Narayan Datt Soni1, Anshuman Swain1, Paul Jacobs1, Halvor Juul1, and Ravinder Reddy1
1Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
Synopsis
Keywords: Alzheimer's Disease, Deuterium, 2H-MRS, Brain, Alzheimer's disease, Metabolism
Motivation: Among all, glucose hypometabolism is a characteristic pathology in Alzheimer’s disease (AD), under such conditions β-Hydroxy butyrate (BHB) can serve as an alternate source of energy. Measurement of BHB metabolism using a sensitive method could serve as a method for early diagnosis of AD.
Goal(s): To monitor BHB metabolism in APPNL-F/NL-F mice.
Approach: Monitoring cerebral 2H2-Glx labeling in mice following subcutaneous administration of 2H4-BHB using pulse-acquired 2H-MRS.
Results: Although rate of cerebral 2H4-BHB uptake was similar in wild type (WT) and AD mice, moderately enhanced labeling of 2H2-Glx was observed in AD mice compared to WT indicates relatively efficient BHB metabolism in AD.
Impact: Although BHB metabolism has been monitored in human and rodent brains
using PET and 13C-MRS, inherent limitations restrict their clinical
translation. Using a safe and sensitive method like 2H-MRS could be
helpful in studying BHB metabolism in various neurodegenerative diseases.
Introduction
Glucose
hypometabolism is a consistently reported characteristic of Alzheimer’s disease
(AD)1. Disruption of glucose
metabolism directly affects neurotransmitter metabolism, glutamate-glutamine
cycling, and neuroenergetics leading to impaired cognitive functions and risk of
oxidative damage. β-Hydroxybutyrate (BHB) serves as an alternate source of
energy for the brain and could be utilized variably under conditions of poor
availability or hypometabolism of glucose. Since, oxidative BHB metabolism through the TCA cycle also bypasses glycolysis (Fig. 1), monitoring its metabolism could be
used for a more direct estimation of the TCA cycle.
Limited
studies have been performed to monitor the real-time metabolism of BHB in human
and rodent brains using quantitative autoradiography2, 13C, and 1H-[13C]-MRS3-5. However, inherent
limitations, like the use of radioactive tracer or low sensitivity of 13C
and technical complexity have limited their clinical translation. Recently, we
demonstrated the utility of 2H4-BHB in the monitoring of 2H2-Glx
labeling using 2H-MRS6. Some
prominent advantages of using 2H-MRS include rapid signal averaging due
to short T1 of 2H improving signal-to-noise ratio (SNR)
and its low natural abundance (0.01156%) resulting in nearly undetectable
metabolite background signals, while 10.12 mM naturally abundant semi-heavy
water (HDO) serves as an internal reference for quantification7,8. In
the current study, our goal was to monitor cerebral metabolism of [3,4,4,4]-2H4-BHB
(d4-BHB) in AD for the first time using 2H-MRS by
observing label accumulation in Glx.Methods
The
protocol used for animal experiments was approved by the Institutional Animal
Care and Use Committee of the University of Pennsylvania. Ten-month-old
C57BL6/J mice (WT; n=2; 1 male and 1 female) and APPNL-F/NL-F mice9 (AD; n=2;
1 male and 1 female) fasted overnight were used for this study. Mice were anesthetized
using isoflurane (1.6%) and a subcutaneous10 catheter was placed for
infusion of the substrate. A home-built four-turn 2H surface coil
tuned to 61.33 MHz was mounted over the head of the mice (Fig.2) and placed in
a 20mm 1H transceiver volume coil. The whole assembly was placed in a 9.4T
preclinical scanner (diameter 30 cm) interfaced with an Avance III HD console
(Bruker, Germany) for 2H-MR spectroscopy. The baseline 2H
MRS spectrum was acquired with a pulse-acquire sequence (bandwidth 1500 Hz, FA
50°, 256 points, 2000 averages, and TR 150 ms; acquisition time: 5 minutes) (Figure 1A). Following the bolus administering a dose of 25µL/g of d4-BHB
(1 mol/L in saline; pH 7.0; Cayman Chemical Company, USA) a total of 12 spectra
were acquired for 60 minutes. A line broadening of a 5 Hz exponential filter
(Mestrelab, Spain) was used, and spectra were denoised using singular value
decomposition11. The fitted peak
integrals of BHB and Glx were normalized to the baseline HDO (10.12 mM12) signal for the
calculation of metabolite concentrations and plotted as a function of time.Results
Representative spectra acquired pre- (Fig. 3A) and post-infusion (Fig.
3B) show clear resonances of HDO (4.8 ppm), d2-Glx, (2.3 ppm), and
d4-BHB (1.3 and 4.1 ppm). A time-course denoised spectra presented
in Figure 4 show the evolution of these signals with time post-d4-BHB
administration. The average concentrations of d4-BHB (Fig. 5A) and d2-Glx
(Fig. 5B) for each time point are plotted over the course of the infusion and a
smooth curve was interpolated. As a result of d4-BHB metabolism, an
increase in the level of d2-Glx and HDO was observed. The units are
converted to µmol/g/min assuming the brain tissue density of 1.1 g/ml. The rate
of d4-BHB uptake in both WT and AD mice followed a steep rise and
stabilized at ~3.5 mM, ~40 minutes post-infusion, however, the rate of d2-Glx
labeling was much different across WT and AD mice. In the case of WT mice, d2-Glx
labeling steeply rose till 40 minutes to 1.5 mM and stabilized. However, in the case of AD mice, the d2-Glx labeling followed a relatively steeper rise till 55
minutes to 2.5 mM before stabilizing. The level of HDO continued to increase
linearly throughout the infusion.Discussions
As an interesting outcome of this study, we observed a much higher
labeling of d2-Glx in AD mice, even though the rate of d4-BHB
uptake was similar across WT and AD mice. This could be arising due to enhanced
BHB metabolism under glucose hypometabolic conditions. This is a preliminary
study and results are encouraging to perform a detailed kinetic analysis following intravenous
administration of d4-BHB and blood plasma collection at regular intervals to include the substrate input function required for kinetic modeling. In conclusion, 2H-MRS being a sensitive and
non-invasive method can be widely applicable in AD diagnosis.Acknowledgements
This project was supported by the National
Institute of Biomedical Imaging and Bioengineering of the National Institutes
of Health through Grant Number P41EB02946 and the National Institute of Aging through Award
Number R01AG063869. 3D printed object printed courtesy of the
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