In vivo 31P-NMR studies of myocardial high energy phosphate metabolism during anoxia and recovery

Detection and quantification of free cytosolic inorganic phosphate and other phosphorus metabolites in the beating mouse heart muscle in situ

The aim of this study was the quantification of inorganic phosphate (Pi) and other phosphorus metabolites by (31)P NMR spectroscopy in the mouse heart muscle in situ, beating at around 600 min(-1). Male adult Quacker-bush mice (mean weight 32 +/- 7 g) were anaesthetized, ventilated and placed in a temperature-controlled animal holder. A purpose-built (31)P NMR surface coil was positioned against the exposed left ventricular myocardium. Partial signal overlap of Pi with 2,3-DPG from chamber blood was minimized using a DEPTH pulse sequence (180 degrees -90 degrees -180 degrees -180 degrees -acq.). Quantification of phosphorus metabolites was performed using an external standard positioned directly above the surface coil. We report for the mouse myocardium in situ an intracellular free [Pi] of <0.4 mM, pH of 7.32 +/- 0.1, free [Mg2+] of 0.41 +/- 0.1 mM, free [ADP] of 13 +/- 1.5 microM, [ATP] of 5 +/- 0.5 mM and [PCr] of 14 +/- 1.5 mM. The phosphorylation ratio (ATP/ADP Pi) was 1005 +/- 200 mM (-1) for a PCr/ATP ratio of 2.7 +/- 0.3. It was concluded that the detection of free [Pi] in the mouse myocardium in situ can be greatly enhanced using a DEPTH pulse sequence. Quantification of compounds using an external standard positioned directly above the surface coil gave comparable results to estimations using internal ATP that was quantified enzymatically. The close agreement between the external and internal methods indicates that ATP is 100% NMR visible in the mouse heart in situ.

Creatine and creatinine metabolism

The goal of this review is to present a comprehensive survey of the many intriguing facets of creatine (Cr) and creatinine metabolism, encompassing the pathways and regulation of Cr biosynthesis and degradation, species and tissue distribution of the enzymes and metabolites involved, and of the inherent implications for physiology and human pathology. Very recently, a series of new discoveries have been made that are bound to have distinguished implications for bioenergetics, physiology, human pathology, and clinical diagnosis and that suggest that deregulation of the creatine kinase (CK) system is associated with a variety of diseases. Disturbances of the CK system have been observed in muscle, brain, cardiac, and renal diseases as well as in cancer. On the other hand, Cr and Cr analogs such as cyclocreatine were found to have antitumor, antiviral, and antidiabetic effects and to protect tissues from hypoxic, ischemic, neurodegenerative, or muscle damage. Oral Cr ingestion is used in sports as an ergogenic aid, and some data suggest that Cr and creatinine may be precursors of food mutagens and uremic toxins. These findings are discussed in depth, the interrelationships are outlined, and all is put into a broader context to provide a more detailed understanding of the biological functions of Cr and of the CK system.

Metabolic regulation of in vivo myocardial contractile function: multiparameter analysis

To gain insight into the mechanisms of myocardial regulation as it relates to the interaction of mechanical and metabolic function and perfusion, intact animal models were instrumented for routine physiological measurements of mechanical function and for measurements of metabolism (31P NMR, NADH fluorescence (redox state)) and perfusion (2H NMR and Laser doppler techniques). These techniques were applied to canine and cat models of volume and/or pressure loading, hypoxia, ischemia and cardiomyopathic states. Data generated using these techniques indicate that myocardial bioenergetic function is quite stable under most loading conditions as long as the heart is not ischemic. In addition, these data indicate that there is no universal regulator and that different biochemical regulators appear to mediate stable function under different physiological and pathophysiological conditions: for example; during hypoxia, NADH redox state appears to play a regulatory role; and in pressure loading, ADP, phosphorylation potential and free energy of ATP hydrolysis as well as NADH redox state appear to be regulatory.

