (EPI) sequences with spectral–spatial (spsp) excitation are commonly used in clinical hyperpolarized [1-13C]pyruvate studies because of their speed, efficiency, and flexibility. In contrast, preclinical systems typically rely on slower spectroscopic methods, such as chemical shift imaging (CSI). In this study, a 2D spspEPI sequence was developed for use on a preclinical 3T Bruker system and tested on in vivo mice experiments with patient-derived xenograft renal cell carcinoma (RCC) or prostate cancer tissues implanted in the kidney or liver. Compared to spspEPI sequences, CSI were found to have a broader point spread function via simulations and exhibited signal bleeding between vasculature and tumors in vivo. Parameters for the spspEPI sequence were optimized using simulations and verified with in vivo data. The expected lactate SNR and pharmacokinetic modeling accuracy increased with lower pyruvate flip angles (less than 15°), intermediate lactate flip angles (25° to 40°), and temporal resolution of 3 s. Overall SNR was also higher with coarser spatial resolution (4 mm isotropic vs. 2 mm isotropic). Pharmacokinetic modelling used to fit kPL maps showed results consistent with the previous literature and across different sequences and tumor xenografts. This work describes and justifies the pulse design and parameter choices for preclinical spspEPI hyperpolarized 13C-pyruvate studies and shows superior image quality to CSI.
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Affiliation(s)
- Sule I. Sahin
- UC Berkeley—UCSF Graduate Program in Bioengineering, Berkeley, CA 94720, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
| | - Xiao Ji
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
| | - Shubhangi Agarwal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
| | - Avantika Sinha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
| | - Ivina Mali
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
| | - Jeremy W. Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
| | | | - Sukumar Subramaniam
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
| | - Peder E. Z. Larson
- UC Berkeley—UCSF Graduate Program in Bioengineering, Berkeley, CA 94720, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
- Correspondence: (P.E.Z.L.); (R.S.)
| | - Renuka Sriram
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
- Correspondence: (P.E.Z.L.); (R.S.)
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Inhibition of Pyruvate Dehydrogenase in the Heart as an Initiating Event in the Development of Diabetic Cardiomyopathy. Antioxidants (Basel) 2023; 12:antiox12030756. [PMID: 36979003 PMCID: PMC10045649 DOI: 10.3390/antiox12030756] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/06/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023] Open
Abstract
Obesity affects a growing fraction of the population and is a risk factor for type 2 diabetes and cardiovascular disease. Even in the absence of hypertension and coronary artery disease, type 2 diabetes can result in a heart disease termed diabetic cardiomyopathy. Diminished glucose oxidation, increased reliance on fatty acid oxidation for energy production, and oxidative stress are believed to play causal roles. However, the progression of metabolic changes and mechanisms by which these changes impact the heart have not been established. Cardiac pyruvate dehydrogenase (PDH), the central regulatory site for glucose oxidation, is rapidly inhibited in mice fed high dietary fat, a model of obesity and diabetes. Increased reliance on fatty acid oxidation for energy production, in turn, enhances mitochondrial pro-oxidant production. Inhibition of PDH may therefore initiate metabolic inflexibility and oxidative stress and precipitate diabetic cardiomyopathy. We discuss evidence from the literature that supports a role for PDH inhibition in loss in energy homeostasis and diastolic function in obese and diabetic humans and in rodent models. Finally, seemingly contradictory findings highlight the complexity of the disease and the need to delineate progressive changes in cardiac metabolism, the impact on myocardial structure and function, and the ability to intercede.
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36
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Sun P, Wu Z, Lin L, Hu G, Zhang X, Wang J. MR-Nucleomics: The study of pathological cellular processes with multinuclear magnetic resonance spectroscopy and imaging in vivo. NMR IN BIOMEDICINE 2023; 36:e4845. [PMID: 36259659 DOI: 10.1002/nbm.4845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/28/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
Clinical medicine has experienced a rapid development in recent decades, during which therapies targeting specific cellular signaling pathways, or specific cell surface receptors, have been increasingly adopted. While these developments in clinical medicine call for improved precision in diagnosis and treatment monitoring, modern medical imaging methods are restricted mainly to anatomical imaging, lagging behind the requirements of precision medicine. Although positron emission tomography and single photon emission computed tomography have been used clinically for studies of metabolism, their applications have been limited by the exposure risk to ionizing radiation, the subsequent limitation in repeated and longitudinal studies, and the incapability in assessing downstream metabolism. Magnetic resonance spectroscopy (MRS) or spectroscopic imaging (MRSI) are, in theory, capable of assessing molecular activities in vivo, although they are often limited by sensitivity. Here, we review some recent developments in MRS and MRSI of multiple nuclei that have potential as molecular imaging tools in the clinic.
