Towards non‐invasive monitoring of mitochondrial function

__Abstract__ The work presented in this thesis describes the development of a non‐invasive and clinically usable system to monitor important aspects of mitochondrial function. This translational research project started with the validation of PpIX‐TSLT for cutaneous use in an animal model and finished with the first study performed in healthy human volunteers. Chapter 1 explores the possibility of using PpIX‐TSLT to measure oxygen‐dependent delayed fluorescence in skin after topical application of the PpIX precursor 5‐ aminolevulinic acid. To enable reliable cutaneous mitoPO2 measurements on the skin, calibration of the signals was necessary. Previous calibrations of PpIX‐TSLT were performed in cultured cells [10], heart and liver [11, 12]. However, the calibration procedures used for cultured cells and isolated organs were not applicable in skin tissue. Therefore, we developed a novel approach that enables simultaneous measurements of cutaneous mitoPO2 and microvascular oxygen tension in rats (Chapter 2). Subsequently, in Chapter 3, we validated the previously found calibration constants for application on skin by means of these simultaneous measurements. The absolute value of mitoPO2 is an important physiological parameter indicating mitochondrial oxygen availability. However, as investigated in Chapter 4, measurement of the kinetics of delayed fluorescence lifetime (indicative of changes in mitoPO2) after artificially blocking local oxygen supply, provides additional information on mitochondrial oxygen consumption (mitoVO2) and oxygen affinity of the respiratory chain. Having established the feasibility of me

Monitoring mitochondrial PO2: the next step

PURPOSE OF REVIEW: To fully exploit the concept of hemodynamic coherence in resuscitating critically ill one should preferably take into account information about the state of parenchymal cells. Monitoring of mitochondrial oxygen tension (mitoPO2) has emerged as a clinical means to assess information of oxygen delivery and oxygen utilization at the mitochondrial level. This review will outline the basics of the technique, summarize its development and describe the rationale of measuring oxygen at the mitochondrial level. RECENT FINDINGS: Mitochondrial oxygen tension can be measured by means of the protoporphyrin IX-Triplet State Lifetime Technique (PpIX-TSLT). After validation and use in preclinical animal models, the technique has recently become commercially available in the form of a clinical measuring system. This system has now been used in a number of healthy volunteer studies and is currently being evaluated in studies in perioperative and intensive care patients in several European university hospitals. SUMMARY: PpIX-TSLT is a noninvasive and well tolerated method to assess aspects of mitochondrial functio

Non-invasive monitoring of mitochondrial oxygenation and respiration in critical illness using a novel technique

Introduction: Although mitochondrial dysfunction is proposed to be involved in the pathophysiology of sepsis, conflicting results are reported. Variation in methods used to assess mitochondrial function might contribute to this controversy. A non-invasive method for monitoring mitochondrial function might help overcome this limitation. Therefore, this study explores the possibility o

Monitoring of mitochondrial oxygenation during perioperative blood loss

One of the challenges in the management of acute blood loss is to differentiate whether blood transfusion is required or not. The sole use of haemoglobin values might lead to unnecessary transfusion in individual cases. The suggestion is that mitochondrial oxygen tension can be used as an additional monitoring technique to determine when blood transfusion is required. In this case report, we report mitochondrial oxygen measurements in a patient with perioperative blood loss requiring blood transfusion

A monitor for Cellular Oxygen METabolism (COMET): monitoring tissue oxygenation at the mitochondrial level

After introduction of the protoporphyrin IX-triplet state lifetime technique as a new method to measure mitochondrial oxygen tension in vivo, the development of a clinical monitor was started. This monitor is the “COMET”, an acronym for Cellular Oxygen METabolism. The COMET is a non-invasive electrically powered optical device that allows measurements on the skin. The COMET is easy to transport, due to its lightweight and compact size. After 5-aminolevulinic acid application on the human skin, a biocompatible sensor enables detection of PpIX in the mitochondria. PpIX acts as a mitochondrially located oxygen-sensitive dye. Three measurement types are available in the touchscreen-integrated user interface, ‘Single’, ‘Interval’ and ‘Dynamic measurement’. COMET is currently used in several clinical studies in our institution. In this first description of the COMET device we show an incidental finding during neurosurgery. To treat persisting intraoperative hypertension a patient was administered clonidine, but due to rapid administration an initial phase of peripheral vasoconstriction occurred. Microvascular flow and velocity parameters measured with laser-doppler (O2C, LEA Medizintechnik) decreased by 44 and 16% respectively, but not the venous-capillary oxygen saturation. However, mitochondrial oxygen tension in the skin detected by COMET decreased from a steady state of 48 to 16 mmHg along with the decrease in flow and velocity. We conclude that COMET is ready for clinical application and we see the future for this bedside monitor on the intensive care, operating theater, and testing of mitochondrial effect of pharmaceuticals

Non-invasive versus ex vivo measurement of mitochondrial function in an endotoxemia model in rat: Toward monitoring of mitochondrial therapy

Mitochondrial function has been predominantly measured ex vivo. Due to isolation and preservation procedures ex vivo measurements might misrepresent in vivo mitochondrial conditions. Direct measurement of in vivo mitochondrial oxygen tension (mitoPO2) and oxygen disappearance rate (ODR) with the protoporphyrin IX‐triplet state lifetime technique (PpIX-TSLT) might increase our understanding of mitochondrial dysfunction in the pathophysiology of acute disease. LPS administration decreased mitochondrial respiration (ODR) in vivo but did not alter mitochondrial function as assessed with ex vivo techniques (high resolution respirometry and specific complex determinations). PpIX-TSLT measures in vivo mitoPO2 and ODR and can be applied non-invasively at the skin

Validation of the protoporphyrin IX-triplet state lifetime technique for mitochondrial oxygen measurements in the skin

Mitochondrial oxygen tension can be measured in vivo by means of oxygen-dependent quenching of delayed fluorescence of protoporphyrin IX (PpIX). Here we demonstrate that mitochondrial PO2 (mitoPO2) can be measured in the skin of a rat after topical application of the PpIX precursor 5-aminolevulinic acid (ALA). Calibration of mitoPO2 measurements was done by comparison with simultaneous measurements of the cutaneous microvascular PO2 This was done under three different conditions: in normal skin tissue, in nonrespiration skin tissue due to the application of cyanide, and in anoxic skin tissue after the ventilation with 100% nitrogen. The results of this study show that it is feasible to measure the mitoPO2 after the topical application of ALA cream by means of the PpIX-triplet state lifetime technique