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Ling S, Blackburn BJ, Jenkins MW, Watanabe M, Ford SM, Lapierre-Landry M, Rollins AM. Segmentation of beating embryonic heart structures from 4-D OCT images using deep learning. Biomed Opt Express 2023; 14:1945-1958. [PMID: 37206115 PMCID: PMC10191668 DOI: 10.1364/boe.481657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/29/2023] [Accepted: 02/20/2023] [Indexed: 05/21/2023]
Abstract
Optical coherence tomography (OCT) has been used to investigate heart development because of its capability to image both structure and function of beating embryonic hearts. Cardiac structure segmentation is a prerequisite for the quantification of embryonic heart motion and function using OCT. Since manual segmentation is time-consuming and labor-intensive, an automatic method is needed to facilitate high-throughput studies. The purpose of this study is to develop an image-processing pipeline to facilitate the segmentation of beating embryonic heart structures from a 4-D OCT dataset. Sequential OCT images were obtained at multiple planes of a beating quail embryonic heart and reassembled to a 4-D dataset using image-based retrospective gating. Multiple image volumes at different time points were selected as key-volumes, and their cardiac structures including myocardium, cardiac jelly, and lumen, were manually labeled. Registration-based data augmentation was used to synthesize additional labeled image volumes by learning transformations between key-volumes and other unlabeled volumes. The synthesized labeled images were then used to train a fully convolutional network (U-Net) for heart structure segmentation. The proposed deep learning-based pipeline achieved high segmentation accuracy with only two labeled image volumes and reduced the time cost of segmenting one 4-D OCT dataset from a week to two hours. Using this method, one could carry out cohort studies that quantify complex cardiac motion and function in developing hearts.
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Affiliation(s)
- Shan Ling
- Department of Biomedical Engineering, School of Engineering and School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Brecken J. Blackburn
- Department of Biomedical Engineering, School of Engineering and School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael W. Jenkins
- Department of Biomedical Engineering, School of Engineering and School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michiko Watanabe
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Division of Pediatric Cardiology, The Congenital Heart Collaborative, Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Stephanie M. Ford
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Division of Pediatric Cardiology, The Congenital Heart Collaborative, Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
- Division of Neonatology, Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Maryse Lapierre-Landry
- Department of Biomedical Engineering, School of Engineering and School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, School of Engineering and School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Blackburn BJ, McPheeters MT, Jenkins MW, Dupps WJ, Rollins AM. Phase-Decorrelation Optical Coherence Tomography Measurement of Cold-Induced Nuclear Cataract. Transl Vis Sci Technol 2023; 12:25. [PMID: 36971678 PMCID: PMC10064939 DOI: 10.1167/tvst.12.3.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Purpose The purpose of this work is to determine the sensitivity of phase-decorrelation optical coherence tomography (OCT) to protein aggregation associated with cataracts in the ocular lens, as compared to OCT signal intensity. Methods Six fresh porcine globes were held at 4°C until cold cataracts developed. As the globes were re-warmed to ambient temperature, reversing the cold cataract, each lens was imaged repeatedly using a conventional OCT system. Throughout each experiment, the internal temperature of the globe was recorded using a needle-mounted thermocouple. OCT scans were acquired, their temporal fluctuations were analyzed, and the rates of decorrelation were spatially mapped. Both decorrelation and intensity were evaluated as a function of recorded temperature. Results Both signal decorrelation and intensity were found to change with lens temperature, a surrogate of protein aggregation. However, the relationship between signal intensity and temperature was not consistent across different samples. In contrast, the relationship between decorrelation and temperature was found to be consistent across samples. Conclusions In this study, signal decorrelation was shown to be a more repeatable metric for quantification of crystallin protein aggregation in the ocular lens than OCT intensity-based metrics. Thus, OCT signal decorrelation measurements could enable more detailed and sensitive study of methods to prevent cataract formation. Translational Relevance This dynamic light scattering-based approach to early cataract assessment can be implemented on existing clinical OCT systems without hardware additions, so it could quickly become part of a clinical study workflow or an indication for use for a pharmaceutical cataract intervention.