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Affiliation(s)
- Peng Sun
- Clinical & Technical Support, Philips Healthcare, China
| | - Zhigang Wu
- Clinical & Technical Support, Philips Healthcare, China
| | - Liangjie Lin
- Clinical & Technical Support, Philips Healthcare, China
| | - Geli Hu
- Clinical & Technical Support, Philips Healthcare, China
| | | | - Jiazheng Wang
- Clinical & Technical Support, Philips Healthcare, China
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37
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Peng C, Zhang Y, Lang X, Zhang Y. Role of mitochondrial metabolic disorder and immune infiltration in diabetic cardiomyopathy: new insights from bioinformatics analysis. J Transl Med 2023; 21:66. [PMID: 36726122 PMCID: PMC9893675 DOI: 10.1186/s12967-023-03928-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Diabetic cardiomyopathy (DCM) is one of the common cardiovascular complications of diabetes and a leading cause of death in diabetic patients. Mitochondrial metabolism and immune-inflammation are key for DCM pathogenesis, but their crosstalk in DCM remains an open issue. This study explored the separate roles of mitochondrial metabolism and immune microenvironment and their crosstalk in DCM with bioinformatics. METHODS DCM chip data (GSE4745, GSE5606, and GSE6880) were obtained from NCBI GEO, while mitochondrial gene data were downloaded from MitoCarta3.0 database. Differentially expressed genes (DEGs) were screened by GEO2R and processed for GSEA, GO and KEGG pathway analyses. Mitochondria-related DEGs (MitoDEGs) were obtained. A PPI network was constructed, and the hub MitoDEGs closely linked to DCM or heart failure were identified with CytoHubba, MCODE and CTD scores. Transcription factors and target miRNAs of the hub MitoDEGs were predicted with Cytoscape and miRWalk database, respectively, and a regulatory network was established. The immune infiltration pattern in DCM was analyzed with ImmuCellAI, while the relationship between MitoDEGs and immune infiltration abundance was investigated using Spearman method. A rat model of DCM was established to validate the expression of hub MitoDEGs and their relationship with cardiac function. RESULTS MitoDEGs in DCM were significantly enriched in pathways involved in mitochondrial metabolism, immunoregulation, and collagen synthesis. Nine hub MitoDEGs closely linked to DCM or heart failure were obtained. Immune analysis revealed significantly increased infiltration of B cells while decreased infiltration of DCs in immune microenvironment of DCM. Spearman analysis demonstrated that the hub MitoDEGs were positively associated with the infiltration of pro-inflammatory immune cells, but negatively associated with the infiltration of anti-inflammatory or regulatory immune cells. In the animal experiment, 4 hub MitoDEGs (Pdk4, Hmgcs2, Decr1, and Ivd) showed an expression trend consistent with bioinformatics analysis result. Additionally, the up-regulation of Pdk4, Hmgcs2, Decr1 and the down-regulation of Ivd were distinctly linked to reduced cardiac function. CONCLUSIONS This study unraveled the interaction between mitochondrial metabolism and immune microenvironment in DCM, providing new insights into the research on potential pathogenesis of DCM and the exploration of novel targets for medical interventions.
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Affiliation(s)
- Cheng Peng
- grid.412463.60000 0004 1762 6325Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150001 China ,grid.410736.70000 0001 2204 9268Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001 China
| | - Yanxiu Zhang
- grid.412463.60000 0004 1762 6325Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150001 China ,grid.410736.70000 0001 2204 9268Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001 China
| | - Xueyan Lang
- grid.412463.60000 0004 1762 6325Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150001 China ,grid.410736.70000 0001 2204 9268Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001 China
| | - Yao Zhang
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China. .,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001, China.
