Development and applications of hyperpolarized 13C and 1H MR spectroscopy of cerebral metabolism at ultra-high field

This thesis is composed of four studies centered on investigating cerebral metabolism using magnetic resonance spectroscopy (MRS) of hyperpolarized and non-hyperpolarized compounds at ultra-high field. In the first two chapters, we studied longitudinally the effects of different treatments for hepatic encephalopathy (HE) on the neurometabolic changes associated with chronic HE using a rat model of type C HE and a multimodal approach including 1H MRS. The effects of the antibiotic rifaximin administered at different doses as well as its combination with probiotics were studied in the established model of bile duct ligated (BDL) rats. We showed for the first time the beneficial effects of the combined rifaximin and the probiotic Vivomixx® on the neurometabolic changes in vivo and longitudinally in a rat model of type C HE. The longitudinal changes of some brain metabolites concentration (glutamine, glutamate, creatine), as well as gut bifidobacteria concentration, were significantly less pronounced in the group of rats treated with rifaximin and probiotics compared to non-treated rats. We also showed that rifaximin treatment alone had limited efficacy. When administered at human dose in rats, its effects appeared only at the early stages of the disease, whereas at a higher dose some neurometabolic changes associated with HE were attenuated but the general condition of the rats was worse. In the third study, we used dissolution dynamic nuclear polarization (DNP) to hyperpolarize [2H7, U-13C6]-D-glucose, which enabled us to monitor real-time glycolysis in the healthy mouse brain. Given that glucose metabolism is tightly linked to neuronal activity, we first investigated how the change in anesthesia impacts the cerebral metabolism of hyperpolarized glucose. Anesthetics are known to influence brain activity, and in this study we showed for the first time that switching from isoflurane anesthesia to a combination of lower doses of isoflurane and medetomidine had a high impact on cerebral glucose uptake and glycolytic flow, as reflected by the increased labelling of downstream [1-13C] lactate. The second part of this study aimed at evaluating the feasibility of quantifying cerebral glucose metabolism kinetics by evaluating two different mathematical models, where kinetic rate constants were determined by fitting the models on 13C curves by non-linear regression using the Levenberg-Marquardt algorithm. We showed that a 3-compartment model is more stable and reliable than a 4-compartment model. Finally, since lithium salts are widely used for treating bipolar disorder but its mechanism of action is still not clearly understood, we evaluated the potential of hyperpolarized 6Li injected at pharmacological doses to assess its real-time bio-distribution and pharmacokinetic in the rat brain. We demonstrated first that hyperpolarized 6Li can be detected at pharmacological concentration in the rat head with high signal-to-noise ratio (SNR). We also showed that the transport of lithium through the intact blood-brain barrier brain is a limiting factor and demonstrated a striking difference between apparent 6Li T1 values in a brain with normal or disrupted blood-brain barrier.

Mathematical Modeling of Brain Energy Metabolism, Measured with PET and MRS in Rodents