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Affiliation(s)
- Brecken J Blackburn
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Matthew T McPheeters
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Michael W Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - William J Dupps
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Ophthalmology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrew M Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
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Abstract
Crosslinking involves the formation of bonds between polymer chains, such as proteins. In biological tissues, these bonds tend to stiffen the tissue, making it more resistant to mechanical degradation and deformation. In ophthalmology, the crosslinking phenomenon is being increasingly harnessed and explored as a treatment strategy for treating corneal ectasias, keratitis, degenerative myopia, and glaucoma. This review surveys the multitude of exogenous crosslinking strategies reported in the literature, both "light" (involving light energy) and "dark" (involving non-photic chemical processes), and explores their mechanisms, cytotoxicity, and stage of translational development. The spectrum of ophthalmic applications described in the literature is then discussed, with particular attention to proposed therapeutic mechanisms in the cornea and sclera. The mechanical effects of crosslinking are then discussed in the context of their proposed site and scale of action. Biomechanical characterization of the crosslinking effect is needed to more thoroughly address knowledge gaps in this area, and a review of reported methods for biomechanical characterization is presented with an attempt to assess the sensitivity of each method to crosslinking-mediated changes using data from the experimental and clinical literature. Biomechanical measurement methods differ in spatial resolution, mechanical sensitivity, suitability for detecting crosslinking subtypes, and translational readiness and are central to the effort to understand the mechanistic link between crosslinking methods and clinical outcomes of candidate therapies. Data on differences in the biomechanical effect of different crosslinking protocols and their correspondence to clinical outcomes are reviewed, and strategies for leveraging measurement advances predicting clinical outcomes of crosslinking procedures are discussed. Advancing the understanding of ophthalmic crosslinking, its biomechanical underpinnings, and its applications supports the development of next-generation crosslinking procedures that optimize therapeutic effect while reducing complications.
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Affiliation(s)
- Brecken J. Blackburn
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - William J. Dupps
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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McPheeters MT, Blackburn BJ, Dupps WJ, Rollins AM, Jenkins MW. Genetically Encoded Calcium Indicators for In Situ Functional Studies of Corneal Nerves. Invest Ophthalmol Vis Sci 2020; 61:10. [PMID: 33151279 PMCID: PMC7645214 DOI: 10.1167/iovs.61.13.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/28/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose Millions of people suffer from diseases that involve corneal nerve dysfunction, caused by various conditions, including dry eye syndrome, neurotrophic keratopathy, diabetes, herpes simplex, glaucoma, and Alzheimer's disease. The morphology of corneal nerves has been studied extensively. However, corneal nerve function has only been studied in a limited fashion owing to a lack of tools. Here, we present a new system for studying corneal nerve function. Methods Optical imaging was performed on the cornea of excised murine globes taken from a model animal expressing a genetically encoded calcium indicator, GCaMP6f, to record calcium transients. A custom perfusion and imaging chamber for ex vivo murine globes was designed to maintain and stabilize the cornea, while allowing the introduction of chemical stimulation during imaging. Results Imaging of calcium signals in the ex vivo murine cornea was demonstrated. Strong calcium signals with minimal photobleaching were observed in experiments lasting up to 10 minutes. Concentrated potassium and lidocaine solutions both modulated corneal nerve activity. Similar responses were observed in the same neurons across multiple chemical stimulations, suggesting the feasibility of using chemical stimulations to test the response of the corneal nerves. Conclusions Our studies suggest that this tool will be of great use for studying functional changes to corneal nerves in response to disease and ocular procedures. This process will enable preclinical testing of new ocular procedures to minimize damage to corneal innervation and therapies for diminished neural function.
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Affiliation(s)
- Matthew T McPheeters
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Brecken J Blackburn
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - William J Dupps
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Andrew M Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Michael W Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, United States
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Elahi S, Blackburn BJ, Lapierre-Landry M, Gu S, Rollins AM, Jenkins MW. Semi-automated shear stress measurements in developing embryonic hearts. Biomed Opt Express 2020; 11:5297-5305. [PMID: 33014615 PMCID: PMC7510878 DOI: 10.1364/boe.395952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 05/09/2023]
Abstract
Blood-induced shear stress influences gene expression. Abnormal shear stress patterns on the endocardium of the early-stage heart tube can lead to congenital heart defects. To have a better understanding of these mechanisms, it is essential to include shear stress measurements in longitudinal cohort studies of cardiac development. Previously reported approaches are computationally expensive and nonpractical when assessing many animals. Here, we introduce a new approach to estimate shear stress that does not rely on recording 4D image sets and extensive post processing. Our method uses two adjacent optical coherence tomography frames (B-scans) where lumen geometry and flow direction are determined from the structural data and the velocity is measured from the Doppler OCT signal. We validated our shear stress estimate by flow phantom experiments and applied it to live quail embryo hearts where observed shear stress patterns were similar to previous studies.