Metabolic and functional effects of perfluorocarbon distal perfusion during coronary angioplasty

Myocardial lactate metabolism and left ventricular function were studied in 12 patients during angioplasty of the left anterior descending artery performed with distal coronary perfusion (oxygenated and nonoxygenated Fluosol) and by conventional technique without distal perfusion. Before balloon inflation there was net lactate extraction by the heart (31 +/- 6%). During balloon inflations performed with distal perfusion there was net lactate release into the great cardiac vein while the balloon was inflated; the great cardiac vein lactate concentration was approximately 25% lower during perfusion with oxygenated versus nonoxygenated Fluosol (p less than 0.02) indicating less myocardial lactate release. After balloon deflation washout of lactate into the great cardiac vein (net myocardial release) was observed in all 3 protocols. Left ventricular ejection fraction measured by echocardiography decreased markedly during nonperfused (53 +/- 3 to 36 +/- 3%, p less than 0.001) and nonoxygenated Fluosol (52 +/- 2 to 30 +/- 3%, p less than 0.001) inflations. This dysfunction was largely prevented by oxygenated Fluosol where only a minimal decrease in ejection fraction (51 +/- 2 vs 48 +/- 2%, p less than 0.02) occurred. Analysis of regional contractile function yielded similar results. Although oxygenated perfluorocarbons decrease cardiac lactate release during angioplasty, this study provides evidence for the onset of lactate production even when ventricular function is preserved.

Effects of diltiazem on phosphate metabolism in ischemic and reperfused myocardium using phosphorus31 nuclear magnetic resonance spectroscopy in vivo

Diltiazem may provide a protective effect to ischemic and reperfused myocardium through preservation of high-energy phosphate metabolism. To test this hypothesis, rabbits had a 1.3 cm solenoidal coil placed over the myocardium to be rendered ischemic. Data were acquired with a 22 cm bore nuclear magnetic resonance spectrometer at 2.0 T. Animals were treated with diltiazem (200 micrograms/kg intravenous bolus of drug followed by a 15 micrograms/kg/min continuous intravenous infusion, n = 10) or by an equal volume of saline (n = 6). The left circumflex artery was occluded and reperfused using a reversible snare while electrocardiogram-gated spectra were accumulated. Levels of phosphocreatine were decreased during occlusion in both groups; however, this decrease was attenuated in the diltiazem treated animals compared to control (in relative percent area: 7.8 +/- 1.0 to 2.5 +/- 0.5, p less than 0.01). Levels of phosphocreatine promptly returned to baseline following reperfusion and there was no difference between the two groups. The inorganic phosphate metabolites of high-energy phosphate consumption increased with occlusion, though more so in the control group compared with the diltiazem-treated rabbits (in relative percent area: 72.5 +/- 0.9 to 55.4 +/- 1.3, p less than 0.01). With reperfusion, levels of inorganic phosphates returned toward baseline in both groups; however, the diltiazem group had a more complete recovery relative to control (in relative percent area: 38.8 +/- 2.1 to 47.6 +/- 2.7, p less than 0.05). Levels of adenosine triphosphate decreased in both groups relative to baseline; however, the amount of decrease was similar in the two groups. With reperfusion there was a definite though incomplete recovery of levels of adenosine triphosphate in the diltiazem-treated group (in relative percent area: 10.7 +/- 1.0 at occlusion, 12.3 +/- 0.4 during reperfusion, p less than 0.05), but in the control group levels of adenosine triphosphate remained depressed (in relative percent area: 9.8 +/- 0.6 at occlusion, 9.8 +/- 0.8 during reperfusion, p = NS). During ischemia there was a trend toward attenuation of intracellular acidosis in the diltiazem group; however, this trend did not reach statistical significance. These data indicate that diltiazem provides a protective effect on myocardial high-energy phosphate metabolism during regional ischemia and reperfusion in the intact animal.

