Name: using multi-fluorinated bile acids and in vivo magnetic resonance imaging to measure bile acid transport
Uploaded: 2016-11-27T14:00:00
Description: Watch this Scientific Journal Video about Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport at JoVE.com

This work was supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (grant numbers R21 DK093406 and T32 DK067872 to J-P.R.) and a VA Merit award (grant number 1BX002129 to J-P.R.).

The following protocol adheres to guidelines approved by the Institutional Animal Care and Use Committee (IACUC) at the University of Maryland School of Medicine (IACUC Protocol #0415011, approved June 18, 2015).
1. Gavaging Mice with 19F-Labeled Bile Acids
<ol>
	<li>Gavage mice with 150 mg/kg body weight 19F-labeled bile acids. Fill a 1-ml syringe to the necessary volume with 19F-labeled bile acid stock solution [cholic acid-trifluoro-acetyl lysine (CA-lys-TFA; in 1:1 polyethyle...

<ol>
	<li>Thomas, C., Pellicciari, R., Pruzanski, M., Auwerx, J., Schoonjans, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Targeting+bile-acid+signalling+for+metabolic+diseases.">Targeting bile-acid signalling for metabolic diseases.</a> Nat Rev Drug Discov. 7, 678-693 (2008).</li><li>Vallim, T. Q., Edwards, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bile+acids+have+the+gall+to+function+as+hormones.">Bile acids have the gall to function as hormones.</a> Cell Metab. 10, 162-164 (2009).</li><li>Dawson, P. A., Karpen, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thematic+Review+Series:+Intestinal+Lipid+Metabolism:+New+Developments+and+Current+Insights+Intestinal+transport+and+metabolism+of+bile+acids.">Thematic Review Series: Intestinal Lipid Metabolism: New Developments and Current Insights Intestinal transport and metabolism of bile acids.</a> Journal of Lipid Research. 56, 1085-1099 (2015).</li><li>Dawson, P. A., 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=Targeted+deletion+of+the+ileal+bile+acid+transporter+eliminates+enterohepatic+cycling+of+bile+acids+in+mice.">Targeted deletion of the ileal bile acid transporter eliminates enterohepatic cycling of bile acids in mice.</a> J Biol Chem. 278, 33920-33927 (2003).</li><li>Pattni, S., Walters, J. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recent+advances+in+the+understanding+of+bile+acid+malabsorption.">Recent advances in the understanding of bile acid malabsorption.</a> Br Med Bull. 92, 79-93 (2009).</li><li>Walters, J. 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=A+new+mechanism+for+bile+acid+diarrhea:+defective+feedback+inhibition+of+bile+acid+biosynthesis.">A new mechanism for bile acid diarrhea: defective feedback inhibition of bile acid biosynthesis.</a> Clin Gastroenterol Hepatol. 7, 1189-1194 (2009).</li><li>Hofmann, A. F., Mangelsdorf, D. J., Kliewer, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+diarrhea+due+to+excessive+bile+acid+synthesis+and+not+defective+ileal+transport:+a+new+syndrome+of+defective+fibroblast+growth+factor+19+release.">Chronic diarrhea due to excessive bile acid synthesis and not defective ileal transport: a new syndrome of defective fibroblast growth factor 19 release.</a> Clin Gastroenterol Hepatol. 7, 1151-1154 (2009).