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Affiliation(s)
- Sahar Elahi
- Department of Pediatrics, Case Western
Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Department of Biomedical Engineering, Case
Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106,
USA
| | - Brecken J. Blackburn
- Department of Biomedical Engineering, Case
Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106,
USA
| | - Maryse Lapierre-Landry
- Department of Biomedical Engineering, Case
Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106,
USA
| | - Shi Gu
- Department of Biomedical Engineering, Case
Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106,
USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case
Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106,
USA
| | - Michael W. Jenkins
- Department of Pediatrics, Case Western
Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Department of Biomedical Engineering, Case
Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106,
USA
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Blackburn BJ, Gu S, Ford MR, de Stefano V, Jenkins MW, Dupps WJ, Rollins AM. Noninvasive Assessment of Corneal Crosslinking With Phase-Decorrelation Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2019; 60:41-51. [PMID: 30601930 PMCID: PMC6322634 DOI: 10.1167/iovs.18-25535] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose There is strong evidence that abnormalities in corneal biomechanical play a causal role in corneal ectasias, such as keratoconus. Additionally, corneal crosslinking (CXL) treatment, which halts progression of keratoconus, directly appeals to corneal biomechanics. However, existing methods of corneal biomechanical assessment have various drawbacks: dependence on IOP, long acquisition times, or limited resolution. Here, we present a method that may avoid these limitations by using optical coherence tomography (OCT) to detect the endogenous random motion within the cornea, which can be associated with stromal crosslinking. Methods Phase-decorrelation OCT (PhD-OCT), based in the theory of dynamic light scattering, is a method to spatially resolve endogenous random motion by calculating the decorrelation rate, Γ, of the temporally evolving complex-valued OCT signal. PhD-OCT images of ex vivo porcine globes were recorded during CXL and control protocols. In addition, human patients were imaged with PhD-OCT using a clinical OCT system. Results In both the porcine cornea and the human cornea, crosslinking results in a reduction of Γ (P < 0.0001), indicating more crosslinks. This effect was repeatable in ex vivo porcine corneas (change in average Γ = −41.55 ± 9.64%, n = 5) and not seen after sham treatments (change in average Γ = 2.83 ± 12.56%, n = 5). No dependence of PhD-OCT on IOP was found, and correctable effects were caused by variations in signal-to-noise ratio, hydration, and motion. Conclusions PhD-OCT may be a useful and readily translatable tool for investigating biomechanical properties of the cornea and for enhancing the diagnosis and treatment of patients.
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Affiliation(s)
- Brecken J Blackburn
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Shi Gu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Matthew R Ford
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | | | - Michael W Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States.,Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, United States
| | - William J Dupps
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States.,Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Andrew M Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States
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Blackburn BJ, Jenkins MW, Rollins AM, Dupps WJ. A Review of Structural and Biomechanical Changes in the Cornea in Aging, Disease, and Photochemical Crosslinking. Front Bioeng Biotechnol 2019; 7:66. [PMID: 31019909 PMCID: PMC6459081 DOI: 10.3389/fbioe.2019.00066] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/07/2019] [Indexed: 12/27/2022] Open
Abstract
The study of corneal biomechanics is motivated by the tight relationship between biomechanical properties and visual function within the ocular system. For instance, variation in collagen fibril alignment and non-enzymatic crosslinks rank high among structural factors which give rise to the cornea's particular shape and ability to properly focus light. Gradation in these and other factors engender biomechanical changes which can be quantified by a wide variety of techniques. This review summarizes what is known about both the changes in corneal structure and associated changes in corneal biomechanical properties in aging, keratoconic, and photochemically crosslinked corneas. In addition, methods for measuring corneal biomechanics are discussed and the topics are related to both clinical studies and biomechanical modeling simulations.
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Affiliation(s)
- Brecken J. Blackburn
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Michael W. Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - William J. Dupps
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
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Thrane L, gu S, Blackburn BJ, Damodaran KV, Rollins AM, Jenkins MW. Complex decorrelation averaging in optical coherence tomography: a way to reduce the effect of multiple scattering and improve image contrast in a dynamic scattering medium. Opt Lett 2017; 42:2738-2741. [PMID: 28708157 PMCID: PMC5997261 DOI: 10.1364/ol.42.002738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We demonstrate that complex decorrelation averaging can reduce the effect of multiple scattering and improve optical coherence tomography (OCT) imaging contrast. Complex decorrelation averaging calculates the product of an A-scan and the complex conjugate of a subsequent A-scan. The resultant signal is the product of the amplitudes and the phase difference. All these resulting complex signals at a particular location are then averaged. We take advantage of the fact that complex averaging, in contrast to conventional magnitude averaging, is sensitive to phase decorrelation. Sample motion that increases signal phase variance results in lower signal magnitude after complex averaging. Such motion preferentially results in a faster decorrelation of the multiple scattering signal when compared to the single scattering signal with each scattering event spreading the phase. This indicates that we may reduce multiple scattering by implementing complex decorrelation averaging to preferentially reduce the magnitude of the multiply scattered light signal in OCT images. By adjusting the time between phase-differenced A-scans, one can regulate the amount of measured decorrelation. We have performed experiments on liquid phantoms that give experimental evidence for this hypothesis. A substantial improvement in OCT image contrast using complex decorrelation averaging is demonstrated.