Bernard Lanz

Positron emission tomography (PET) and nuclear magnetic resonance spectroscopy (MRS) are two biomedical measurement techniques developed in the end of the XXth century, which drastically improved the amount of accessible information available in vivo. PET became popular through the most widely used tracer, fluorodeoxyglucose (FDG), which enables the measurement of the local glucose utilization and is nowadays routinely applied in clinical practice. Nuclear magnetic resonance is used in a large array of applications such as in analytical chemistry or chemical structure determination and is essentially known for its versatile medical imaging capabilities, grouped under the name of magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). In vivo MRS measures concentrations of metabolites by interacting with various nuclei such as 1H, 13C or 15N, with the major asset that MRS enables the identification of the chemical position at which the detected nuclei is located in the measured molecule. When coupled with labeled substrate infusions, dynamic MRS gives the opportunity to probe specific biochemical reactions directly in vivo, which opens the way to a wide range of metabolic studies. However, the correct interpretation of the elaborate dynamic labeling data acquired either with MRS or PET tracer experiments requires the application of adapted metabolic models to derive quantitative metabolic rates characterizing the biochemical processes under study. The work of this thesis involves both PET and MRS studies of brain energy metabolism in rodents and focuses on the development of adapted metabolic models to derive reliable metabolic fluxes characterizing various brain metabolic processes, such as glucose consumption, glial and neuronal oxidative metabolism and neurotransmission. FDG-PET enables the measurement of the cerebral metabolic rate of glucose (CMRGlc) using a three-compartment metabolic model for FDG transport across the blood-brain barrier and FDG phosphorylation to FDG-6P. Although this method is well established, a main drawback of CMRGlc measurement with FDG-PET is the necessity to characterize the available FDG concentration in the plasma over the experiment duration, the so-called arterial input function. This constraint is a strong limitation for preclinical studies in rodents, due to their low blood volume. We developed therefore a new method to extract the FDG input function directly from the PET images in rats and mice, using the time-activity curve of a voxel located in the inferior vena cava. The method was validated by comparison with a dedicated external blood counter and manual blood sampling. Using this method, a CMRGlc of ~0.22 μmol/g/min was determined in the mouse cortex. Glial oxidative metabolism can be specifically assessed using glial specific substrates, in particular [1-11C] acetate. However, no existing metabolic model described the 11C tissue activity curve in terms of neuroglial energy metabolism. In order to extract quantitative metabolic fluxes characterizing the glial TCA cycle rate and glutamate/glutamine cycling, we adapted the neuroglial two-compartment modeling approach previously used in 13C MRS cerebral metabolic studies to interpret positron emission data following 11C-acetate injection in the rat. The precision and accuracy of the estimated metabolic parameters was tested and a composite glial metabolic flux Vgtg=0.136 ± 0.042 μmol/g/min and a neurotransmission flux Vnt=0.170 ± 0.103 μmol/g/min were obtained. This approach enabled a direct comparison of the metabolic fluxes measured using 11C PET with the values determined with 13C MRS. In the field of 13C MRS, we took advantage of the higher sensitivity and spectral resolution available at high magnetic field (14.1T) to measure glial and neuronal oxidative metabolism, glutamatergic neurotransmission and pyruvate carboxylation in more details and with higher precision using both [1,6-13C2] glucose and [2-13C] acetate infusions in rats. In the acetate study, the glial specific uptake of acetate enabled a quantification of glial oxidative metabolism with unrivalled precision. We could estimate for the first time separately the transmitochondrial flux Vx in the glial and neuronal compartment, a biochemical pathway which has been subject of strong controversy. The glial and neuronal Vx were determined with high precision, as calculated through Monte Carlo simulation, and their value was on the same order of magnitude than the respective glial and neuronal TCA cycle flux. The model was extended to estimate the fraction of glutamate located in the glial compartment. A glial glutamate concentration of 0.6 ± 0.1 μmol/g was found. The values of the different metabolic fluxes characterizing the neuroglial system (Vtcag=0.27, Vxg=0.17, VPC=0.087, VNT=0.15, Vtcan=0.37 and Vxn=0.46 μmol/g/min) were in very good agreement with the values found using [1,6-13C2] glucose infusion. In addition, the effect of the MRS temporal resolution, experiment duration and signal- to-noise ratio on the precision of the derived metabolic fluxes was analyzed. Previous simulation studies showed that two-compartment modeling of neuroglial metabolism using 13C glucose infusion could lead to unreliable parameter estimations. However, using polarization transfer 13C MRS at 14.1T, the carbon positions C4, C3 and C2 of glutamate and glutamine as well as the positions C3 and C2 of aspartate could be measured with high SNR. The C2 positions were used in two-compartment modeling for the first time, enabling a precise measurement of the apparent glutamatergic neurotransmission and glial metabolism, including pyruvate carboxylation, as confirmed by Monte Carlo simulation. The glial dilution at the level of acetyl-CoA, which is related to the metabolism of other substrates than glucose, could also be characterized. Brain metabolism under hyperammonemic conditions was probed with 15N MRS under labeled ammonia infusion and modeled using a modified neuroglial two- compartment model describing the dynamics of [5-15N] glutamine, [2-15N] glutamate and [2-15N] glutamine. Due to detoxification processes, the total glutamine concentration, measured with 1H MRS, was steadily increasing. This non-steady- state metabolic condition resulting from the hyperammonemic stress was taken into account in the model, resulting in the determination of the apparent neurotransmission (0.26 ± 0.030 μmol/g/min), the glutamate dehydrogenase (0.029 ± 0.002 μmol/g/min) and net glutamine accumulation (0.033 ± 0.001 μmol/g/min). Finally, compartmental modeling was applied to 13C labeling studies in the awake rat, fed during 5, 24 or 48 h with a [1-13C]-labeled glucose solution, to determine brain glycogen and NAA turnover times (τGlyc=5.3 ± 3.2 h and τNAA=15.6 ± 6.5 h), using 13C spectra of brain extracts. A group of rats followed a mild brain activation protocol over 5 hours, which resulted in a decreased glycogen turnover time (τGlyc =2.9 ± 1.2 h).