</li><li>Flynn, C., 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=Deoxycholic+acid+promotes+the+growth+of+colonic+aberrant+crypt+foci.">Deoxycholic acid promotes the growth of colonic aberrant crypt foci.</a> Mol Carcinog. 46, 60-70 (2007).</li><li>Glinghammar, B., Rafter, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Carcinogenesis+in+the+colon:+interaction+between+luminal+factors+and+genetic+factors.">Carcinogenesis in the colon: interaction between luminal factors and genetic factors.</a> Eur J Cancer Prev. 8, S87-S94 (1999).</li><li>Bernstein, C., 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=Carcinogenicity+of+deoxycholate,+a+secondary+bile+acid.">Carcinogenicity of deoxycholate, a secondary bile acid.</a> Arch Toxicol. 85, 863-871 (2011).</li><li>Zheng, X., Ekins, S., Raufman, J. P., Polli, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computational+models+for+drug+inhibition+of+the+human+apical+sodium-dependent+bile+acid+transporter.">Computational models for drug inhibition of the human apical sodium-dependent bile acid transporter.</a> Mol Pharm. 6, 1591-1603 (2009).</li><li>Vivian, D., 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=Design+and+characterization+of+a+novel+fluorinated+magnetic+resonance+imaging+agent+for+functional+analysis+of+bile+Acid+transporter+activity.">Design and characterization of a novel fluorinated magnetic resonance imaging agent for functional analysis of bile Acid transporter activity.</a> Pharm Res. 30, 1240-1251 (2013).</li><li>Vivian, D., 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=Design+and+evaluation+of+a+novel+trifluorinated+imaging+agent+for+assessment+of+bile+acid+transport+using+fluorine+magnetic+resonance+imaging.">Design and evaluation of a novel trifluorinated imaging agent for assessment of bile acid transport using fluorine magnetic resonance imaging.</a> J Pharm Sci. 103, 3782-3792 (2014).</li><li>Vivian, D., 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=In+vivo+performance+of+a+novel+fluorinated+magnetic+resonance+imaging+agent+for+functional+analysis+of+bile+acid+transport.">In vivo performance of a novel fluorinated magnetic resonance imaging agent for functional analysis of bile acid transport.</a> Mol Pharm. 11, 1575-1582 (2014).</li><li>Raufman, J. P., 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=In+Vivo+Magnetic+Resonance+Imaging+to+Detect+Biliary+Excretion+of+19F-Labeled+Drug+in+Mice.">In Vivo Magnetic Resonance Imaging to Detect Biliary Excretion of 19F-Labeled Drug in Mice.</a> Drug Metab Dispos. 39, 736-739 (2011).</li><li>Ridlon, J. M., Kang, D. J., Hylemon, P. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bile+salt+biotransformations+by+human+intestinal+bacteria.">Bile salt biotransformations by human intestinal bacteria.</a> J Lipid Res. 47, 241-259 (2006).</li><li>Frisch, K., 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=N-methyl-11C]cholylsarcosine,+a+novel+bile+acid+tracer+for+PET/CT+of+hepatic+excretory+function:+radiosynthesis+and+proof-of-concept+studies+in+pigs.">N-methyl-11C]cholylsarcosine, a novel bile acid tracer for PET/CT of hepatic excretory function: radiosynthesis and proof-of-concept studies in pigs.</a> J Nucl Med. 53, 772-778 (2012).</li></ol>

