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Key Words: dynamic nuclear polarization ischemia pyruvate dehydrogenase TCA cycle
metabolism via the Krebs cycle. For example, in myocardial ischemia, the glycolytic rate is maintained despite suppressed oxidative metabolism (4, 5). In the
hypertrophic heart, fatty acid oxidation is decreased,
with an increase in glycolysis (6, 7). However, increased
glucose oxidation via PDH does not compensate for
reduced fatty acid oxidation, which raises the question
as to how Krebs cycle flux and cardiac energetics can be
maintained in the state of hypertrophy (8).
The mechanisms that lead to energetic imbalances in
heart disease could be better studied by simultaneously
monitoring the source and fate of glucose-derived
acetyl CoA in the heart (glycolytic and Krebs cycle
metabolism). To date, Krebs cycle flux and substrate
selection have been measured using carbon-13 MR
spectroscopy (13C MRS) combined with isotopomer
analysis (8 10). This technique models the steady-state
incorporation of 13C label into the glutamate pool and
therefore has limited application in non-steady-state
situations (11) and in vivo studies of cardiac metabolism (12).
Metabolic imaging with hyperpolarized 13C MRS (13,
14) has enabled the measurement of normal and
abnormal metabolism in real time in several systems
(1519). In the heart, hyperpolarized [1-13C]pyruvate is
rapidly converted to [1-13C]lactate, [1-13C]alanine, and
H13CO3 (in pH-dependent equilibrium with 13CO2);
thus, glycolysis via lactate dehydrogenase (LDH) and
flux through the PDH enzyme complex can be assessed
(20, 21). However, since PDH-mediated oxidation of
hyperpolarized [1-13C]pyruvate releases the hyperpolarized 13C nucleus as 13CO2, the formation of acetyl
CoA and its incorporation into the Krebs cycle cannot
be followed.
In this study, we developed the use of hyperpolarized
[2-13C]pyruvate as a tracer to monitor Krebs cycle metabolism in the isolated perfused heart directly. Hyperpolarized [2-13C]pyruvate was infused into healthy hearts, and
the metabolic products that had sufficient MR signal to be
1
Correspondence: Cardiac Metabolism Research Group,
Department of Physiology, Anatomy and Genetics, Sherrington Bldg., University of Oxford, Parks Rd., Oxford, UK.,
OX1 3PT. E-mail: damian.tyler@dpag.ox.ac.uk
doi: 10.1096/fj.09-129171
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C MR spectroscopy
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SCHROEDER ET AL.
C MR data acquisition
Immediately after infusion of hyperpolarized [2-13C]pyruvate, MR acquisition of 13C-pyruvate and its metabolic derivatives was initiated. Metabolites were detected with a 1-s
temporal resolution over the course of 4 min (TR1 s,
excitation flip angle30, pulse length30 s, 240 acquisitions). Over a bandwidth of 180 ppm, 4096 points were
acquired. Spectra were centered at 125 ppm.
Total global ischemia
Global ischemia was initiated in perfused hearts by shutting
off the peristaltic pump to stop buffer flow to the heart.
Hearts were maintained in this state for 10 min, at which
point hyperpolarized [2-13C]pyruvate was infused into the
buffer reservoir and the pump was switched on (at the same flow
rate previously measured) to restart buffer flow. The perfusion
line was briefly disconnected immediately above the magnet to
wash out nonhyperpolarized buffer from the dead volume, such
that each heart was reperfused with nonhyperpolarized buffer
for no more than 5 s. By this means, the hyperpolarized
pyruvate experiments enabled rapid measurement of changes
to the myocardium almost immediately on reperfusion, following no-flow ischemia.
