We thank Paul O&#39;Brien, Marizel Mina and Isabella Freedman for animal experiments, Jacquie Gonzalez and Danielle Weiner from NIH/NIAID for help with gamma irradiation of rabbit tissues prior to laser capture microdissection and Jansy Sarathy for manuscript thoughts and advice. This work was supported by funding from the Bill and Melinda Gates Foundation (OPP1174780) and NIH shared instrumentation grant 1S10OD018072. We thank Eliseo A. Eugenin for providing access to the Leica LMD 6500 microscope and sharing expertise and advice. The purchase, and ongoing support of, the LMD 6500 was funded by The National Institute of Mental Health grant, MH096625, the National Institute of Neurological Disorders and Stroke, NS105584, PHRI funding (to E.A.E) and GSK contributions (to E.A.E).

All animal studies were carried out in accordance with the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health with approval from the Institutional Animal Care and Use Committee of the NIAID (NIH), Bethesda, MD.
1. Animal Experiments and Tissue Collection
This section of the protocol describes animal procedures and sample collection under Biosafety Level 3 (BSL3) conditions. Detailed protocols of the Mycobacterium tuberculosis</em...

<ol>
	<li>Dartois, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+path+of+anti-tuberculosis+drugs:+From+blood+to+lesions+to+mycobacterial+cells.">The path of anti-tuberculosis drugs: From blood to lesions to mycobacterial cells.</a> Nat Rev Microbiol. 12 (3), 159-167 (2014).</li><li>Prideaux, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+association+between+sterilizing+activity+and+drug+distribution+into+tuberculosis+lesions.">The association between sterilizing activity and drug distribution into tuberculosis lesions.</a> Nat Med. 21 (10), 1223-1227 (2015).</li><li>Prideaux, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High-sensitivity+MALDI-MRM-MS+imaging+of+moxifloxacin+distribution+in+tuberculosis-infected+rabbit+lungs+and+granulomatous+lesions.">High-sensitivity MALDI-MRM-MS imaging of moxifloxacin distribution in tuberculosis-infected rabbit lungs and granulomatous lesions.</a> Anal Chem. 83 (6), 2112-2118 (2011).</li><li>Roscioli, K. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Desorption+electrospray+ionization+(DESI)+with+atmospheric+pressure+ion+mobility+spectrometry+for+drug+detection.">Desorption electrospray ionization (DESI) with atmospheric pressure ion mobility spectrometry for drug detection.</a> Analyst. 139 (7), 1740-1750 (2014).</li><li>Prideaux, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mass+spectrometry+imaging+of+levofloxacin+distribution+in+TB-infected+pulmonary+lesions+by+MALDI-MSI+and+continuous+liquid+microjunction+surface+sampling.">Mass spectrometry imaging of levofloxacin distribution in TB-infected pulmonary lesions by MALDI-MSI and continuous liquid microjunction surface sampling.</a> Int J Mass Spectrom. 377, 699-708 (2015).</li><li>Griffiths, R. L., Randall, E. C., Race, A. M., Bunch, J., Cooper, H. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Raster-mode+continuous-flow+liquid+microjunction+mass+spectrometry+imaging+of+proteins+in+thin+tissue+sections.">Raster-mode continuous-flow liquid microjunction mass spectrometry imaging of proteins in thin tissue sections.</a> Anal Chem. 89 (11), 5683-5687 (2017).</li><li>Prideaux, B., Stoeckli, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mass+spectrometry+imaging+for+drug+distribution+studies.">Mass spectrometry imaging for drug distribution studies.</a> J Proteomics. 75 (16), 4999-5013 (2012).</li><li>Dilillo, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mass+spectrometry+imaging,+laser+capture+microdissection,+and+LC-MS/MS+of+the+same+tissue+section.">Mass spectrometry imaging, laser capture microdissection, and LC-MS/MS of the same tissue section.</a> J Proteome Res. 16 (8), 2993-3001 (2017).</li><li>Xu, B. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combining+laser+capture+microdissection+and+proteomics:+methodologies+and+clinical+applications.">Combining laser capture microdissection and proteomics: methodologies and clinical applications.</a> Proteomics Clin Appl. 4 (2), 116-123 (2010).</li><li>Cahill, J. F., Kertesz, V., Van Berkel, G. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+dissection+sampling+modes+for+direct+mass+spectral+analysis.">Laser dissection sampling modes for direct mass spectral analysis.</a> Rapid Commun Mass Spectrom. 30 (5), 611-619 (2016).</li><li>Subbian, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+pulmonary+cavitary+tuberculosis+in+rabbits:+A+failed+host+immune+response.">Chronic pulmonary cavitary tuberculosis in rabbits: A failed host immune response.</a> Open Biol. 1 (4), 110016 (2011).</li><li>Zimmerman, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ethambutol+partitioning+in+tuberculous+pulmonary+lesions+explains+its+clinical+efficacy.">Ethambutol partitioning in tuberculous pulmonary lesions explains its clinical efficacy.</a> Antimicrob Agents Chemother. 61 (9), (2017).</li><li>Kempker, R. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cavitary+penetration+of+levofloxacin+among+patients+with+multidrug-resistant+tuberculosis.">Cavitary penetration of levofloxacin among patients with multidrug-resistant tuberculosis.</a> Antimicrob Agents Chemother. 59 (6), 3149-3155 (2015).</li><li>Zhao, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Unraveling+drug+penetration+of+echinocandin+antifungals+at+the+site+of+infection+in+an+intra-abdominal+abscess+model.">Unraveling drug penetration of echinocandin antifungals at the site of infection in an intra-abdominal abscess model.</a> Antimicrob Agents Chemother. , (2017).</li><li>Pascal, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanistic+modeling+identifies+drug-uptake+history+as+predictor+of+tumor+drug+resistance+and+nano-carrier-mediated+response.">Mechanistic modeling identifies drug-uptake history as predictor of tumor drug resistance and nano-carrier-mediated response.</a> ACS Nano. 7 (12), 11174-11182 (2013).</li></ol>