The synthesis of CA-lys-TFA and CA-sar-TFMA and the in vitro analysis of their transport using stably transfected Madin-Darby canine kidney cells expressing ASBT and human embryonic kidney cells expressing the sodium/taurocholate co-transporting polypeptide (NTCP) are detailed elsewhere13,14. Here, the focus is on oral administration of MFBA by gavage to live animals, followed by harvest of the gallbladder, liver, and blood for analysis of MFBA content, and, notably, imaging MFBA in the gallbladder by...

Along with their classical role as detergents that facilitate fat absorption from the gut, bile acids have emerged as potent signaling molecules affecting multiple organs in addition to those associated with their enterohepatic circulation1,2. In addition to controlling their own metabolism, bile acids modulate several aspects of gastrointestinal physiology (e.g., gut motility and incretin hormone production, colon physiology, and cancer susceptibility) and have systemic effects on vascular tone, glucose and lipid metabolism, and energy utilization. While some of these effects are mediated in the gut, others are due to postprandial changes in systemic bile acid levels, as noted in obese patients or after gastric by-pass surgery. To elucidate the complex metabolic actions of bile acids new technology is required that permits simultaneous monitoring of bile acid levels in different anatomical compartments, in the gastrointestinal tract and metabolic tissues (liver, pancreas, skeletal muscle and adipose). Obtaining such temporal and spatial information requires innovative technology - in vivo imaging using novel bile acid tracers as described here is such a novel approach.
Bile acid composition and distribution in anatomical compartments are regulated by factors that modulate their hepatic synthesis and ileal uptake, including diet, surgery, antibiotic use and changes in gut flora. A key regulator of intestinal bile acid uptake for their enterohepatic circulation3 (Figure 1) is the ileal Apical Sodium-dependent Bile Acid Transporter (ASBT; SLC10A2). Although passive absorption occurs throughout the intestines, ASBT mediates uptake of 95% of intestinal bile acids so that normally there is limited spillage of bile acids into the feces. Asbt-deficient (Slc10a2-/-) mice have increased fecal bile acids and a diminished bile acid pool4.
<img alt="Figure 1" src="/files/ftp_upload/54597/54597fig1.jpg" /> 
Figure 1: Enterohepatic Circulation of Bile Acids. 
Illustration of Enterohepatic Circulation whereby Bile Acids are Synthesized in the Liver, Excreted into the Biliary Tree, Stored in the Gallbladder, Released into the Proximal Small Intestine with Meals, and Actively taken up via ASBT in the Distal Ileum. Whereas small amounts of bile acids are absorbed passively throughout the gut, approximately 95% of intestinal bile acids are transported actively by ASBT resulting in minimal (approximately 5%) loss in the stool which is compensated by a similar amount of new bile acid synthesis in the liver, thereby maintaining a steady-state bile acid pool. The arrows on the right identify factors that may impact native and fluorine-labeled bile acid stability, including gastric acid, pancreatic and intestinal mucosal enzymes, and, most importantly, hydrolytic enzymes released by Clostridial species that colonize the distal small bowel and colon. (Modified with permission16) <a href="http://cloudflare.jove.com/files/ftp_upload/54597/54597fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
Bile acid malabsorption can be categorized into three types, each of which increases fecal dihydroxy bile acids, thereby causing intermittent or chronic diarrhea. Type 1 results from gross ileal pathology (e.g., resection, Crohn disease)5. Type 3 results from cholecystectomy, vagotomy, celiac disease, bacterial overgrowth, and pancreatic insufficiency. In contrast, persons with &#39;primary&#39; (Type 2) bile acid malabsorption pose a formidable diagnostic challenge because they lack such antecedent conditions and do not have evidence of pathology in the ileum. Hence, primary bile acid malabsorption is commonly misdiagnosed as diarrhea-predominant irritable bowel syndrome (IBS-D), perhaps the most common reason for gastroenterology-related out-patient visits. It has been estimated that one-third of patients with IBS-D have primary bile acid malabsorption; in the U.S., this may represent several million persons5. Recent insights indicate that primary BAM derives from impaired feedback inhibition of hepatic bile acid synthesis by intestinal fibroblast growth factor-19 (FGF19), not from reduced expression or function of ASBT.
In primary bile acid malabsorption, low plasma levels of FGF19 fail to shut off hepatic bile acid synthesis - the resulting increase in intestinal bile acids saturates bile acid transporters, including ASBT, and the augmented spillage of bile acids into the feces causes diarrhea6 (Figure 2). Mice deficient in Fgf15 (murine FGF19) have an expanded bile acid pool and increased fecal bile acids7.