Regional metabolism during coronary occlusion, reperfusion, and reocclusion using phosphorus31 nuclear magnetic resonance spectroscopy in the intact rabbit

Few studies have examined metabolic consequences of coronary occlusion and reperfusion using phosphorus31 nuclear magnetic resonance (31P-NMR) in an intact animal model. Accordingly, we developed a model to study serial changes in myocardial metabolism in the intact open-chest rabbit. Ten animals underwent 20 +/- 2 minutes of regional coronary occlusion and 60 +/- 10 minutes of reperfusion followed by reocclusion. Cardiac-gated 31P-NMR spectra were obtained with a regional surface coil over the ischemic area during baseline, occlusion, reperfusion, and reocclusion conditions. Phosphocreatine fell with both the initial and second ischemic insults to 65% +/- 5% of baseline for the first occlusion (p less than 0.01) and tended to decrease to 89% +/- 8% of baseline for the second occlusion (p = 0.07), with normal levels reattained in the intervening period of reperfusion (99% +/- 5% of baseline, p = NS). Concordant inverse changes were seen with inorganic phosphates. At occlusion levels of inorganic phosphates were 135% +/- 10% of baseline (p less than 0.05) and 139% +/- 10% of baseline at reocclusion (p less than 0.05). Levels of adenosine triphosphate decreased during occlusion to 78% +/- 9% of baseline and were significantly lower than baseline during the second occlusion (75% +/- 5% of baseline, p less than 0.01). The ratio of phosphocreatine to inorganic phosphates, when compared with values at baseline, decreased at occlusion (49.6% +/- 4.7% of baseline, p less than 0.01) and at reocclusion (64.7% +/- 4.9% of baseline, p less than 0.01), with a normal ratio reattained in the intervening period of reperfusion (93.3% +/- 3.1% of baseline, p = NS). We conclude that reperfusion restores levels of phosphocreatine and adenosine triphosphate while returning levels of inorganic phosphates to baseline. Deleterious changes in high-energy phosphate metabolism are not potentiated by reocclusion in this model. 31P-NMR spectroscopy holds promise as a technique to noninvasively monitor intracellular biochemical processes serially during various interventions in the intact animal model.

Characterization of high-energy phosphate compounds during reperfusion of the irreversibly injured myocardium using 31P MRS

Phosphorus-31 magnetic resonance spectroscopy (MRS) was used to monitor regional changes in high-energy phosphorus compounds and intracellular pH during 60 min of acute regional ischemia (acute occlusion of left anterior descending artery) and reperfusion in open-chest cats using a 1.2-cm two-turn coil sutured to the myocardium. During the 60-min ischemic phase, phosphocreatine (PCr) intensity was reduced to 47 +/- 4.9% (mean +/- SE) of control (p less than 0.01) by 15 min postocclusion while adenosine triphosphate (ATP) intensity decreased more slowly with the decrease (66 +/- 5.6%) achieving significance (p less than 0.05) only at 60 min postocclusion. Inorganic phosphate (Pi) increased to a maximum of 397 +/- 42% of control (p less than 0.01) while the pH decreased progressively from 7.36 +/- 0.02 to 6.02 +/- 0.14 (p less than 0.01). After release of occlusion PCr intensity recovered to 86 +/- 12% of the initial control value at 15 min postreperfusion but showed a subsequent downward trend to 79 +/- 8.8%. The ATP did not recover but tended to decline further during reperfusion. The Pi intensity decreased to 260 +/- 38% of control while the pH increased to 7.01 +/- 0.23 by 15 min postreperfusion. Thus, the reperfused irreversibly injured myocardium is characterized by persistent depletion of PCr and ATP and elevation of Pi. Phosphorus-31 MRS provides a nondestructive method for characterizing the reperfused irreversibly damaged myocardium.

31P NMR measurements of myocardial pH in vivo

A 31P NMR magnetization transfer method for measuring myocardial pH in vivo is demonstrated in the lamb, dog and cat. The method involves measuring the difference in chemical shift between the resonances of phosphocreatine and inorganic phosphate in magnetization transfer difference spectra in which the gamma-phosphate resonance of ATP has been saturated. The method has been verified by measuring the chemical shift difference between the resonances of 2-deoxyglucose 6-phosphate and phosphocreatine following infusion of the animals with 2-deoxyglucose. The measured pH values are significantly lower than those obtained in previous studies on the heart in vivo.