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Affiliation(s)
- Lars Thrane
- Department of Pediatrics, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Corresponding author:
| | - Shi gu
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Brecken J. Blackburn
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Kishore V. Damodaran
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Michael W. Jenkins
- Department of Pediatrics, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
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Kepron C, Novak M, Blackburn BJ. Effect of Echinococcus multilocularis on the origin of acetyl-coA entering the tricarboxylic acid cycle in host liver. J Helminthol 2002; 76:31-6. [PMID: 12018193 DOI: 10.1079/joh200188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Carbon-13 nuclear magnetic resonance (NMR) spectroscopy was employed to investigate alterations in hepatic carbohydrate metabolism in Meriones unguiculatus infected with Echinococcus multilocularis. Following portal vein injections of an equimolar mixture of [1,2-13C2]acetate and [3-13C]lactate, perchloric acid extracts of the livers were prepared and NMR spectra obtained. Isotopomer analysis using glutamate resonances in these spectra showed that the relative contributions of endogenous and exogenous substrates to the acetyl-CoA entering the tricarboxylic acid cycle differed significantly between infected and control groups. The mole fraction of acetyl-CoA that was derived from endogenous, unlabelled sources (F(U)) was 0.50 +/- 0.10 in controls compared to 0.34 +/- 0.04 in infected animals. However, the fraction of acetyl-CoA derived from [3-13C]lactate (FLL) was larger in livers of infected animals than those from controls with values of 0.27 +/- 0.04 and 0.18 +/- 0.04, respectively. Similarly, the fraction of acetyl-CoA derived from [1,2-13C2]acetate (FLA) was larger in livers of infected animals compared to those in controls; the fractions were 0.38 +/- 0.01 and 0.32 +/- 0.07, respectively. The ratio of FLA:FLL was significantly smaller in the infected group with a value of 1.42 +/- 0.18 compared to 1.74 +/- 0.09 for the controls. These results indicate that alveolar hydatid disease has a pronounced effect on the partitioning of substrates within the pathways of carbohydrate metabolism in the host liver.
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Affiliation(s)
- C Kepron
- Department of Biology, University of Winnipeg, Manitoba, Canada
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Corbin I, Novak M, Blackburn BJ. Changes in hepatic lipids of mice infected with cysticerci of Taenia crassiceps. J Helminthol 2000; 74:209-14. [PMID: 10953220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Nuclear magnetic resonance (NMR) spectroscopy was employed to investigate the effect of infection with Taenia crassiceps cysticerci on the lipid profile of mouse liver. Chloroform/methanol extracts of livers from infected mice showed lower concentrations of phosphatidylethanolamine, phosphatidylcholine, phosphatidylinositol, total glycerophospholipid, triacylglycerol, total fatty acid (FA) and all measured FA components than those from controls. Furthermore, the ratios obtained on dividing concentrations of the FA components by that of total FA demonstrate that the concentration decreases caused by infection are less for polyunsaturated fatty acids (FAs) than for other FAs. Extracts of T. crassiceps displayed a similar lipid profile to that of host liver but contained a lower lipid content and a shorter average FA chain length.
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Affiliation(s)
- I Corbin
- Department of Biology, University of Winnipeg, Manitoba, Canada
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Abstract
Carbon-13-decoupled proton spin-echo nuclear magnetic resonance (NMR) spectroscopy, with and without13C population inversion, was used to study carbon flow between the host and the parasite in the mouse - Taenia crassiceps system. This NMR analysis revealed that 2 h after intraduodenal injection of [3-13C]alanine, livers from both uninfected mice and those infected with cysticerci of T. crassiceps contained13C label in glycogen, glucose, succinate, glutamate, alanine, and lactate. Livers of infected animals had a lower percentage of13C in alanine, indicating increased utilization of the substrate. In addition, infected mice had a lower concentration of total hepatic glucose and glutamate. The data are consistent with an increased rate of gluconeogenesis in the liver of infected animals. Cysticerci possessed13C label in glucose, acetate, alanine, and lactate. Since these metacestodes are unable to make glucose de novo from pyruvate, labelled glucose found in cysticerci had to be newly synthesized via the host gluconeogenic pathway and then siphoned off by the parasite.