<img alt="Figure 2" src="/files/ftp_upload/54597/54597fig2.jpg" /> 
Figure 2: Mechanisms of Intestinal Bile Acid Malabsorption. 
Normally, as shown in panel A, approximately 95% of intestinal bile acids are absorbed by active transport in the distal ileum via ASBT. When ASBT expression or activity is diminished (panel B), impaired intestinal bile acid uptake results in spillage of bile acids into the colon. With impaired FGF19 signaling (panel C), the lack of feedback inhibition of hepatic bile acid synthesis results in increased concentrations of intestinal bile acids that overwhelm ASBT transport capacity with spillage of bile acids into the colon. <a href="http://cloudflare.jove.com/files/ftp_upload/54597/54597fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
Long-term, chronic elevation in fecal bile acids may promote colon neoplasia. Colon neoplasia arises from progressive mucosal dysplasia associated with somatic gene mutations, but environmental factors that increase fecal bile acids may accelerate and augment this process. In rodents, increased fecal bile acids either as a consequence of exogenous administration or Asbt deficiency promote colon dysplasia and tumor formation8-10.
Notably, provocative findings indicate that commonly-used drugs approved by the Food and Drug Administration (FDA) potently inhibit bile acid transport by ASBT in vitro11. If these drugs reduce small intestinal bile acid transport in vivo and increase fecal bile acid levels, the potential impact on colon pathology would be concerning. Even a small increase in colon pathology attributed to use of such a drug could have a major health impact. A toolkit which can assess the plausibility of these in vitro findings and epidemiologic observations would spur additional research, including post-marketing safety studies.
Despite the need, practical assays to identify people with bile acid malabsorption are lacking. Direct measurement of fecal bile acids was rejected years ago as cumbersome, impractical, and unreliable5. Alternative approaches include measuring retention of a radioactive selenium-labeled cholic acid derivative (75SeHCAT) and plasma levels of 7&#945;-hydroxy-4-cholesten-3-one (C4), or a therapeutic trial of bile acid binders. 75SeHCAT testing has limited availability in Europe and is not FDA-approved or available for use in the U.S. Moreover, even modest radiation exposure (0.26 mSv/75SeHCAT test) from diagnostic testing raises concerns, and bacterial overgrowth and advanced liver disease may confound 75SeHCAT results. C4 testing is potentially attractive since only plasma is required, but it has low positive-predictive value and testing is not widely available. Measuring serum levels of FGF19 has similar limitations. Frequently clinicians resort to a therapeutic trial of bile acid sequestrants, but this approach cannot provide a definitive diagnosis of bile acid malabsorption5.
For these reasons, a novel MRI approach was conceived to measure bile acid transport and distribution in vivo using innovative multi-fluorinated bile acids (MFBA-MRI). MFBA containing three atoms of fluorine (19F), a stable isotope of 100% natural abundance, are transported similarly to native bile acids12, and can be used to visualize bile acid transport with a combination of proton (1H) and fluorine (19F) MRI, a sensitive, safe method without ionizing radiation exposure13,14.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Duall size-21 all glass tissue grinder</td>
			<td>Kimble Chase Life Science, Vineland, NJ</td>
			<td>885351-0022</td>
			<td></td>
		</tr>
		<tr>
			<td>Bruker BioSpec 70/30USR Avance III 7T horizontal bore MR Scanner</td>
			<td>Bruker Biospin MRI GmbH, Germany</td>
			<td></td>
			<td>Use companion Paravision Version 5.1 software (see step 3.5)</td>
		</tr>
		<tr>
			<td>Bruker 40 mm 19F/1H dual-tuned linerar volume coil</td>
			<td>Bruker Biospin MRI GmbH, Germany</td>
			<td></td>
			<td>Use companion Paravision Version 5.1 software (see step 3.5)</td>
		</tr>
		<tr>
			<td>Waters Acquity UPLC System with Quadrupole Detector</td>
			<td>Waters Corporation, Milford, MA</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Waters Acquity UPLC ethylene bridged hybrid C8 1.7 &#956;m 2.1 X 50 mm column</td>
			<td>Waters Corporation, Milford, MA</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Gavage Needle</td>
			<td>Braintree Scientific, INC.</td>
			<td>N-010</td>
			<td>20 G-1.5&#34; curved 2.25mm ball</td>
		</tr>
		<tr>
			<td>2 Stainless Steel Hemostats&#160;</td>
			<td>VWR</td>
			<td>10755-018</td>
			<td>4 and 5 inch, straight</td>
		</tr>
		<tr>
			<td>Ketamine</td>
			<td>MWI Veterinary Supply</td>
			<td>501090</td>
			<td>Ketamin zetamine 100 mg / ml</td>
		</tr>
		<tr>
			<td>Xylazine</td>
			<td>Akorn, Inc.</td>
			<td></td>
			<td>20 mg/ml</td>
		</tr>
		<tr>
			<td>Intraperitoneal Catheter</td>
			<td>Abbott</td>
			<td>AbbocathTM-T.I.V. G720-A01 4535-42</td>
			<td>24-G x 0.75&#34;</td>
		</tr>
	</tbody>
</table>