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Grist JT, Bøgh N, Hansen ES, Schneider AM, Healicon R, Ball V, Miller JJJJ, Smart S, Couch Y, Buchan AM, Tyler DJ, Laustsen C. Developing a metabolic clearance rate framework as a translational analysis approach for hyperpolarized 13C magnetic resonance imaging. Sci Rep 2023; 13:1613. [PMID: 36709217 PMCID: PMC9884306 DOI: 10.1038/s41598-023-28643-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023] Open
Abstract
Hyperpolarized carbon-13 magnetic resonance imaging is a promising technique for in vivo metabolic interrogation of alterations between health and disease. This study introduces a formalism for quantifying the metabolic information in hyperpolarized imaging. This study investigated a novel perfusion formalism and metabolic clearance rate (MCR) model in pre-clinical stroke and in the healthy human brain. Simulations showed that the proposed model was robust to perturbations in T1, transmit B1, and kPL. A significant difference in ipsilateral vs contralateral pyruvate derived cerebral blood flow (CBF) was detected in rats (140 ± 2 vs 89 ± 6 mL/100 g/min, p < 0.01, respectively) and pigs (139 ± 12 vs 95 ± 5 mL/100 g/min, p = 0.04, respectively), along with an increase in fractional metabolism (26 ± 5 vs 4 ± 2%, p < 0.01, respectively) in the rodent brain. In addition, a significant increase in ipsilateral vs contralateral MCR (0.034 ± 0.007 vs 0.017 ± 0.02/s, p = 0.03, respectively) and a decrease in mean transit time (31 ± 8 vs 60 ± 2 s, p = 0.04, respectively) was observed in the porcine brain. In conclusion, MCR mapping is a simple and robust approach to the post-processing of hyperpolarized magnetic resonance imaging.
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Affiliation(s)
- James T Grist
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
- Division of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
- Department of Radiology, Oxford University Hospitals Trust, Oxford, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nikolaj Bøgh
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Esben Søvsø Hansen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Anna M Schneider
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Richard Healicon
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
| | - Vicky Ball
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
| | - Jack J J J Miller
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
- Division of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Sean Smart
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Yvonne Couch
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Damian J Tyler
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
- Division of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
| | - Christoffer Laustsen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark.
- Aarhus University Hospital, MR Center, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.
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39
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Tabatabaei Dakhili SA, Greenwell AA, Ussher JR. Pyruvate Dehydrogenase Complex and Glucose Oxidation as a Therapeutic Target in Diabetic Heart Disease. J Lipid Atheroscler 2023; 12:47-57. [PMID: 36761067 PMCID: PMC9884548 DOI: 10.12997/jla.2023.12.1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 01/26/2023] Open
Abstract
Diabetic cardiomyopathy was originally described as the presence of ventricular dysfunction in the absence of coronary artery disease and/or hypertension. It is characterized by diastolic dysfunction and is more prevalent in people with diabetes than originally realized, leading to the suggestion in the field that it simply be referred to as diabetic heart disease. While there are currently no approved therapies for diabetic heart disease, a multitude of studies clearly demonstrate that it is characterized by several disturbances in myocardial energy metabolism. One of the most prominent changes in myocardial energy metabolism in diabetes is a robust impairment in glucose oxidation. Herein we will describe the mechanisms responsible for the diabetes-induced decline in myocardial glucose oxidation, and the pharmacological approaches that have been pursued to correct this metabolic disorder. With surmounting evidence that stimulating myocardial glucose oxidation can alleviate diastolic dysfunction and other pathologies associated with diabetic heart disease, this may also represent a novel strategy for decreasing the prevalence of heart failure with preserved ejection fraction in the diabetic population.