Spatially-resolved quantification of drugs within pulmonary TB lesions is required to determine whether drug exposure reaches sterilizing concentrations to bacterial populations residing within the different lesion compartments. The LCM-LC/MS method described here enables absolute quantification of anti-TB drugs within all lesion compartments, including the bacteria-rich caseum, using only 1 - 3 tissue sections in total. Traditional tissue homogenization and LC/MS approaches for drug quantification in tissue often lack t...

The ability to spatially resolve and quantify drug levels is a crucial requirement for determining whether anti-tuberculosis drugs reach bacterial subpopulations within pulmonary lesions at sterilizing concentrations1. Of particular importance is determining drug penetration into the necrotic core of the lesion (called caseum), which typically contains the highest number of bacilli and may be poorly accessible to drugs due to the absence of vascularization.
Traditional methods to assess lesion penetration, which involve homogenization of excised pulmonary lesions followed by solvent extraction and liquid chromatography mass spectrometry (LC/MS) analysis, are highly sensitive and selective for the drugs of interest. However, these methods offer poor spatial information, limited to the size of the original homogenized tissue. Mass spectrometry-based imaging approaches, such as matrix-assisted laser desorption ionization (MALDI)2,3, desorption electrospray ionization (DESI)4 or liquid-enhanced surface extraction5,6 offer highly spatially-resolved imaging capabilities, but direct quantification can be extremely challenging or impossible due to heterogeneous ion suppression effects and differing extraction efficiencies of analyte from the various cell or tissue types7. Additionally, most direct tissue MS imaging approaches are inherently less sensitive than LC/MS due to the lack of chromatographic separation of endogenous species competing for ionization and the lower solvent extraction efficiency of the drug from tissue.
Laser capture microdissection (LCM) combined with LC/MS analysis has been routinely applied to isolate and characterize distinct tissue regions for proteomic studies8,9 and recently utilized for drug quantification in dosed animal tissue10. Here we present an optimized protocol applying LCM combined with LC/MS (LCM-LC/MS) analysis to quantify anti-TB drugs within distinct granuloma compartments. In the laser capture microdissection process, a UV laser is focused through the microscope objective onto the tissue section, which cuts and isolates the desired tissue area by following a path defined by the user. For gravity-assisted LCM (the technique used for this research), the tissue section is mounted onto a thin polymer membrane slide (PET or PEN) and the tissue is captured in a collection tube cap sited below the slide. The drugs are extracted from the excised tissue and quantified using standard LC/MS approaches. The amount of tissue required to be collected is ultimately determined from the expected concentration of the drug present in the tissue and the sensitivity of the LC/MS method. For most analyses of drugs dosed at therapeutic levels and analyzed using a routine triple quadrupole mass spectrometer, 3 million &#181;m2 (3 mm2) of tissue surface area is sufficient.
This protocol describes the powerful combination of spatial profiling and full quantification offered by LCM-LC/MS, providing absolute drug concentrations within all compartments of TB granulomas. The technique may also be applied to determining drug concentrations in many different diseased tissues providing vital drug discovery and development information.