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Abstract
When metacestodes of Mesocestoides vogae were incubated with oxaloacetate, the 1H NMR spectra of the incubation media established the presence of citrate in addition to the usual worm excretory products succinate, acetate, alanine, and lactate. Given the known impermeability of the inner mitochondrial membrane to multiply charged matrix metabolites, the finding strongly suggests the presence of a transporter to convey citrate from the mitochondria to the cytosol. It is proposed that some of the extramitochondrial citrate serves as a source of cytosolic acetyl-CoA, via the citrate lyase reaction, for conversion to malonyl-CoA and subsequent fatty acid chain elongation. The data demonstrate that because citrate is excreted, further forward steps in the tricarboxylic acid cycle are either very slow or not operating.
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Abstract
Carbon-13 decoupled 1H spin-echo nuclear magnetic resonance (NMR) spectra, with and without 13C population inversion, of extracts of Taenia crassiceps cysticerci incubated in media containing [3-(13C)]-pyruvate showed 13C enrichment in alanine, lactate, acetate, succinate, and citrate. Labeling in the latter three metabolites provides substantial evidence that the malic enzyme reaction in this cestode also functions in the direction opposite to that in which it is normally portrayed. The direct passage of pyruvate from the cytosol to the mitochondrion is suggested by the greater percentage of 13C detected in acetate relative to succinate.
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Affiliation(s)
- I Corbin
- Department of Biology, University of Winnipeg, Manitoba, Canada
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Modha A, Novak M, Blackburn BJ. Alteration in brain metabolites of jirds infected with alveolar Echinococcus. J Parasitol 1997; 83:764-6. [PMID: 9267426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The Meriones unguiculatus-Echinococcus multilocularis host-parasite system was used to evaluate changes in metabolite levels in the brain of the infected host. Nuclear magnetic resonance analysis of perchloric acid extracts of the entire brain of jirds revealed that infection caused a change in the concentration of several metabolites, especially those that serve as amino acidergic neurotransmitters in this organ. The concentrations of the neuroexcitatory compounds glutamate and aspartate and the neuroinhibitory compounds glycine and taurine were significantly reduced. Those of 2 other amino acids, glutamine and alanine, were also decreased. In addition, concentrations of glycerophosphocholine and phosphocholine were also lower, whereas those of phosphocreatine and N-acetylaspartate were elevated.
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Affiliation(s)
- A Modha
- Department of Biology, University of Winnipeg, Manitoba, Canada
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15
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Abstract
In vivo NMR spectra of uninfected and Hymenolepis diminuta-infected Tenebrio molitor fed D-(1-13C)glucose showed that infected beetles of both sexes had a significantly higher ratio for (glycogen C1/lipid (CH2)n) than the corresponding controls. Quantitative metabolic profiles and the per cent 13C-label in metabolites, based on NMR of perchloric acid extracts, are presented for control and infected beetles fed D-(1-13C)glucose and for H. diminuta cysticercoids. Female beetles, both control and infected, contained more glycogen than their male counterparts and infected beetles of both sexes possessed less glycerophos-phocholine, but more glycogen and a higher percentage label in glucose and trehalose than their respective controls. Label was also incorporated into glycogen, succinate, acetate, alanine and lactate. Extracts of cysticercoids from beetles fed D-(1-13C)glucose contained the following labelled compounds, in order of decreasing per cent 13C label: glucose, trehalose, alanine, succinate, lactate, glycogen and acetate. In vitro cultivation experiments, employing D-(1-13C)glucose, revealed that trehalose found in cysticercoids was of parasite, and not beetle, origin.
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Affiliation(s)
- J Schoen
- Department of Biology, University of Winnipeg, Manitoba, Canada
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Affiliation(s)
- I Corbin
- Department of Biology, University of Winnipeg, Manitoba, Canada
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Blackburn BJ, Modha A, Novak M. Phosphate metabolites of Tenebrio molitor (Coleoptera: tenebrionidae) infected with metacestodes of Hymenolepis diminuta. J Med Entomol 1995; 32:223-228. [PMID: 7616510 DOI: 10.1093/jmedent/32.3.223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In vivo phosphorus-31 nuclear magnetic resonance (31P NMR) spectra and those of extracts of Tenebrio molitor L. infected with metacestodes of Hymenolepis diminuta R. showed modifications in the amounts of phosphorous-containing metabolites when compared with those of uninfected beetles. Infected females were more affected than infected males, having significantly more glucose-6-phosphate (Glu-6-P), glycerol-3-phosphate (Gly-3-P), and phosphorylethanolamine (PE), but less inorganic orthophosphate (Pi), glycerophosphorylethanolamine (GPE), gylcerolphosphorylcholine (GPC), phosphoarginine (PAr), and adenosine diphosphate (ADP). Infected males had more Glu-6-P and PE, but less Pi, GPE, and GPC. These changes directly reflected the phosphorylation potential of infected hosts, which increased approximately 100% and 50% in infected females and males, respectively.