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Affiliation(s)
- Seyed Amirhossein Tabatabaei Dakhili
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.,Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Amanda A. Greenwell
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.,Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - John R. Ussher
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.,Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
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40
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Fuetterer M, Traechtler J, Busch J, Peereboom SM, Dounas A, Manka R, Weisskopf M, Cesarovic N, Stoeck CT, Kozerke S. Hyperpolarized Metabolic and Parametric CMR Imaging of Longitudinal Metabolic-Structural Changes in Experimental Chronic Infarction. JACC Cardiovasc Imaging 2022; 15:2051-2064. [PMID: 36481073 DOI: 10.1016/j.jcmg.2022.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prolonged ischemia and myocardial infarction are followed by a series of dynamic processes that determine the fate of the affected myocardium toward recovery or necrosis. Metabolic adaptions are considered to play a vital role in the recovery of salvageable myocardium in the context of stunned and hibernating myocardium. OBJECTIVES The potential of hyperpolarized pyruvate cardiac magnetic resonance (CMR) alongside functional and parametric CMR as a tool to study the complex metabolic-structural interplay in a longitudinal study of chronic myocardial infarction in an experimental pig model is investigated. METHODS Metabolic imaging using hyperpolarized [1-13C] pyruvate and proton-based CMR including cine, T1/T2 relaxometry, dynamic contrast-enhanced, and late gadolinium enhanced imaging were performed on clinical 3.0-T and 1.5-T MR systems before infarction and at 6 days and 5 and 9 weeks postinfarction in a longitudinal study design. Chronic myocardial infarction in pigs was induced using catheter-based occlusion and compared with healthy controls. RESULTS Metabolic image data revealed temporarily elevated lactate-to-bicarbonate ratios at day 6 in the infarcted relative to remote myocardium. The temporal changes of lactate-to-bicarbonate ratios were found to correlate with changes in T2 and impaired local contractility. Assessment of pyruvate dehydrogenase flux via the hyperpolarized [13C] bicarbonate signal revealed recovery of aerobic cellular respiration in the hibernating myocardium, which correlated with recovery of local radial strain. CONCLUSIONS This study demonstrates the potential of hyperpolarized CMR to longitudinally detect metabolic changes after cardiac infarction over days to weeks. Viable myocardium in the area at risk was identified based on restored pyruvate dehydrogenase flux.
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Affiliation(s)
- Maximilian Fuetterer
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Julia Traechtler
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Julia Busch
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | | | - Andreas Dounas
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Miriam Weisskopf
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Nikola Cesarovic
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland; Institute of Translational Cardiovascular Technologies, ETH Zurich, Zurich, Switzerland
| | - Christian Torben Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
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41
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Monga S, Valkovič L, Tyler D, Lygate CA, Rider O, Myerson SG, Neubauer S, Mahmod M. Insights Into the Metabolic Aspects of Aortic Stenosis With the Use of Magnetic Resonance Imaging. JACC Cardiovasc Imaging 2022; 15:2112-2126. [PMID: 36481080 PMCID: PMC9722407 DOI: 10.1016/j.jcmg.2022.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/25/2022] [Accepted: 04/29/2022] [Indexed: 01/13/2023]
Abstract
Pressure overload in aortic stenosis (AS) encompasses both structural and metabolic remodeling and increases the risk of decompensation into heart failure. A major component of metabolic derangement in AS is abnormal cardiac substrate use, with down-regulation of fatty acid oxidation, increased reliance on glucose metabolism, and subsequent myocardial lipid accumulation. These changes are associated with energetic and functional cardiac impairment in AS and can be assessed with the use of cardiac magnetic resonance spectroscopy (MRS). Proton MRS allows the assessment of myocardial triglyceride content and creatine concentration. Phosphorous MRS allows noninvasive in vivo quantification of the phosphocreatine-to-adenosine triphosphate ratio, a measure of cardiac energy status that is reduced in patients with severe AS. This review summarizes the changes to cardiac substrate and high-energy phosphorous metabolism and how they affect cardiac function in AS. The authors focus on the role of MRS to assess these metabolic changes, and potentially guide future (cellular) metabolic therapy in AS.
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Affiliation(s)
- Shveta Monga
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ladislav Valkovič
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Damian Tyler
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Craig A Lygate
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Wellcome Centre for Human Genetics, Oxford, United Kingdom
| | - Oliver Rider
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Saul G Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
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42
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Merritt ME. Editorial for "Whole-Abdomen Metabolic Imaging of Healthy Volunteers Using Hyperpolarized [1- 13 C]pyruvate MRI". J Magn Reson Imaging 2022; 56:1807-1808. [PMID: 35416358 DOI: 10.1002/jmri.28202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Matthew E Merritt
- Department of Biochemistry and Molecular Biology, University of Florida, Florida, USA
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43
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Ke J, Pan J, Lin H, Gu J. Diabetic cardiomyopathy: a brief summary on lipid toxicity. ESC Heart Fail 2022; 10:776-790. [PMID: 36369594 PMCID: PMC10053269 DOI: 10.1002/ehf2.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/30/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2022] Open
Abstract
Diabetes mellitus (DM) is a serious epidemic around the globe, and cardiovascular diseases account for the majority of deaths in patients with DM. Diabetic cardiomyopathy (DCM) is defined as a cardiac dysfunction derived from DM without the presence of coronary artery diseases and hypertension. Patients with either type 1 or type 2 DM are at high risk of developing DCM and even heart failure. Metabolic disorders of obesity and insulin resistance in type 2 diabetic environments result in dyslipidaemia and subsequent lipid-induced toxicity (lipotoxicity) in organs including the heart. Although various mechanisms have been proposed underlying DCM, it remains incompletely understood how lipotoxicity alters cardiac function and how DM induces clinical heart syndrome. With recent progress, we here summarize the latest discoveries on lipid-induced cardiac toxicity in diabetic hearts and discuss the underlying therapies and controversies in clinical DCM.