EPFL2012

Development and implementation of ¹H magnetic resonance techniques for an improved in vivo assessment of models of cerebral metabolic disorders

Mélanie Craveiro

Nuclear magnetic resonance (NMR) is a physical phenomenon that is widely used in the biomedical field due to its non-invasive and non-destructive properties, which make it an optimal tool for the in vivo investigation of living organs such as the brain. This thesis focused on the development of 1H magnetic resonance (MR) techniques at ultra-high magnetic field strength to improve the measurement and quantification of the 1H MR signal in the rodent brain, and to accurately assess the alterations of the metabolite and water concentrations in several cerebral metabolic disorders. In rodents, 1H MR spectroscopy (MRS) allows the assessment of the concentration of up to 20 metabolites that take part in many cerebral metabolic processes such as neurotransmission, cell energy metabolism, cell growth and osmosis. 1H MRS thus provides a unique tool to non-invasively investigate the cerebral metabolism in healthy and pathological conditions in vivo. However, it is essential for reliable quantification that systematic errors and overlap of the measured metabolite signals are minimized. To that aim, the impact of a potential additional short T2 relaxation time component, which might affect the glutamine quantification at long echo times, was assessed in this thesis. The J-difference editing technique MEGA-SPECIAL was optimized to obtain the unequivocal detection of the glutamine signal at moderate echo time. As a control, the glutamine concentration obtained with this method was then compared to short echo time 1H MR spectroscopy measurements. Since the two measurements of the glutamine concentration at short and moderate echo time did not result in significant differences, this study concluded that there is a low probability of an effect of a short T2 relaxation time component on the glutamine concentration measurement. Since a reliable quantification of 1H spectra partly relies on the accurate assessment of the overlapping macromolecule contribution to the metabolites, an optimized method for the post-processing of the measured macromolecule signal was developed to ensure an accurate assessment of its contribution. This method was applied to investigate potential regional differences in the mouse brain macromolecule signals that may affect metabolite quantification when not taken into account, as well as for the assessment of macromolecule alterations in a human-glioma mouse model. No regional macro- molecule variation was found to significantly affect the metabolite quantification in the healthy mouse brain, which supports the common use of a general macromolecule spec- trum for healthy rodent brain 1H spectra quantification. However, several alterations of the macromolecule spectrum, some of which were reported for the first time, were observed in glioma tissues, and their accurate assessment was shown to be necessary for reliable metabolite quantification. Localized 1H MR spectroscopy techniques that are designed to acquire the1H MR signal from a 3D volume can also be combined with MR imaging (MRI) to acquire information on the spatial distribution of the individual metabolites, which is often of interest when heterogeneous tissues are investigated (such as in pathological conditions). This MR spectroscopic imaging (MRSI) technique is however limited in its conventional implementation by the long measurement time that is necessary to acquire the spatial information. A fast MRSI technique, spectroscopic RARE (spRARE), was therefore implemented at high magnetic field strength in this thesis in order to benefit from the advantage of high magnetic fields in addition to the rapid spatial encoding scheme offered by spRARE. Several optimizations of the metabolite signal detection were implemented in spRARE, before the efficiency of the technique was validated at 9.4 T through a comparison of the acquired in vitro metabolite signals with numerical simulations using the density matrix formalism. The in vivo quantification of the water content is also of interest as it offers perspec- tives for investigating cerebral disease progression that is associated with brain water content alterations. In addition, when the water signal is used as an internal reference for metabolite concentration quantification in MRS, such knowledge can also contribute to a more reliable quantification. A method that is based on the multi-spin-echo MRI technique was therefore developed for the absolute quantification of the water content in the rodent brain, with the aim of assessing alterations of its content in pathological conditions. It was then applied on a bile-duct-ligation rat model of chronic hepatic encephalopathy (HE) to assess the brain water content changes associated with the disease as well as its metabolic alterations. The absence of significant brain water content changes detected in the investigated HE rat model, which was supported by post-mortem brain water content measurements using gravimetry and the dry/wet weight-ratio technique, potentially opens the way for investigating cerebral metabolic processes in chronic HE in absence of edema formation. Localized 1H MRS and conventional MRSI were also applied for the investigation of rodent models of brain disorders in order to assess the metabolic profile associated with those disorders. These studies for the first time allowed the assessment of GABA as a potential early Parkinson’s disease marker, while they also provided new insights into the role of the PPAR-β brain receptor in the early neuroprotective effects following ischemia.