using multi-fluorinated bile acids and in vivo magnetic resonance imaging to measure bile acid transport

Along with their traditional role as detergents that facilitate fat absorption, emerging literature indicates that bile acids are potent signaling molecules that affect multiple organs; they modulate gut motility and hormone production, and alter vascular tone, glucose metabolism, lipid metabolism, and energy utilization. Changes in fecal bile acids may alter the gut microbiome and promote colon pathology including cholerrheic diarrhea and colon cancer. Key regulators of fecal bile acid composition are the small intestinal Apical Sodium-dependent Bile Acid Transporter (ASBT) and fibroblast growth factor-19 (FGF19). Reduced expression and function of ASBT decreases intestinal bile acid up-take. Moreover, in vitro data suggest that some FDA-approved drugs inhibit ASBT function. Deficient FGF19 release increases hepatic bile acid synthesis and release into the intestines to levels that overwhelm ASBT. Either ASBT dysfunction or FGF19 deficiency increases fecal bile acids and may cause chronic diarrhea and promote colon neoplasia. Regrettably, tools to measure bile acid malabsorption and the actions of drugs on bile acid transport in vivo are limited. To understand the complex actions of bile acids, techniques are required that permit simultaneous monitoring of bile acids in the gut and metabolic tissues. This led us to conceive an innovative method to measure bile acid transport in live animals using a combination of proton (1H) and fluorine (19F) magnetic resonance imaging (MRI). Novel tracers for fluorine (19F)-based live animal MRI were created and tested, both in vitro and in vivo. Strengths of this approach include the lack of exposure to ionizing radiation and translational potential for clinical research and practice.

The use of MFBA for in vivo MRI to &#39;see&#39; bile acid transport in real time has great potential for both research and clinical use. Moreover, the methods described here for resection of the gallbladder and biochemical analysis of its contents using liquid chromatography and mass spectrometry provide a means of confirming imaging results. However, the validity of these methods requires precise dosing, timing of assays, and localization of the gallbladder for imaging or surgi...

Watch this Scientific Journal Video about Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport at JoVE.com

Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport

Tools to diagnose bile acid malabsorption and measure bile acid transport in vivo are limited. An innovative approach in live animals is described that utilizes combined proton (1H) plus fluorine (19F) magnetic resonance imaging; this novel methodology has translational potential to screen for bile acid malabsorption in clinical practice.

Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport

Along with their traditional role as detergents that facilitate fat absorption, emerging literature indicates that bile acids are potent signaling ...