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Affiliation(s)
- Jiahan Ke
- Department of Cardiology Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine Shanghai China
| | - Jianan Pan
- Department of Cardiology Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine Shanghai China
| | - Hao Lin
- Department of Cardiology Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine Shanghai China
| | - Jun Gu
- Department of Cardiology Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine Shanghai China
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Wamil M, Goncalves M, Rutherford A, Borlotti A, Pellikka PA. Multi-modality cardiac imaging in the management of diabetic heart disease. Front Cardiovasc Med 2022; 9:1043711. [DOI: 10.3389/fcvm.2022.1043711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Diabetic heart disease is a major healthcare problem. Patients with diabetes show an excess of death from cardiovascular causes, twice as high as the general population and those with diabetes type 1 and longer duration of the disease present with more severe cardiovascular complications. Premature coronary artery disease and heart failure are leading causes of morbidity and reduced life expectancy. Multimodality cardiac imaging, including echocardiography, cardiac computed tomography, nuclear medicine, and cardiac magnetic resonance play crucial role in the diagnosis and management of different pathologies included in the definition of diabetic heart disease. In this review we summarise the utility of multi-modality cardiac imaging in characterising ischaemic and non-ischaemic causes of diabetic heart disease and give an overview of the current clinical practice. We also describe emerging imaging techniques enabling early detection of coronary artery inflammation and the non-invasive characterisation of the atherosclerotic plaque disease. Furthermore, we discuss the role of MRI-derived techniques in studying altered myocardial metabolism linking diabetes with the development of diabetic cardiomyopathy. Finally, we discuss recent data regarding the use of artificial intelligence applied to large imaging databases and how those efforts can be utilised in the future in screening of patients with diabetes for early signs of disease.
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45
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Andrew R, Stimson RH. Mapping endocrine networks by stable isotope tracing. CURRENT OPINION IN ENDOCRINE AND METABOLIC RESEARCH 2022; 26:100381. [PMID: 39185272 PMCID: PMC11344083 DOI: 10.1016/j.coemr.2022.100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Hormones regulate metabolic homeostasis through interlinked dynamic networks of proteins and small molecular weight metabolites, and state-of-the-art chemical technologies have been developed to decipher these complex pathways. Stable-isotope tracers have largely replaced radiotracers to measure flux in humans, building on advances in nuclear magnetic resonance spectroscopy and mass spectrometry. These technologies are now being applied to localise molecules within tissues. Radiotracers are still highly valuable both preclinically and in 3D imaging by positron emission tomography. The coming of age of vibrational spectroscopy in conjunction with stable-isotope tracing offers detailed cellular insights to map complex biological processes. Together with computational modelling, these approaches are poised to coalesce into multi-modal platforms to provide hitherto inaccessible dynamic and spatial insights into endocrine signalling.