EPFL2013

In vivo magnetic resonance studies of glycogen and hyperpolarized lithium in the rat brain

Ruud van Heeswijk

Nuclear magnetic resonance (NMR) is used for a large array of applications, ranging from chemical characterization to oil drilling to medical imaging. In these fields NMR is used as an investigational tool, but new techniques and applications are continuously being developed as well. The latter is also the subject of this thesis. After an introduction to NMR theory, it focuses on the development of new methodologies for two separate areas of investigation: the metabolism of brain glycogen and hyperpolarization via dynamic nuclear polarization (DNP). Brain glycogen is the main storage form of glucose in the brain. However, because it is present in much lower concentrations in the brain than in other tissues, the significance of this storage and other roles are subject to debate. To better understand the roles of brain glycogen, it is important to quantify its metabolic parameters. The only currently available method to detect brain glycogen in vivo is 13C NMR spectroscopy. Incorporation of 13C-labeled glucose is necessary to allow glycogen measurement, but might be affected by changes in the turnover between glucose and glycogen. We therefore established a protocol to measure the glycogen absolute concentration in the rat brain by eliminating label turnover as a variable. The approach is based on establishing an increased, constant 13C isotopic enrichment (IE). 13C-glucose infusion is then performed at this IE of brain glycogen. As glycogen IE cannot be assessed in vivo, we validated that it can be inferred from the N-acetyl-aspartate (NAA) IE in vivo: after [1-13C]-glucose ingestion, glycogen IE was 2.2 ± 0.1 times that of NAA. Glycogen concentration measured in vivo by 13C NMR (5.8 ± 0.7 µmol/g) was in excellent agreement with post-mortem biochemistry (6.4 ± 0.6 µmol/g). A second glycogen NMR protocol was then implemented to measure concentration and turnover simultaneously. After reaching isotopic steady state for glycogen C1 using [1-13C]-glucose administration, [1,6-13C2]-glucose was infused such that isotopic steady state was maintained at the C1 position, but the C6 position reflected 13C label incorporation. To overcome the large chemical shift displacement error between the C1 and C6 resonances of glycogen, 2D gradient-based localization using the Fourier series window approach was implemented. The glycogen concentration of 5.1 ± 1.6 µmol/g measured from the C1 position was in excellent agreement with concomitant biochemical determinations, while glycogen turnover measured from the rate of label incorporation into the C6 position of glycogen in the α-chloralose anesthetized rat was 0.7 µmol/g/h. The contrast agent Omniscan was added to a formic acid-filled glass reference sphere in the abovementioned protocols in order to shorten its T1 relaxation time and to accelerate the calibration procedure it is used in; therefore it was established that Omniscan in pure 13C formic acid has a relaxivity of 2.9 mM-1s-1. The study was expanded, and the relaxivity of several commercially available gadolinium (Gd)-based contrast agents was determined for X-nuclei resonances with long intrinsic relaxation times. The relaxivity of Omniscan on the glutamate C1 and C5 in aqueous solution was ~ 0.5 mM-1s-1. These relaxivities allow the preparation of solutions with a predetermined short 13C T1. Another isotope with a long relaxation time is lithium-6 (6Li). Lithium is an ion that is widely used in psychotherapy, and 6Li has an intrinsic relaxation time on the order of several minutes, which was strongly affected by the contrast agents. Its relaxivity ranged from ~ 0.1 mM-1s-1 for Omniscan to 0.3 for Magnevist, whereas the relaxivity of Gd-DOTP was 11 mM-1s-1. Overall, these experiments suggested that the presence of submicromolar contrast agent concentrations should be detectable, provided sufficient sensitivity is available, such as that afforded by hyperpolarization. This submicromolar contrast agent concentration detection was demonstrated in a subsequent study: first it was established that lithium-6 can be readily hyperpolarized through DNP within 30 min while retaining a long polarization relaxation time on the order of a minute. The shortening of this relaxation time was used for the detection of 500 nM contrast agent in vitro. Hyperpolarized lithium-6 was then administered to the rat, where its signal retained a relaxation time on the order of 70 s in vivo. Localization experiments implied that the lithium signal originated from within the brain and that it was detectable up to 5 min after administration. Next, ~ 1.5 µM of contrast agent was injected in the rat, and its effect on previously injected hyperpolarized lithium-6 was successfully quantified. It was concluded that the detection of submicromolar contrast agent concentrations using hyperpolarized NMR nuclei such as 6Li may provide a novel avenue for molecular imaging. In a separate set of of experiments, hyperpolarization through DNP was applied to 15N-labeled choline, 13C-labeled bicarbonate and 13C-labeled acetate. All three metabolites were successfully polarized and were detected both in vitro and in vivo.

EPFL2009