The overall goal of this procedure is to label bile acids with naturally-occurring, non-radioactive fluorine for measurement of their concentration in the gall bladder by MRI to access bile acid transport in live animals. This approach has a potential for identifying individuals with chronic diarrhea who should be treated for bile acid malabsorption. The main advantages of this approach are that it does not require exposure to ionizing radiation and that it has great translational potential for both clinical research and practice.We first had the idea for this method when we realized that in the United States there are no practical clinical tests for detecting impaired intestinal bile acid transport. Begin by filling a one-milliliter syringe with the appropriate volume of fluorine-labeled bile acid stock solution and attached a 20-gauge, 1.5-inch, curved bulb-tipped gastric gavage needle. Then use the thumb and index finger to firmly grasp the mouse by the loose skin at the back of the neck and the remaining fingers to grasp the skin on the lower back and tail.Holding the animal upright, pass the gavage needle along the side and roof of the mouth into the esophagus and down into the stomach. At the appropriate experimental endpoint, make a midline abdominal skin incision from the pubis to the xiphoid followed by a corresponding incision through the peritoneal lining to expose the abdominal organs without piercing the diaphragm. Next, use a five-inch clamp to lift the xiphoid process, exposing the upper abdominal cavity.Using forceps and a blunt instrument, dissect and move the liver aside to reveal the gallbladder. Then place a four-inch clamp across the common bile duct and sever the ligament attaching the superior pole of the gallbladder to the diaphragm allowing the gallbladder to be moved to the right side of the abdomen. Take care and clamp the common bile duct as soon as possible after the laparotomy to avoid laceration of the liver or the inadvertent emptying of the gallbladder.After exsanguination, transfer the harvested blood into a 1.5-milliliter heparinized tube for centrifugation. Precipitate the plasma with four parts of acetonitrile and centrifuge the blood sample again. Then analyze the supernatant by liquid chromatography and mass spectroscopy.To free the gallbladder, blunt dissect the surrounding tissue followed by transection of the common bile duct below the clamp. Weigh the harvested gallbladder, then place the tissue in a 1.5-milliliter microcentrifuge tube and remove the liver. TO extract the tissues, add 75%acetonitrile and 25%water and homogenize approximately 100 milligrams of the liver and the entire gallbladder in individual-sized 21 glass tissue homogenizers on ice.Transfer the samples to a 1.5-milliliter Eppendorf tube and centrifuge. Then dilute the extracts as appropriate and quantify the bile acid contents using liquid chromatography and mass spectroscopy. At the appropriate experimental endpoint, cleanse the inner left inner thigh of the anesthetized mouse and inset a 24-gauge by 0.75-inch needle catheter subcutaneously through the thigh into the abdominal cavity.Remove the needle, leaving the intraperitoneal catheter in place. Transfer the mouse to the MRI scanner animal bed and attach a temperature-controlled thermal pad. Connect the catheter to a 72-inch piece of sterile tubing and connect the tubing to a sterile 1-milliliter syringe for maintenance of anesthesia throughout the procedure.After confirming that no metals are near the scanner, use a fluorine proton dual-tuned linear volume MRI coil to transmit and receive the radio frequency signals. Then use a fast low angle shot sequence to obtain three-slice scalp images to calibrate the system and verify the position of the animal. To start the experiment, click the traffic light button to acquire multi-slice proton magnetic resonance images using the rapid acquisition with relaxation and enhancement sequence in the crossview of the sample.Finally, click the GOP button in the spectrometer control tool window to acquire fluorine images using a second fast low angle shot sequence in the same region. Using this method, a highly-selective concentration of multi-fluorinated bile acid, or MFBA, can be measured in the gallbladder that is a thousandfold order of magnitude higher than the levels observed in the liver or the plasma, inconsistent with physiological levels of bile acids. As expected for the physiological connectics of bile acid enterohepatic circulation, peak gallbladder concentrations of MFBA are apparent four to seven hours after oral dosing.Indeed, two and a half to four hours after MFBA oral gavage, fluorine signals emanating from what appears to be the common bile duct and a more robust signal emanating from the gallbladder are observed. By seven to eight and a half hours, the common bile duct signal is no longer detected and the gallbladder fluorine signal increases to the same intensity as the signal emanating from the adjacent MFBA phantom. In apical sodium-dependent bile acid transporter-deficient mice, which exhibit a reduced intestinal uptake of bile acids, in approximately 22-fold reduction in the concentration of MFBA occurs compared to controlled wild-type animals.Indeed, whereas a robust fluorine signal is detected in the gallbladders of wild-type mice, there is no corresponding fluorine signal in apical sodium-dependent bile acid transporter-deficient animals, confirming both that MFBA are handled similarly to physiological bile acids and that MFBA MRI can be used to detect the impaired intestinal uptake of bile acids. Once mastered and performed properly, the laparotomy, blood draw and gallbladder and liver incision can be completed within 20 minutes. Signal acquisition during MRI will take one and half to two hours.After it's development and commercialization, this technique has the potential for paving the way for the exploration of the role of intestinal bile acid transport in physiology and disease in both small animals and humans. After watching this video you should have a good understanding of how to administer foreign-labeled bile acids to small animals and to measure their uptake in the liver and gallbladder by MRI or organ incision.