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Affiliation(s)
- Ruth Andrew
- University/ British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47, Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom
| | - Roland H Stimson
- University/ British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47, Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom
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46
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Healicon R, Rooney CHE, Ball V, Shinozaki A, Miller JJ, Smart S, Radford‐Smith D, Anthony D, Tyler DJ, Grist JT. Assessing the effect of anesthetic gas mixtures on hyperpolarized 13 C pyruvate metabolism in the rat brain. Magn Reson Med 2022; 88:1324-1332. [PMID: 35468245 PMCID: PMC9325476 DOI: 10.1002/mrm.29274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/11/2022] [Accepted: 03/31/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To determine the effect of altering anesthetic oxygen protocols on measurements of cerebral perfusion and metabolism in the rodent brain. METHODS Seven rats were anesthetized and underwent serial MRI scans with hyperpolarized [1-13 C]pyruvate and perfusion weighted imaging. The anesthetic carrier gas protocol used varied from 100:0% to 90:10% to 60:40% O2 :N2 O. Spectra were quantified with AMARES and perfusion imaging was processed using model-free deconvolution. A 1-way ANOVA was used to compare results across groups, with pairwise t tests performed with correction for multiple comparisons. Spearman's correlation analysis was performed between O2 % and MR measurements. RESULTS There was a significant increase in bicarbonate:total 13 C carbon and bicarbonate:13 C pyruvate when moving between 100:0 to 90:10 and 100:0 to 60:40 O2 :N2 O % (0.02 ± 0.01 vs. 0.019 ± 0.005 and 0.02 ± 0.01 vs. 0.05 ± 0.02, respectively) and (0.04 ± 0.01 vs. 0.03 ± 0.01 and 0.04 ± 0.01 vs. 0.08 ± 0.02, respectively). There was a significant difference in 13 C pyruvate time to peak when moving between 100:0 to 90:10 and 100:0 to 60:40 O2 :N2 O % (13 ± 2 vs. 10 ± 1 and 13 ± 2 vs. 7.5 ± 0.5 s, respectively) as well as significant differences in cerebral blood flow (CBF) between gas protocols. Significant correlations between bicarbonate:13 C pyruvate and gas protocol (ρ = -0.47), mean transit time and gas protocol (ρ = 0.41) and 13 C pyruvate time-to-peak and cerebral blood flow (ρ = -0.54) were also observed. CONCLUSIONS These results demonstrate that the detection and quantification of cerebral metabolism and perfusion is dependent on the oxygen protocol used in the anesthetized rodent brain.
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Affiliation(s)
- Richard Healicon
- Department of Physiology, Anatomy, and GeneticsUniversity of OxfordOxfordUnited Kingdom
| | - Catriona H. E. Rooney
- Department of Physiology, Anatomy, and GeneticsUniversity of OxfordOxfordUnited Kingdom
| | - Vicky Ball
- Department of Physiology, Anatomy, and GeneticsUniversity of OxfordOxfordUnited Kingdom
| | - Ayaka Shinozaki
- Department of Physiology, Anatomy, and GeneticsUniversity of OxfordOxfordUnited Kingdom
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Jack J. Miller
- Department of Physiology, Anatomy, and GeneticsUniversity of OxfordOxfordUnited Kingdom
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Clarendon Laboratory, Department of PhysicsUniversity of OxfordOxfordUnited Kingdom
- The PET Centre and The MR Centre, Clinical MedicineAarhus University and Aarhus University HospitalAarhusDenmark
| | - Sean Smart
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
| | | | - Daniel Anthony
- Department of PharmacologyUniversity of OxfordOxfordUnited Kingdom
| | - Damian J. Tyler
- Department of Physiology, Anatomy, and GeneticsUniversity of OxfordOxfordUnited Kingdom
- The PET Centre and The MR Centre, Clinical MedicineAarhus University and Aarhus University HospitalAarhusDenmark
| | - James T. Grist
- Department of Physiology, Anatomy, and GeneticsUniversity of OxfordOxfordUnited Kingdom
- The PET Centre and The MR Centre, Clinical MedicineAarhus University and Aarhus University HospitalAarhusDenmark
- Department of RadiologyOxford University HospitalsOxfordUnited Kingdom
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUnited Kingdom
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47
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Yurista SR, Chen S, Welsh A, Tang WHW, Nguyen CT. Targeting Myocardial Substrate Metabolism in the Failing Heart: Ready for Prime Time? Curr Heart Fail Rep 2022; 19:180-190. [PMID: 35567658 PMCID: PMC10950325 DOI: 10.1007/s11897-022-00554-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We review the clinical benefits of altering myocardial substrate metabolism in heart failure. RECENT FINDINGS Modulation of cardiac substrates (fatty acid, glucose, or ketone metabolism) offers a wide range of therapeutic possibilities which may be applicable to heart failure. Augmenting ketone oxidation seems to offer great promise as a new therapeutic modality in heart failure. The heart has long been recognized as metabolic omnivore, meaning it can utilize a variety of energy substrates to maintain adequate ATP production. The adult heart uses fatty acid as a major fuel source, but it can also derive energy from other substrates including glucose and ketone, and to some extent pyruvate, lactate, and amino acids. However, cardiomyocytes of the failing heart endure remarkable metabolic remodeling including a shift in substrate utilization and reduced ATP production, which account for cardiac remodeling and dysfunction. Research to understand the implication of myocardial metabolic perturbation in heart failure has grown in recent years, and this has raised interest in targeting myocardial substrate metabolism for heart failure therapy. Due to the interdependency between different pathways, the main therapeutic metabolic approaches include inhibiting fatty acid uptake/fatty acid oxidation, reducing circulating fatty acid levels, increasing glucose oxidation, and augmenting ketone oxidation.
