Imaging Neurodegenerative Metabolism in Amyotrophic Lateral Sclerosis with Hyperpolarized [1-13C]pyruvate MRI

The cause of amyotrophic lateral sclerosis (ALS) is still unknown, and consequently, early diagnosis of the disease can be difficult and effective treatment is lacking. The pathology of ALS seems to involve specific disturbances in carbohydrate metabolism, which may be diagnostic and therapeutic targets. Magnetic resonance imaging (MRI) with hyperpolarized [1-(13)C]pyruvate is emerging as a technology for the evaluation of pathway-specific changes in the brain’s metabolism. By imaging pyruvate and the lactate and bicarbonate it is metabolized into, the technology is sensitive to the metabolic changes of inflammation and mitochondrial dysfunction. In this study, we performed hyperpolarized MRI of a patient with newly diagnosed ALS. We found a lateralized difference in [1-(13)C]pyruvate-to-[1-(13)C]lactate exchange with no changes in exchange from [1-(13)C]pyruvate to (13)C-bicarbonate. The 40% increase in [1-(13)C]pyruvate-to-[1-(13)C]lactate exchange corresponded with the patient’s symptoms and presentation with upper-motor neuron affection and cortical hyperexcitability. The data presented here demonstrate the feasibility of performing hyperpolarized MRI in ALS. They indicate potential in pathway-specific imaging of dysfunctional carbohydrate metabolism in ALS, an enigmatic neurodegenerative disease

Lactate saturation limits bicarbonate detection in hyperpolarized 13 C-pyruvate MRI of the brain

PURPOSE: To investigate the potential effects of [1‐(13)C]lactate RF saturation pulses on [(13)C]bicarbonate detection in hyperpolarized [1‐(13)C]pyruvate MRI of the brain. METHODS: Thirteen healthy rats underwent MRI with hyperpolarized [1‐(13)C]pyruvate of either the brain (n = 8) or the kidneys, heart, and liver (n = 5). Dynamic, metabolite‐selective imaging was used in a cross‐over experiment in which [1‐(13)C]lactate was excited with either 0° or 90° flip angles. The [(13)C]bicarbonate SNR and apparent [1‐(13)C]pyruvate‐to‐[(13)C]bicarbonate conversion (k (PB)) were determined. Furthermore, simulations were performed to identify the SNR optimal flip‐angle scheme for detection of [1‐(13)C]lactate and [(13)C]bicarbonate. RESULTS: In the brain, the [(13)C]bicarbonate SNR was 64% higher when [1‐(13)C]lactate was not excited (5.8 ± 1.5 vs 3.6 ± 1.3; 1.2 to 3.3–point increase; p = 0.0027). The apparent k (PB) decreased 25% with [1‐(13)C]lactate saturation (0.0047 ± 0.0008 s(−1) vs 0.0034 ± 0.0006 s(−1); 95% confidence interval, 0.0006–0.0019 s(−1) increase; p = 0.0049). These effects were not present in the kidneys, heart, or liver. Simulations suggest that the optimal [(13)C]bicarbonate SNR with a TR of 1 s in the brain is obtained with [(13)C]bicarbonate, [1‐(13)C]lactate, and [1‐(13)C]pyruvate flip angles of 60°, 15°, and 10°, respectively. CONCLUSIONS: Radiofrequency saturation pulses on [1‐(13)C]lactate limit [(13)C]bicarbonate detection in the brain specifically, which could be due to shuttling of lactate from astrocytes to neurons. Our results have important implications for experimental design in studies in which [(13)C]bicarbonate detection is warranted

Metabolic MRI with hyperpolarized [1-13C]pyruvate separates benign oligemia from infarcting penumbra in porcine stroke