NMR spectroscopy for clinical medicine. Animal models and clinical examples

Magnetic resonance spectroscopy is able to measure noninvasively a variety of important metabolites involved in cell energetics. These include phosphocreatine, ATP, inorganic phosphate, pH, and lactate. Anoxia, ischemia, and infarction produce rapid loss of high-energy phosphates and accumulation of hydrolysis products. Many animal studies have shown that MRS monitors metabolic changes in various models of human disease. The availability of large, high field magnets and the development of noninvasive localization techniques permits MRS to be performed on selected volumes within the body. It is now clear that MRS in humans will be immediately useful in several areas including studies of malignancy, ischemia, and infarction of various organs and metabolic disorders. It is expected that human MRS will be increasingly used for clinical investigation and eventually for medical diagnosis.

Methods for the metabolic quantification of regional myocardial ischemia

An adequate balance between oxygen supply and demand is a basic requirement for normal cardiac function. When oxygen supply does not meet the demand, progressive cellular damage occurs leading to cardiac dysfunction and, ultimately, tissue death. While traditionally "ischemia" has been defined as decreased oxygen supply secondary to a decrease in blood flow, and "hypoxia" as decreased oxygen supply secondary to a decrease in oxygen tension, this review defines ischemia in its broader sense, namely as a pathophysiologic state in which there is a lack of oxygen relative to the demand for it. In a large number of experimental studies involving the heart, there is need to promptly recognize the ischemic state, to monitor its course in vivo, and to quantify it. Because of cardiac autoregulatory mechanisms, research methods which attempt to quantify supply (e.g., measurement of myocardial blood flow) and/or demand (e.g., measurement of myocardial oxygen consumption) do not necessarily reflect the status of the balance between supply and demand. An imbalance between myocardial supply and demand is more likely to be reflected by metabolic fluxes and by the accumulation of products specific to the ischemic state. Thus, the purpose of this review is to summarize the various methods available to the cardiac surgical investigator today for the metabolic quantification of myocardial ischemia. Due to the complexity of the heart and its inherent regional differences, myocardial ischemic changes are frequently regional in nature. Thus, this review will address metabolic methods for the regional quantification of myocardial ischemia.

Cardiac transfer function relating energy metabolism to workload in different species as studied with 31P NMR

Cardiac metabolism was studied with 31P NMR in 7 dogs and 4 cats to determine whether animals adapted for different life-styles (stalk and sprint vs endurance running) respond to increased work loads (heart rate X blood pressure product) with different high-energy phosphate kinetics. Hearts were exposed via a left lateral thoracotomy under Nembutal anesthesia (40 mg/kg). Two-turned solenoid surface coils were placed on the left ventricles; pacing wires were sutured into the left ventricular apices. The femoral artery and vein were cannulated for blood pressure and arterial blood gas monitoring and fluid and drug infusion, respectively. Animals were placed in a plexiglass holder into a 2.1-T, 31-cm-bore, superconducting magnet. 31P spectra were obtained from the heart using respiratory and electrocardiogram gating. Cardiac work loads were changed by pacing the heart at 4, 4.5, and 5 Hz. Heart rate X blood pressure product "work" was correlated with Pi/PCr ratios. Dog hearts were more resistant than those of cats to changes in Pi/PCr with increasing work load. It is possible that animals adapted to different life-styles may have cardiovascular systems which are metabolically and mechanically adapted for different forms of stress. These differences may be elicited and effectively delineated using in vivo NMR techniques during various physiological interventions, such as pacing. The basis for these differences may be related to cardiac microvasculature or to intrinsic differences in enzyme kinetics. Delineation of these mechanisms may be helpful in the understanding of the physiological basis of cardiac function in health and disease.

