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

Fumarase activity: an in vivo and in vitro biomarker for acute kidney injury:an in vivo and in vitro biomarker for acute kidney injury

Renal ischemia/reperfusion injury (IRI) is a leading cause of acute kidney injury (AKI), and at present, there is a lack of reliable biomarkers that can diagnose AKI and measure early progression because the commonly used methods cannot evaluate single-kidney IRI. Hyperpolarized [1,4-C-13(2)] fumarate conversion to [1,4-C-13(2)] malate by fumarase has been proposed as a measure of necrosis in rat tumor models and in chemically induced AKI rats. Here we show that the degradation of cell membranes in connection with necrosis leads to elevated fumarase activity in plasma and urine and secondly that hyperpolarized [1,4-C-13(2)] malate production 24 h after reperfusion correlates with renal necrosis in a 40-min unilateral ischemic rat model. Fumarase activity screening on bio-fluids can detect injury severity, in bilateral as well as unilateral AKI models, differentiating moderate and severe AKI as well as short-and long-term AKI. Furthermore after verification of renal injury by bio-fluid analysis the precise injury location can be monitored by in vivo measurements of the fumarase activity non-invasively by hyperpolarized [1,4-C-13] fumarate MR imaging. The combined in vitro and in vivo biomarker of AKI responds to the essential requirements for a new reliable biomarker of AKI

Hyperpolarized ¹³C Urea Relaxation Mechanism Reveals Renal Changes in Diabetic Nephropathy

PURPOSE: Our aim was to assess a novel (13)C radial fast spin echo golden ratio single shot method for interrogating early renal changes in the diabetic kidney, using hyperpolarized (HP) [(13)C,(15)N(2)]urea as a T(2) relaxation based contrast bio‐probe. METHODS: A novel HP (13)C MR contrast experiment was conducted in a group of streptozotocin type‐1 diabetic rat model and age matched controls. RESULTS: A significantly different relaxation time (P = 0.004) was found in the diabetic kidney (0.49 ± 0.03 s) compared with the controls (0.64 ± 0.02 s) and secondly, a strong correlation between the blood oxygen saturation level and the relaxation times were observed in the healthy controls. CONCLUSION: HP [(13)C,(15)N(2)]urea apparent T(2) mapping may be a useful for interrogating local renal pO(2) status and renal tissue alterations. Magn Reson Med, 2015. © 2015 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. Magn Reson Med 75:515–518, 2016. © 2015 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine

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

Detection of increased pyruvate dehydrogenase flux in the human heart during adenosine stress test using hyperpolarized [1-13C]pyruvate cardiovascular magnetic resonance imaging

BACKGROUND: Hyperpolarized (HP) [1-(13)C]pyruvate cardiovascular magnetic resonance (CMR) imaging can visualize the uptake and intracellular conversion of [1-(13)C]pyruvate to either [1-(13)C]lactate or (13)C-bicarbonate depending on the prevailing metabolic state. The aim of the present study was to combine an adenosine stress test with HP [1-(13)C]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-(13)C]pyruvate CMR at rest and during adenosine stress. HP [1-(13)C]pyruvate CMR images were acquired at the mid-left-ventricle (LV) level. Semi-quantitative assessment of first-pass myocardial [1-(13)C]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-(13)C]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 (k(PL)) for lactate increased from 11 ± 9 *10(–3) to 20 ± 10 * 10(–3) s(−1), p = 0.04. The pyruvate oxidation rate (k(PB)) 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 (R(2) = 0.44, p = 0.02). CONCLUSIONS: Adenosine stress testing combined with HP [1-(13)C]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-(13)C]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=2018-003533-1

Can Hyperpolarized 13C-Urea Be Used to Assess Glomerular Filtration Rate? A Retrospective Study

This study investigated a simple method for calculating the single-kidney glomerular filtration rate (GFR) using dynamic hyperpolarized 13C-urea magnetic resonance (MR) renography. A retrospective data analysis was applied to renal hyperpolarized 13C-urea MR data acquired from control rats, prediabetic nephropathy rats, and rats in which 1 kidney was subjected to ischemia-reperfusion. Renal blood flow was determined by the model-free bolus differentiation method, GFR was determined using the Baumann–Rudin model method. Reference single-kidney and total GFRs were measured by plasma creatinine content and compared to 1H dynamic contrast-enhanced estimated GFR and fluorescein isothiocyanate-inulin clearance GFR estimation. In healthy and prediabetic nephropathy rats, single-kidney hyperpolarized 13C-urea GFR was estimated to be 2.5 ± 0.7 mL/min in good agreement with both gold-standard inulin clearance GFR (2.7 ± 1.2 ml/min) and 1H dynamic contrast-enhanced estimated GFR (1.8 ± 0.8 mL/min), as well as plasma creatinine measurements and literature findings. Following ischemia-reperfusion, hyperpolarized 13C-urea revealed a significant reduction in single-kidney GFR of 57% compared with the contralateral kidney. Hyperpolarized 13C MR could be a promising tool for accurate determination of GFR. The model-free renal blood flow and arterial input function-insensitive GFR estimations are simple to implement and warrant further translational adaptation