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Affiliation(s)
- B J Blackburn
- Department of Chemistry, University of Winnipeg, Canada
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Novak M, Hudspeth C, Blackburn BJ. 1H NMR study of metabolic alterations in the small intestine of rats infected with Hymenolepis diminuta. Int J Biochem 1993; 25:1587-91. [PMID: 8288027 DOI: 10.1016/0020-711x(93)90516-h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
1H NMR spectra of the duodenum, jejunum and ileum tissues of the small intestine of a rat showed metabolic gradients. 2. The concentrations of metabolites in these gut regions were altered by the presence of the tapeworm Hymenolepis diminuta. 3. In the infected duodenum there was significantly less glycogen, glucose and phosphocreatine/creatine, but significantly more lactate than in the corresponding controls. 4. Infected jejunum contained significantly less betaine but significantly more succinate, alanine and lactate. 5. Infected ileum had significantly less glycogen and taurine but significantly more alanine and lactate.
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Affiliation(s)
- M Novak
- Department of Biology, University of Winnipeg, Manitoba, Canada
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Abstract
Proton NMR spectra of liver extracts from mice infected with Mesocestoides vogae for 24 or 133 days showed differences in the concentrations of liver metabolites when compared to those of normal liver. Moderately infected livers (24 d.p.i.) had significantly less glucose and significantly more glycine, cholines, alanine and lactate than uninfected controls. Similar changes in the concentrations of these metabolites were also found in mice with heavily infected livers (133 d.p.i.), and, in addition, there was significantly more succinate in this group than in the other 2 groups. Furthermore, the heavily infected livers contained more taurine and less acetate than the controls. Tetrathyridia extracts were rich in glycogen and contained high levels of betaine.
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Affiliation(s)
- B J Blackburn
- Department of Chemistry, University of Winnipeg, Manitoba, Canada
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Novak M, Modha A, Blackburn BJ. Metabolic alterations in organs of Meriones unguiculatus infected with Echinococcus multilocularis. Comp Biochem Physiol B 1993; 105:517-21. [PMID: 8365107 DOI: 10.1016/0305-0491(93)90082-g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
1. 1H-NMR spectra of liver, spleen and kidney extracts from Meriones unguiculatus infected with Echinococcus multilocularis showed decreased levels of glucose. In addition, the liver extracts were severely glycogen-depleted. 2. Both livers and spleens contained less glycine, taurine and acetate. Spleens also had fewer cholines and less lactate but more betaine and alanine. 3. In the kidneys, elevated concentrations of succinate, acetate and lactate were found.
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Affiliation(s)
- M Novak
- Department of Biology, University of Winnipeg, Manitoba, Canada
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Abstract
31P NMR in vivo spectra of mouse livers infected with Hymenolepis microstoma for 130 or 265 days showed modifications in phosphorus-containing metabolite ratios when compared to those of normal liver. After 130 days of infection the metabolite ratio of inorganic phosphate (Pi)/beta ATP significantly increased whereas that of phosphocreatine (PCr)/beta ATP significantly decreased. In older, 265 day infections, the increase in Pi/beta ATP and decrease in PCr/beta ATP persisted. Changes in the group infected for 130 days were accompanied by lowered pH. Analysis of liver extracts from mice with 130-day-old. H. microstoma revealed significantly lower concentrations of Pi, ATP and ADP compounds. In those from mice infected for 265 days the concentration of Pi remained low whereas concentrations of ATP and ADP increased to levels in between those of controls and the 130-day-old infection. In addition, levels of phosphorylethanolamine (PE) and of an unknown metabolite significantly increased in this latter group. Worm extracts contained high levels of glycerophosphorylcholine (GPC), Pi, fructose 1,6-diphosphate (FDP), PE, diphosphodiesters (DPDE), phosphorylcholine (PC) and glycerolphosphorylethanolamine (GPE) in order of declining concentrations, respectively.