<table border="0" cellpadding="0" cellspacing="0" width="841">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">New Zealand White rabbits</td>
			<td style="width:159px;">Covance</td>
			<td style="width:155px;">N/A</td>
			<td style="width:255px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">HN878 Mycobacterium tuberculosis</td>
			<td style="width:159px;">BEI Resources</td>
			<td style="width:155px;">NR-13647</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:273px;">Ketathesia (Ketamine) 100 mg/mL C3N</td>
			<td style="width:159px;">Henry Schein Animal Health</td>
			<td style="width:155px;">56344</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:273px;">Anased (Xylazine) 100 mg/mL</td>
			<td style="width:159px;">Henry Schein Animal Health</td>
			<td style="width:155px;">33198</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:273px;">Euthasol (pentobarbital sodium and phenytoin sodium) Solution&#160;</td>
			<td style="width:159px;">Virbac</td>
			<td style="width:155px;">710101</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">Acetonitrile (LC-MS grade)</td>
			<td style="width:159px;">Fisher</td>
			<td style="width:155px;">A955-212</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">Methanol (LC-MS grade)</td>
			<td style="width:159px;">Fisher</td>
			<td style="width:155px;">A456-212</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">Formic Acid (LC-MS grade)</td>
			<td style="width:159px;">Fisher</td>
			<td style="width:155px;">A117-50</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">Water (LC-MS grade)&#160;</td>
			<td style="width:159px;">Fisher</td>
			<td style="width:155px;">W6212</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">0.2 mL flat-cap PCR tubes</td>
			<td style="width:159px;">Corning</td>
			<td style="width:155px;">07-200-392</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">Steel frames, PET-membrane</td>
			<td style="width:159px;">Leica</td>
			<td style="width:155px;">11505151</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">Premium Frosted Microscope Slides</td>
			<td style="width:159px;">Fisher</td>
			<td style="width:155px;">12-544-2</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">&#160;96 Deep well plate 2.0ML PP RB&#160;</td>
			<td style="width:159px;">Fisher</td>
			<td style="width:155px;">NC0363259</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:273px;">Zorbax SB-C8&#160;column (4.6 by 50 mm; particle size, 3.5 &#956;m)</td>
			<td style="width:159px;">Agilent</td>
			<td style="width:155px;">820631-001D</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">&#34;Zipper&#8221; Seal Sample Bags</td>
			<td style="width:159px;">Fisher</td>
			<td style="width:155px;">01-816-1B</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">Name</td>
			<td style="width:159px;">Company</td>
			<td style="width:155px;">Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">Equipment</td>
			<td style="width:159px;"></td>
			<td style="width:155px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">CM1850&#160;cryostat</td>
			<td style="width:159px;">Leica</td>
			<td style="width:155px;">Discontinued</td>
			<td>Leica CM1860 is the current model</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">Laser Microdissection System 6500</td>
			<td style="width:159px;">Leica</td>
			<td style="width:155px;">Discontinued</td>
			<td>Leica LMD 6 is the current model</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">Agilent 1260 Infinity II HPLC&#160;</td>
			<td style="width:159px;">Agilent</td>
			<td style="width:155px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:273px;">API 4000 QTRAP Mass Spectrometer</td>
			<td style="width:159px;">Sciex</td>
			<td style="width:155px;"></td>
			<td></td>
		</tr>
	</tbody>
</table>