In vivo evaluation of intracellular pH and high-energy phosphate metabolites during regional myocardial ischemia in cats using 31P nuclear magnetic resonance

Phosphorus-31 nuclear magnetic resonance spectroscopy (31P NMR) was used to assess the temporal changes of high-energy phosphate metabolites in the region of acute myocardial ischemia of open-chest cats. Eight anesthetized cats were studied following ligation of the left anterior descending coronary artery. Creatine phosphate showed a 79 +/- 16% (mean +/- SD) reduction by 4 min after the onset of ischemia. Prominent qualitative reductions of the spectral peak of creatine phosphate occurred by 40 s after ischemia. Adenosine triphosphate measured under the beta spectral peak (beta-ATP) decreased 37 +/- 9% by 20-25 min after ligation of the left anterior descending coronary artery. These reductions developed more slowly and were of smaller magnitude than those of creatine phosphate. Intracellular pH decreased from 7.39 +/- 0.07 to 7.13 +/- 0.09 units by 40 s after ischemia. By 30 min, pH decreased to 6.07 +/- 0.40 units. The study shows, therefore, the temporal changes of high-energy phosphate metabolites during ischemia in localized regions of the myocardium of open-chest animals.

Noninvasive detection and monitoring of regional myocardial ischemia in situ using depth-resolved 31P NMR spectroscopy

Phosphorus (31P) NMR spectra showing the relative concentrations of phosphocreatine, ATP, and Pi were recorded noninvasively from localized regions in the left ventricles of dog hearts in situ by using depth-resolved surface-coil spectroscopy at 1.5 T. Proton (1H) NMR surface-coil imaging was used to position 31P NMR coils and to determine the location of depth-resolved volumes immediately prior to 31P examination. Occlusion of the left anterior descending coronary artery produced regional ischemia detected as changes in the ratios of phosphocreatine, ATP, and Pi and by changes in the pH measured from the spectra. Spectral changes were not typically observed in regions adjacent to ischemic myocardium. Reperfusion produced some recovery, and ventricular fibrillation resulted in deterioration in high-energy metabolites. The location and size of ischemic tissue was measured by single-photon-emission computed tomography (SPECT) and gamma-ray counting or by staining excised hearts. The technique should permit the long-term noninvasive monitoring of the metabolic response of the heart to pathologic processes and allow assessment of interventions.

Carbon-13 nuclear magnetic resonance studies of myocardial glycogen metabolism in live guinea pigs

Myocardial glycogen metabolism was studied in live guinea pigs by 13C NMR at 20.19 MHz. Open-chest surgery was used to expose the heart, which was then positioned within a solenoidal radio frequency coil for NMR measurements. The time course of myocardial glycogen synthesis during 1-h infusions of 0.5 g of D-[1-13C]glucose (and insulin) into the jugular vein was investigated. The possible turnover of the 13C-labeled glycogen was also studied in vivo by following the labeled glucose infusion with a similar infusion of unlabeled glucose. The degree of 13C enrichment of the C-1 glycogen carbons during these infusions was measured in heart extracts by 1H NMR at 360 MHz. High-quality proton-decoupled 13C NMR spectra of the labeled C-1 carbons of myocardial glycogen in vivo were obtained in 1 min of data accumulation. This time resolution allowed measurement of the time course of glycogenolysis of the 13C-labeled glycogen during anoxia by 13C NMR in vivo. With the solenoidal coil used for 13C NMR, the spin-lattice relaxation time of the labeled C-1 carbons of myocardial glycogen could be measured in vivo. For a comparison, spin-lattice relaxation times of heart glycogen were measured in vitro at 90.55 MHz. Natural abundance 13C NMR studies of the quantitative hydrolysis of extracted heart glycogen in vitro at 90.55 MHz showed that virtually all the carbons in heart glycogen contribute to the 13C NMR signals. The same result was obtained in 13C NMR studies of glycogen hydrolysis in excised guinea pig heart.

Anoxia followed by hyperoxia: in vivo 31-P NMR of cat brain

In vivo 31P NMR spectroscopy was performed on a cat brain subjected to an extended period of anoxia followed by restoration of oxygen. High energy phosphate spectra were continuously obtained and pH measured. Following the onset of anoxia, phosphocreatine and ATP peaks decreased with a concomitant increase in inorganic phosphate. Following 34 min ventilation on 100% N2, the animal was ventilated on 100% O2. The spectral content progressively changed, inorganic phosphate decreased and ATP increased with the spectrum closely resembling that of control. Our results suggest that the absence of NMR detectable ATP signal cannot be interpreted as an irreversable change in cellular metabolic function.