Data analysis
Cardiac 13C MR spectra were analyzed using the AMARES
algorithm as implemented in the jMRUI software package
(24). Spectra were DC-offset corrected based on the last half
of acquired points and peaks corresponding with [2-13C]pyruvate and its metabolic derivatives (quantifiable at 1-s temporal
resolution) were fitted assuming a Gaussian line shape and
initial peak frequencies, relative phases and linewidths. Quantified peak areas were plotted against time in Microsoft Excel
(Microsoft Corporation, Redmond, WA, USA). The averaged
maximum peak area of each metabolite over the 60 s of
acquisition was determined for each series of spectra, as
described previously (21) along with the area under the
metabolic progression curve (AUC). The initial rate of signal
production for each metabolite, in arbitrary units per second
(s1), was measured as the slope of its average metabolite
progression plot over the first 5 s following metabolite
appearance when the detected signal increased linearly. The
time to appearance of signal from each metabolite was
defined as the delay between pyruvate appearance in that
particular experiment and the first time point that was 10%
of the maximum peak area. This corrected for the variation in
hyperpolarized pyruvate arrival at the heart due to the
variable flow rate at which tracer was delivered. In addition,
an exponential signal decay term was fit to each metabolite
progression plot from the point of maximum signal over the
course of signal decay.
MONITORING INSTANTANEOUS KREBS CYCLE METABOLISM
Statistical analysis
Data are reported as means se. Statistical significance
between healthy and ischemic groups was assessed using a
paired Students t test. Statistical significance was considered
at P 0.05.
Peak assignment
[2-13C]pyruvate phantom
Infusion of hyperpolarized [2-13C]pyruvate into an empty
perfusion rig was performed according to the same protocol
as infusion into the isolated perfused heart. 13C data were
acquired and processed identically for comparison to perfused heart spectra.
Metabolite extraction
One heart was perfused further for 30 min with the
Krebs-Henseleit perfusion buffer described above containing
both 80 mM [1-13C]pyruvate and [2-13C]pyruvate, after which
time the heart was immediately excised and frozen in liquid
nitrogen before being stored at 80C until analysis. Metabolites were extracted from heart tissue using methanol/
chloroform/water as described previously (25). Briefly, frozen tissue (100 mg) was placed in methanol/chloroform
(2:1, 600 l) and homogenized. Samples were then sonicated
for 5 min before chloroform/water (1:1) was added (200 l
of each). Samples were centrifuged (13,500 rpm, 20 min),
and the aqueous layer was removed and dried overnight in an
evacuated centrifuge (Eppendorf, Hamburg, Germany).
NMR spectroscopy
Dried extracts were rehydrated in 600 l of D2O and buffered
in 0.24 M sodium phosphate (pH 7.0) containing 1 mM
sodium-3-(trimethylsilyl)-2,2,3,3-tetradeuteriopropionate (TSP;
Cambridge Isotope Laboratories, Andover, MA, USA) as an
internal standard. The samples were analyzed using an Avance
II spectrometer operating at 500 MHz for the 1H frequency
(Bruker) equipped with a 5-mm broadband TXI automatic
tuning and matching (ATMA) probe. One-dimensional spectra
were collected using a solvent suppression pulse sequence based
on a 1-D nuclear Overhauser effect spectroscopy pulse sequence
to saturate the residual [1H] water proton signal (relaxation
delay2 s, t1 3 s, mixing time150 ms, solvent presaturation
applied during the relaxation time and the mixing time,
NS128, SW12 ppm, T37C). Two-dimensional heteronuclear multiple bond correlations (HMBCs; ref. 26) were also
performed to correlate 1H and 13C resonances [hmbcgplpndqf
Bruker pulse program, TD4096 (F1) and 256 (F2), NS256,
D12.5 s, SW(1H)12 ppm, SW(13C)250 ppm, AQ0.31 s).
Peak assignments were based on their 13C chemical shifts
relative to the known 1-D 1H peaks using the 2-D NMR spectrum.
RESULTS
Polarization of [2-13C]pyruvate
[2-13C]Pyruvic acid polarized similarly to the [1-13C]pyruvic
acid used previously (20). [2-13C]Pyruvate polarization
levels were slightly below the 30% polarization
reached by [1-13C]pyruvate and were estimated by
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Figure 2. Example stacked spectra acquired in the first 60 s following [2-13C]pyruvate infusion into a perfused rat heart.