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Affiliation(s)
- Salva R Yurista
- Cardiovascular Research Center, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Boston, MA, 02129, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - Shi Chen
- Cardiovascular Research Center, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Boston, MA, 02129, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Aidan Welsh
- Cardiovascular Research Center, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Boston, MA, 02129, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - W H Wilson Tang
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Cardiovascular Innovation Research Center, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher T Nguyen
- Cardiovascular Research Center, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Boston, MA, 02129, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Division of Health Science Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA, USA
- Cardiovascular Innovation Research Center, Cleveland Clinic, Cleveland, OH, USA
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
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48
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Increased cardiac Pi/PCr in the diabetic heart observed using phosphorus magnetic resonance spectroscopy at 7T. PLoS One 2022; 17:e0269957. [PMID: 35709167 PMCID: PMC9202907 DOI: 10.1371/journal.pone.0269957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/01/2022] [Indexed: 12/04/2022] Open
Abstract
Phosphorus magnetic resonance spectroscopy (31P-MRS) has previously demonstrated decreased energy reserves in the form of phosphocreatine to adenosine-tri-phosphate ratio (PCr/ATP) in the hearts of patients with type 2 diabetes (T2DM). Recent 31P-MRS techniques using 7T systems, e.g. long mixing time stimulated echo acquisition mode (STEAM), allow deeper insight into cardiac metabolism through assessment of inorganic phosphate (Pi) content and myocardial pH, which play pivotal roles in energy production in the heart. Therefore, we aimed to further explore the cardiac metabolic phenotype in T2DM using STEAM at 7T. Seventeen patients with T2DM and twenty-three healthy controls were recruited and their cardiac PCr/ATP, Pi/PCr and pH were assessed at 7T. Diastolic function of all patients with T2DM was assessed using echocardiography to investigate the relationship between diastolic dysfunction and cardiac metabolism. Mirroring the decreased PCr/ATP (1.70±0.31 vs. 2.07±0.39; p<0.01), the cardiac Pi/PCr was increased (0.13±0.07 vs. 0.10±0.03; p = 0.02) in T2DM patients in comparison to healthy controls. Myocardial pH was not significantly different between the groups (7.14±0.12 vs. 7.10±0.12; p = 0.31). There was a negative correlation between PCr/ATP and diastolic function (R2 = 0.33; p = 0.02) in T2DM. No correlation was observed between diastolic function and Pi/PCr and (R2 = 0.16; p = 0.21). In addition, we did not observe any correlation between cardiac PCr/ATP and Pi/PCr (p = 0.19). Using STEAM 31P-MRS at 7T we have for the first time explored Pi/PCr in the diabetic human heart and found it increased when compared to healthy controls. The lack of correlation between measured PCr/ATP and Pi/PCr suggests that independent mechanisms might contribute to these perturbations.
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Joergensen SH, Hansen ESS, Bøgh N, Bertelsen LB, Staehr PB, Schulte RF, Malloy C, Wiggers H, Laustsen C. Detection of increased pyruvate dehydrogenase flux in the human heart during adenosine stress test using hyperpolarized [1- 13C]pyruvate cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2022; 24:34. [PMID: 35658896 PMCID: PMC9169396 DOI: 10.1186/s12968-022-00860-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hyperpolarized (HP) [1-13C]pyruvate cardiovascular magnetic resonance (CMR) imaging can visualize the uptake and intracellular conversion of [1-13C]pyruvate to either [1-13C]lactate or 13C-bicarbonate depending on the prevailing metabolic state. The aim of the present study was to combine an adenosine stress test with HP [1-13C]pyruvate CMR to detect cardiac metabolism in the healthy human heart at rest and during moderate stress. METHODS A prospective descriptive study was performed between October 2019 and August 2020. Healthy human subjects underwent cine CMR and HP [1-13C]pyruvate CMR at rest and during adenosine stress. HP [1-13C]pyruvate CMR images were acquired at the mid-left-ventricle (LV) level. Semi-quantitative assessment of first-pass myocardial [1-13C]pyruvate perfusion and metabolism were assessed. Paired t-tests were used to compare mean values at rest and during stress. RESULTS Six healthy subjects (two female), age 29 ± 7 years were studied and no adverse reactions occurred. Myocardial [1-13C]pyruvate perfusion was significantly increased during stress with a reduction in time-to-peak from 6.2 ± 2.8 to 2.7 ± 1.3 s, p = 0.02. This higher perfusion was accompanied by an overall increased myocardial uptake and metabolism. The conversion rate constant (kPL) for lactate increased from 11 ± 9 *10-3 to 20 ± 10 * 10-3 s-1, p = 0.04. The pyruvate oxidation rate (kPB) increased from 4 ± 4 *10-3 to 12 ± 7 *10-3 s-1, p = 0.008. This increase in carbohydrate metabolism was positively correlated with heart rate (R2 = 0.44, p = 0.02). CONCLUSIONS Adenosine stress testing combined with HP [1-13C]pyruvate CMR is feasible and well-tolerated in healthy subjects. We observed an increased pyruvate oxidation during cardiac stress. The present study is an important step in the translation of HP [1-13C]pyruvate CMR into clinical cardiac imaging. Trial registration EUDRACT, 2018-003533-15. Registered 4th of December 2018, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2018-003533-15.