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Affiliation(s)
- B J Blackburn
- Department of Chemistry, University of Winnipeg, Manitoba, Canada
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Affiliation(s)
- B J Blackburn
- Department of Chemistry, University of Winnepeg, Manitoba, Canada
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Novak M, Hameed N, Buist R, Blackburn BJ. Metabolites of alveolar Echinococcus as determined by [31P]- and [1H]-nuclear magnetic resonance spectroscopy. Parasitol Res 1992; 78:665-70. [PMID: 1480603 DOI: 10.1007/bf00931518] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
[31P]-Nuclear magnetic resonance (NMR) in vivo spectra of Echinococcus multilocularis cysts growing subcutaneously in Meriones unguiculatus showed prominent signals due to phosphomonoesters (PME), phosphodiesters (PDE), inorganic phosphate (Pi) and the alpha, beta and gamma phosphate groups of adenosine triphosphate (ATP). The internal pH of the parasite cysts was 6.7-6.8. The 31P spectra of extracts of these subcutaneous cysts showed peaks identified as glucose-6-phosphate (Glu-6-P), glycerol-3-phosphate (Gly-3-P), phosphorylethanolamine (PE), adenosine-5'-monophosphate (5'-AMP), nicotinamide adenine dinucleotide phosphate (NADP), phosphorylcholine (PC), Pi, glycerolphosphorylethanolamine (GPE), glycerolphosphorylcholine (GPC), phosphoenolpyruvate (PEP), adenosine diphosphate (ADP), ATP and diphosphodiesters (DPDE). These metabolites were also detected at comparable concentrations in the extracts of intraperitoneally grown cysts. In addition, significantly more phosphocreatine (PCr), probably of host origin, was detected in the subcutaneous cysts than in the intraperitoneal cysts. [1H]-NMR spectra of cyst extracts revealed that parasites grown in the abdominal cavity contained significantly less glucose but significantly more succinate, acetate, alanine and beta-hydroxybutyrate. Glycogen, creatine, glycine, taurine, betaine, cholines and lactate were present at similar concentrations in cyst material from both locations.
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Affiliation(s)
- M Novak
- Department of Biology, University of Winnipeg, Manitoba, Canada
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Novak M, Hall CL, Blackburn BJ. A nuclear magnetic resonance study of the glucose metabolism of Hymenolepis diminuta exposed to histamine and serotonin in vitro. Int J Parasitol 1991; 21:589-96. [PMID: 1743855 DOI: 10.1016/0020-7519(91)90064-e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The direct effects of the inflammatory mediators, histamine (HI) and serotonin (SE), on the glucose metabolism of Hymenolepis diminuta in vitro were studied by analyzing the excretory products from culture media, containing D-1-13C-glucose and various concentrations of HI and/or SE, by 1H-nuclear magnetic resonance (n.m.r.) spectroscopy. The results revealed that HI markedly accelerated the glycolysis process by increasing the amount of lactate production. The increased glycolytic activity was reflected in a concentration-dependent increase in glucose uptake. Excretion of acetate was also stimulated by HI. A low concentration of SE significantly increased succinate, acetate and lactate excretions, whereas a high concentration had little effect on lactate production and significantly decreased succinate and acetate excretions. A combination of HI and SE treatment at a low concentration had no significant effect, but at a high concentration showed an additive effect, with an increase in lactate production, a decrease in succinate production and an increase in glucose uptake. Thus this work confirms that HI and SE directly influence, albeit differently, energy metabolism of the tapeworm H. diminuta.
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Affiliation(s)
- M Novak
- Department of Biology, University of Winnipeg, Manitoba, Canada
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Novak M, Horvath A, Blackburn BJ. Mesocestoides corti: a GC/MS study of the effects of oxaloacetate and iodoacetate on the isotope ratios in succinate and lactate excreted in the presence of NaH13CO3. Exp Parasitol 1991; 72:69-75. [PMID: 1847107 DOI: 10.1016/0014-4894(91)90122-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The current study was undertaken to gain further insight into the carbohydrate metabolism of the proliferating larvae of Mesocestoides corti by studying the effect of the metabolic inhibitors oxaloacetate and iodoacetate on the incorporation of label from NaH13CO3 into the excretory products lactate and succinate. These products were converted to their methyl derivatives and analyzed by gas chromatography/mass spectrometry (GC/MS) to determine the isotope ratios. The percentage of [1-13C]lactate, [1-13C]succinate, and [1,4-13C2]succinate decreased in the presence of oxaloacetate; iodoacetate did not significantly influence the relative amount of the former, but markedly increased percentages of the latter two. The data provide information on the relative rates of the pathways and steps within them and the influence of the inhibitors on these pathways.
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Affiliation(s)
- M Novak
- Department of Biology, University of Winnipeg, Manitoba, Canada
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Novak M, Marat K, Johnson L, Blackburn BJ. H and 13C n.m.r. studies of serum from normal and Echinococcus multilocularis infected jirds. Int J Parasitol 1989; 19:395-400. [PMID: 2777462 DOI: 10.1016/0020-7519(89)90095-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The major components of the 13C and high field region of the 1H nuclear magnetic resonance (n.m.r.) spectra of normal and Echinococcus multilocularis infected jirds were identified and compared. Substantial depletion of the glucose and fatty acid chains from lower density lipoproteins was detected in sera from infected animals. In addition, this proliferating metacestode markedly changed the appearance of the spectral region recently assigned to N-acetyl protons of carbohydrate side chains of N-acetylated glycoproteins.