[2-13C]Pyruvate was observed at 207.8 ppm. Peaks 1, 2, and 3 represent the metabolic products [5-13C]glutamate (183.7 ppm),
[1-13C]citrate (181.0 ppm), and [1-13C]acetylcarnitine (175.2 ppm), respectively. [1-13C]Pyruvate derived from natural
abundance 13C was seen as a quartet at 172.8 ppm (peak 4, left inset). [2-13C]Pyruvate hydrate, which is in chemical equilibrium
with pyruvate, was detected at 96.5 ppm (peak 5, right inset). Impurities in the [2-13C]pyruvic acid preparation were observed
at 149 and 89 ppm (peak 6, right inset). [2-13C]Lactate and [2-13C]alanine could also be observed (peaks 7 and 8,
respectively).
and [5-13C]glutamate; Fig. 5 details the fitted parameters for each metabolite.
The [2-13C]lactate peak was first detected 4 1 s
after pyruvate arrival and was the highest amplitude
peak (maximum peak area0.050.01, relative to maximum [2-13C]pyruvate peak area). The [1-13C]acetyl
carnitine and [1-13C]citrate peaks were first detected at
5 1 s and 4 1 s after pyruvate arrival and with
maximum normalized peak areas of 0.029 0.004 and
0.014 0.002 respectively. The [5-13C]glutamate peak
appeared significantly later than the other metabolites, at
7 1 s following pyruvate arrival (P0.001 vs. citrate
arrival) and had the lowest maximum normalized peak
area (0.0090.002).
The time constant of [2-13C]lactate MR signal decay
was calculated to be 24 1 s, whereas the decay time
constant of hyperpolarized [1-13C]acetyl carnitine was
the longest of all [2-13C]pyruvate-derived metabolites at
30 1 s. The decay time constants of [5-13C]glutamate
and [1-13C]citrate were calculated to be 17 1 and
26 5 s, respectively.
MONITORING INSTANTANEOUS KREBS CYCLE METABOLISM
Figure 3. Annotated 2-D heteronuclear multiple bond correlations. The y axis shows 13C
chemical shifts, and the x axis shows 1H chemical shifts. Shaded regions within the plot indicate nuclei for which coupling between 1H and
13
1
C resonances had been detected. Peaks were assigned based on both H and 13C resonances. Inset: spectral region
corresponding with previously unassigned hyperpolarized 13C peaks detected in the isolated perfused heart.
DISCUSSION
This work has demonstrated the use of hyperpolarized
[2-13C]pyruvate as a metabolic tracer. Observation of
[2-13C]pyruvate metabolism in real time in the perfused heart has provided simultaneous information on
glycolysis, via [2-13C]lactate appearance; PDH flux and
energy demand, via [1-13C]acetyl carnitine; and a direct assessment of Krebs cycle metabolism. Detection of
[1-13C]citrate and [5-13C]glutamate has enabled the
first instantaneous measurements of oxidative metabolism in whole organs. The simultaneous appearance of
[1-13C]citrate, [2-13C]lactate, and [1-13C]acetyl carnitine revealed that pyruvate-derived acetyl CoA was
incorporated into the Krebs cycle within 1 s of both its
production by PDH and the cytosolic conversion of
pyruvate to lactate. All of these enzymatic conversions
occurred within 5 s of [2-13C]pyruvate arrival at the
coronary arteries.
Direct assessment of Krebs cycle flux
Figure 4. Progression of the metabolic products of [2-13C]pyruvate, for healthy perfused hearts (n6). Data were acquired with
a 1-s temporal resolution, using a 30 RF pulse.
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Figure 5. Summary of the metabolic fate of infused [2-13C]pyruvate along with the measured parameters of the observed
metabolites.
Figure 6. Comparison of the average metabolic time courses for lactate, acetylcarnitine, citrate, and glutamate in both the
healthy and postischemic hearts. Image shows a significant elevation in the lactate signal following a 10 min ischemic period,
along with a significant reduction in the citrate and glutamate signals.
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