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Research

JoVE Journal

Medicine

Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking

Purpose: An accurate and practical method to measure parameters like strain in myocardial tissue is of great clinical value, since it has been shown, that strain is a more sensitive and earlier marker for contractile dysfunction than the frequently used parameter EF. Current technologies for CMR are time consuming and difficult to implement in clinical practice. Feature tracking is a technology that can lead to more automization and robustness of quantitative analysis of medical images with less time consumption than comparable methods.
Methods: An automatic or manual input in a single phase serves as an initialization from which the system starts to track the displacement of individual patterns representing anatomical structures over time. The specialty of this method is that the images do not need to be manipulated in any way beforehand like e.g. tagging of CMR images.
Results: The method is very well suited for tracking muscular tissue and with this allowing quantitative elaboration of myocardium and also blood flow.
Conclusions: This new method offers a robust and time saving procedure to quantify myocardial tissue and blood with displacement, velocity and deformation parameters on regular sequences of CMR imaging. It therefore can be implemented in clinical practice.

An accurate and practical method to measure parameters like strain in myocardial tissue is of great clinical value, since it has been shown, that strain is a more sensitive and earlier marker for contractile dysfunction than the frequently used parameter EF.

Purpose: An accurate and practical method to measure parameters like strain in myocardial tissue is of great clinical value, since it has been shown, that ...

Magnetic Resonance Imaging Quantification of Pulmonary Perfusion using Calibrated Arterial Spin Labeling

This demonstrates a MR imaging method to measure the spatial distribution of pulmonary blood flow in healthy subjects 
during normoxia (inspired O2, fraction (FIO2) = 0.21) hypoxia (FIO2 = 0.125), and hyperoxia 
(FIO2 = 1.00). In addition, the physiological responses of the subject are monitored in the MR scan environment. MR images 
were obtained on a 1.5 T GE MRI scanner during a breath hold from a sagittal slice in the right lung at functional residual capacity. An arterial 
spin labeling sequence (ASL-FAIRER) was used to measure the spatial distribution of pulmonary blood flow 1,2 and a multi-echo fast 
gradient echo (mGRE) sequence 3 was used to quantify the regional proton (i.e. H2O) density, allowing the quantification 
of density-normalized perfusion for each voxel (milliliters blood per minute per gram lung tissue). 
With a pneumatic switching valve and facemask equipped with a 2-way non-rebreathing valve, different oxygen concentrations 
were introduced to the subject in the MR scanner through the inspired gas tubing. A metabolic cart collected expiratory gas via expiratory tubing. Mixed expiratory O2 and CO2 concentrations, oxygen consumption, carbon dioxide production, respiratory exchange ratio, 
respiratory frequency and tidal volume were measured. Heart rate and oxygen saturation were monitored using pulse-oximetry. 
Data obtained from a normal subject showed that, as expected, heart rate was higher in hypoxia (60 bpm) than during normoxia (51) or hyperoxia (50) and the arterial oxygen saturation (SpO2) was reduced during hypoxia to 86%. Mean ventilation was 8.31 L/min BTPS during hypoxia, 7.04 L/min during normoxia, and 6.64 L/min during hyperoxia. Tidal volume was 0.76 L during hypoxia, 0.69 L during normoxia, and 0.67 L during hyperoxia. 
Representative quantified ASL data showed that the mean density normalized perfusion was 8.86 ml/min/g during hypoxia, 8.26 ml/min/g during normoxia and 8.46 ml/min/g during hyperoxia, respectively. In this subject, the relative dispersion4, an index of global heterogeneity, was increased in hypoxia (1.07 during hypoxia, 0.85 during normoxia, and 0.87 during hyperoxia) while the fractal dimension (Ds), another index of heterogeneity reflecting vascular branching structure, was unchanged (1.24 during hypoxia, 1.26 during normoxia, and 1.26 during hyperoxia). 
Overview. This protocol will demonstrate the acquisition of data to measure the distribution of pulmonary perfusion noninvasively under conditions of normoxia, hypoxia, and hyperoxia using a magnetic resonance imaging technique known as arterial spin labeling (ASL). 
Rationale: Measurement of pulmonary blood flow and lung proton density using MR technique offers high spatial resolution images which can be quantified and the ability to perform repeated measurements under several different physiological conditions. In human studies, PET, SPECT, and CT are commonly used as the alternative techniques. However, these techniques involve exposure to ionizing radiation, and thus are not suitable for repeated measurements in human subjects.