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Novak M, Blackburn BJ. A nuclear magnetic resonance study of the D-[13C6]glucose metabolism of Mesocestoides corti tetrathyridia in the absence and presence of monensin. Int J Parasitol 1988; 18:1029-33. [PMID: 3220643 DOI: 10.1016/0020-7519(88)90072-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Blackburn BJ, Hutton HM, Novak M, Evans WS. Hymenolepis diminuta: nuclear magnetic resonance analysis of the excretory products resulting from the metabolism of D-[13C6]glucose. Exp Parasitol 1986; 62:381-8. [PMID: 3780931 DOI: 10.1016/0014-4894(86)90046-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Excretory products of the tapeworm Hymenolepis diminuta, fed D-[13C6]glucose in vitro for 90 min, were studied using 1H and 13C nuclear magnetic resonance spectroscopy. Signals due to lactate, succinate, acetate, and alanine were identified in the spectra. Several differently labeled species were present for these metabolites; the variations of higher concentration were a consequence of metabolic factors while those of lower concentration could be accounted for by residual 12C in the glucose. The two major labeled lactates, U-13C and 2,3-13C2, were in the ratio 2:1, respectively, and the three major labeled succinates, 1,2,2'-13C3,2,2'-13C2, and U-13C, were present in the ratio 20:10:3, respectively. The different species of labeled end products are related to the overall glucose metabolism of H. diminuta.
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Novak M, Blackburn BJ. Comparison of the effects of imidazo[1,2-a]pyridine-2-carbamates and benzimidazole-2-carbamates on the development of Hymenolepis nana in Tribolium confusum. Experientia 1985; 41:687-9. [PMID: 3996549 DOI: 10.1007/bf02007722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The anthelmintic properties of several imidazo[1,2-a]pyridine carbamates and benzimidazole carbamates against Hymenolepis nana are compared. The results of this study, coupled with previous work, indicate that methyl 6-(trichloroethenyl)-imidazo[1,2-a]pyridine-2-carbamate has the potential of being a broad spectrum anthelmintic effective against both nematodes and cestodes.
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Novak M, Hardy M, Evans WS, Blackburn BJ, Ankrom D. A comparison of the effects of ten, 5-substituted benzimidazolyl carbamates on larval development of three hymenolepidid tapeworms. J Parasitol 1982; 68:1165-7. [PMID: 7175618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Novak M, Blackburn BJ. Anthelmintic activity of several 5-substituted benzimidazolyl carbamates against Hymenolepis nana cysticercoids. Experientia 1981; 37:250-1. [PMID: 7238776 DOI: 10.1007/bf01991637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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González RG, Blackburn BJ, Schleich T. Fractionation and structural elucidation of the active components of aurintricarboxylic acid, a potent inhibitor of protein nucleic acid interactions. Biochim Biophys Acta 1979; 562:534-45. [PMID: 378260 DOI: 10.1016/0005-2787(79)90116-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Commercially available, as well as synthetically prepared, samples of aurintricarboxylic acid (a widely employed potent inhibitor of protein nucleic acid interactions) consist mostly of a heterogeneous collection of polymers, as shown by fractionation schemes utilizing both dialysis and ultrafiltration, and by molecular weight measurements. 13C-NMR studies suggest that the polymeric material is of the phenol-formaldehyde type; inhibitory assays that depend on the formation of a protein-nucleic acid complex revealed that potency varied directly with the molecular weight of the polymer. Fractions of molecular weight 400 were essentially inactive.
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Schleich T, Blackburn BJ, Lapper RD, Smith IC. A nuclear magnetic resonance study of the influence of aqueous sodium perchlorate and temperature on the solution conformations of uracil nucleosides and nucleotides. Biochemistry 1972; 11:137-45. [PMID: 4333200 DOI: 10.1021/bi00752a001] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Neville GA, Deslauriers R, Blackburn BJ, Smith IC. Conformational studies of amphetamine and medicinally important derivatives by nuclear magnetic resonance spectroscopy. J Med Chem 1971; 14:717-21. [PMID: 4398854 DOI: 10.1021/jm00290a012] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Dugas H, Blackburn BJ, Robins RK, Deslauriers R, Smith IC. A nuclear magnetic resonance study of the conformation of beta-cyanuric acid riboside. Further evidence for the anti rotamer in pyrimidine nucleosides. J Am Chem Soc 1971; 93:3468-70. [PMID: 5560465 DOI: 10.1021/ja00743a029] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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