spatial quantification of drugs in pulmonary tuberculosis lesions by laser capture microdissection liquid chromatography mass spectrometry (lcm-lc/ms)

Tuberculosis is still a leading cause of morbidity and mortality worldwide. Improvements to existing drug regimens and the development of novel therapeutics are urgently required. The ability of dosed TB drugs to reach and sterilize bacteria within poorly-vascularized necrotic regions (caseum) of pulmonary granulomas is crucial for successful therapeutic intervention. Effective therapeutic regimens must therefore contain drugs with favorable caseum penetration properties. Current LC/MS methods for quantifying drug levels in biological tissues have limited spatial resolution capabilities, making it difficult to accurately determine absolute drug concentrations within small tissue compartments such as those found within necrotic granulomas. Here we present a protocol combining laser capture microdissection (LCM) of pathologically-distinct tissue regions with LC/MS quantification. This technique provides absolute quantification of drugs within granuloma caseum, surrounding cellular lesion and uninvolved lung tissue and, therefore, accurately determines whether bactericidal concentrations are being achieved. In addition to tuberculosis research, the technique has many potential applications for spatially-resolved quantification of drugs in diseased tissues.

An overview of the LCM-LC/MS approach is shown in Figure 1. After sterilizing the tissue by gamma-irradiation, all subsequent steps (from tissue sectioning onwards) take place outside of BSL3 conditions. Figure 2 shows the lesion biopsy sections before and after tissue isolation by LCM. Necrotic and cellular areas of TB lesions can be easily identified and isolated by visual inspection of optical images alone (without the require...

Watch this Scientific Journal Video about Spatial Quantification of Drugs in Pulmonary Tuberculosis Lesions by Laser Capture Microdissection Liquid Chromatography Mass Spectrometry LCM-LC/MS at JoVE.c

Spatial Quantification of Drugs in Pulmonary Tuberculosis Lesions by Laser Capture Microdissection Liquid Chromatography Mass Spectrometry LCM-LC/MS

Here, we describe a protocol using laser capture microdissection coupled with LC/MS analysis to spatially-quantify drug distributions within pulmonary tuberculosis granulomas. The approach has broad applicability to quantifying drug concentrations within tissues at high spatial detail.

Spatial Quantification of Drugs in Pulmonary Tuberculosis Lesions by Laser Capture Microdissection Liquid Chromatography Mass Spectrometry (LCM-LC/MS)

Tuberculosis is still a leading cause of morbidity and mortality worldwide. Improvements to existing drug regimens and the development of novel ...

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8.9K visualizações.  Rutgers, The State University of New Jersey. Aqui, descrevemos um protocolo usando laser captura microdissection juntamente com análise de LC/MS espacialmente-quantificar as distribuições de drogas dentro de granulomas de tuberculose pulmonar. A abordagem tem ampla aplicabilidade para quantificar as concentrações de droga dentro de tecidos em alto detalhe espacial.

Vídeo: Spatial Quantification of Drugs in Pulmonary Tuberculosis Lesions by Laser Capture Microdissection Liquid Chromatography Mass Spectrometry LCM-LC/MS