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Affiliation(s)
- Steen Hylgaard Joergensen
- Department of Clinical Medicine, Aarhus University Hospital, The MR-Research Centre, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Department of Cardiology, Aarhus University Hospital, Hjoerring, Denmark.
- Department of Cardiology, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjoerring, Denmark.
| | - Esben Soevsoe S Hansen
- Department of Clinical Medicine, Aarhus University Hospital, The MR-Research Centre, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Nikolaj Bøgh
- Department of Clinical Medicine, Aarhus University Hospital, The MR-Research Centre, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Lotte Bonde Bertelsen
- Department of Clinical Medicine, Aarhus University Hospital, The MR-Research Centre, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Peter Bisgaard Staehr
- Department of Cardiology, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjoerring, Denmark
| | | | - Craig Malloy
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, USA
| | - Henrik Wiggers
- Department of Clinical Medicine, Department of Cardiology, Aarhus University Hospital, Hjoerring, Denmark
| | - Christoffer Laustsen
- Department of Clinical Medicine, Aarhus University Hospital, The MR-Research Centre, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
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50
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Heather LC, Hafstad AD, Halade GV, Harmancey R, Mellor KM, Mishra PK, Mulvihill EE, Nabben M, Nakamura M, Rider OJ, Ruiz M, Wende AR, Ussher JR. Guidelines on Models of Diabetic Heart Disease. Am J Physiol Heart Circ Physiol 2022; 323:H176-H200. [PMID: 35657616 PMCID: PMC9273269 DOI: 10.1152/ajpheart.00058.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Diabetes is a major risk factor for cardiovascular diseases, including diabetic cardiomyopathy, atherosclerosis, myocardial infarction, and heart failure. As cardiovascular disease represents the number one cause of death in people with diabetes, there has been a major emphasis on understanding the mechanisms by which diabetes promotes cardiovascular disease, and how antidiabetic therapies impact diabetic heart disease. With a wide array of models to study diabetes (both type 1 and type 2), the field has made major progress in answering these questions. However, each model has its own inherent limitations. Therefore, the purpose of this guidelines document is to provide the field with information on which aspects of cardiovascular disease in the human diabetic population are most accurately reproduced by the available models. This review aims to emphasize the advantages and disadvantages of each model, and to highlight the practical challenges and technical considerations involved. We will review the preclinical animal models of diabetes (based on their method of induction), appraise models of diabetes-related atherosclerosis and heart failure, and discuss in vitro models of diabetic heart disease. These guidelines will allow researchers to select the appropriate model of diabetic heart disease, depending on the specific research question being addressed.
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Affiliation(s)
- Lisa C Heather
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Anne D Hafstad
- Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Ganesh V Halade
- Department of Medicine, The University of Alabama at Birmingham, Tampa, Florida, United States
| | - Romain Harmancey
- Department of Internal Medicine, Division of Cardiology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Paras K Mishra
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Erin E Mulvihill
- University of Ottawa Heart Institute, Ottawa, ON, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Miranda Nabben
- Departments of Genetics and Cell Biology, and Clinical Genetics, Maastricht University Medical Center, CARIM School of Cardiovascular Diseases, Maastricht, the Netherlands
| | - Michinari Nakamura
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Oliver J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Matthieu Ruiz
- Montreal Heart Institute, Montreal, Quebec, Canada.,Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - Adam R Wende
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - John R Ussher
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.,Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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