Acute ischemic stroke patients benefit from reperfusion in a short time-window after debut. Later treatment may be indicated if viable brain tissue is demonstrated and this outweighs the inherent risks of late reperfusion. Magnetic resonance imaging (MRI) with hyperpolarized [1-(13)C]pyruvate is an emerging technology that directly images metabolism. Here, we investigated its potential to detect viable tissue in ischemic stroke. Stroke was induced in pigs by intracerebral injection of endothelin 1. During ischemia, the rate constant of pyruvate-to-lactate conversion, k(PL), was 52% larger in penumbra and 85% larger in the infarct compared to the contralateral hemisphere (P = 0.0001). Within the penumbra, the k(PL) was 50% higher in the regions that later infarcted compared to non-progressing regions (P = 0.026). After reperfusion, measures of pyruvate-to-lactate conversion were slightly decreased in the infarct compared to contralateral. In addition to metabolic imaging, we used hyperpolarized pyruvate for perfusion-weighted imaging. This was consistent with conventional imaging for assessment of infarct size and blood flow. Lastly, we confirmed the translatability of simultaneous assessment of metabolism and perfusion with hyperpolarized MRI in healthy volunteers. In conclusion, hyperpolarized [1-(13)C]pyruvate may aid penumbral characterization and increase access to reperfusion therapy for late presenting patients

The potential of hyperpolarized ¹³C magnetic resonance spectroscopy to monitor the effect of combretastatin based vascular disrupting agents

<p><b>Background:</b> Targeting tumor vasculature with vascular disrupting agents (VDAs) results in substantial cell death that precede tumor shrinkage. Here, we investigate the potential of hyperpolarized magnetic resonance spectroscopy (HPMRS) to monitor early metabolic changes associated with VDA treatment.</p> <p><b>Methods:</b> Mice bearing C3H mammary carcinomas were treated with the VDAs combretastatin-A4-phosphate (CA4P) or the analog OXi4503, and HPMRS was performed following [1-¹³C]pyruvate administration. Similarly, treated mice were positron emission tomography (PET) scanned following administration of the glucose analog FDG. Finally, metabolic imaging parameters were compared to tumor regrowth delay and measures of vascular damage, derived from dynamic contrast-agent enhanced magnetic resonance imaging (DCE-MRI) and histology.</p> <p><b>Results:</b> VDA-treatment impaired tumor perfusion (histology and DCE-MRI), reduced FDG uptake, increased necrosis, and slowed tumor growth. HPMRS, revealed that the [1-¹³C]pyruvate-to-[1-¹³C]lactate conversion remained unaltered, whereas [1-¹³C]lactate-to-[¹³C]bicarbonate (originating from respiratory CO₂) ratios increased significantly following treatment.</p> <p><b>Conclusions:</b> DCE-MRI and FDG-PET revealed loss of vessel functionality, impaired glucose delivery and reduced metabolic activity prior to cell death. [1-¹³C]lactate-to-[¹³C]bicarbonate ratios increased significantly during treatment, indicating a decline in respiratory activity driven by the onset of hypoxia. HPMRS is promising for early detection of metabolic stress inflicted by VDAs, which cannot easily be inferred based on blood flow measurements.</p

Association of Genomic Domains in BRCA1 and BRCA2 with Prostate Cancer Risk and Aggressiveness

Pathogenic sequence variants (PSV) in BRCA1 or BRCA2 (BRCA1/2) are associated with increased risk and severity of prostate cancer. We evaluated whether PSVs in BRCA1/2 were associated with risk of overall prostate cancer or high grade (Gleason 8þ) prostate cancer using an international sample of 65 BRCA1 and 171 BRCA2 male PSV carriers with prostate cancer, and 3,388 BRCA1 and 2,880 BRCA2 male PSV carriers without prostate cancer. PSVs in the 3 0 region of BRCA2 (c.7914þ) were significantly associated with elevated risk of prostate cancer compared with reference bin c.1001c.7913 [HR ¼ 1.78; 95% confidence interval (CI), 1.25–2.52; P ¼ 0.001], as well as elevated risk of Gleason 8þ prostate cancer (HR ¼ 3.11; 95% CI, 1.63–5.95; P ¼ 0.001). c.756-c.1000 was also associated with elevated prostate cancer risk (HR ¼ 2.83; 95% CI, 1.71–4.68; P ¼ 0.00004) and elevated risk of Gleason 8þ prostate cancer (HR ¼ 4.95; 95% CI, 2.12–11.54; P ¼ 0.0002). No genotype–phenotype associations were detected for PSVs in BRCA1. These results demonstrate that specific BRCA2 PSVs may be associated with elevated risk of developing aggressive prostate cancer