A MR imaging method to study the distribution of pulmonary blood flow under a variety of physiological conditions, in this case exposure to three different inspired oxygen concentrations: hypoxia, normoxia, and hyperoxia, is described. This technique utilizes human pulmonary physiology research techniques in an MR scanning environment.

This demonstrates a MR imaging method to measure the spatial distribution of pulmonary blood flow in healthy subjects 
during normoxia (inspired O2, ...

Multi-modal Imaging of Angiogenesis in a Nude Rat Model of Breast Cancer Bone Metastasis Using Magnetic Resonance Imaging, Volumetric Computed Tomography and Ultrasound

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell proliferation in the bone marrow cavity as well as for interaction of tumor and bone cells resulting in local bone destruction. Our aim was to develop a model of experimental bone metastasis that allows in vivo assessment of angiogenesis in skeletal lesions using non-invasive imaging techniques.
For this purpose, we injected 105 MDA-MB-231 human breast cancer cells into the superficial epigastric artery, which precludes the growth of metastases in body areas other than the respective hind leg1. Following 25-30 days after tumor cell inoculation, site-specific bone metastases develop, restricted to the distal femur, proximal tibia and proximal fibula1. Morphological and functional aspects of angiogenesis can be investigated longitudinally in bone metastases using magnetic resonance imaging (MRI), volumetric computed tomography (VCT) and ultrasound (US).
MRI displays morphologic information on the soft tissue part of bone metastases that is initially confined to the bone marrow cavity and subsequently exceeds cortical bone while progressing. Using dynamic contrast-enhanced MRI (DCE-MRI) functional data including regional blood volume, perfusion and vessel permeability can be obtained and quantified2-4. Bone destruction is captured in high resolution using morphological VCT imaging. Complementary to MRI findings, osteolytic lesions can be located adjacent to sites of intramedullary tumor growth. After contrast agent application, VCT angiography reveals the macrovessel architecture in bone metastases in high resolution, and DCE-VCT enables insight in the microcirculation of these lesions5,6. US is applicable to assess morphological and functional features from skeletal lesions due to local osteolysis of cortical bone. Using B-mode and Doppler techniques, structure and perfusion of the soft tissue metastases can be evaluated, respectively. DCE-US allows for real-time imaging of vascularization in bone metastases after injection of microbubbles7.
In conclusion, in a model of site-specific breast cancer bone metastases multi-modal imaging techniques including MRI, VCT and US offer complementary information on morphology and functional parameters of angiogenesis in these skeletal lesions.

In the pathogenesis of bone metastasis, angiogenesis is a crucial process and therefore represents a target for imaging and therapy. Here, we present a rat model of site-specific breast cancer bone metastasis and describe strategies to non-invasively image angiogenesis in vivo using magnetic resonance imaging, volumetric computed tomography and ultrasound.

Angiogenesis is an essential feature of cancer growth and metastasis formation. In bone metastasis, angiogenic factors are pivotal for tumor cell ...

3-Dimensional Resin Casting and Imaging of Mouse Portal Vein or Intrahepatic Bile Duct System

In organs, the correct architecture of vascular and ductal structures is indispensable for proper physiological function, and the formation and maintenance of these structures is a highly regulated process. The analysis of these complex, 3-dimensional structures has greatly depended on either 2-dimensional examination in section or on dye injection studies. These techniques, however, are not able to provide a complete and quantifiable representation of the ductal or vascular structures they are intended to elucidate. Alternatively, the nature of 3-dimensional plastic resin casts generates a permanent snapshot of the system and is a novel and widely useful technique for visualizing and quantifying 3-dimensional structures and networks.
A crucial advantage of the resin casting system is the ability to determine the intact and connected, or communicating, structure of a blood vessel or duct. The structure of vascular and ductal networks are crucial for organ function, and this technique has the potential to aid study of vascular and ductal networks in several ways. Resin casting may be used to analyze normal morphology and functional architecture of a luminal structure, identify developmental morphogenetic changes, and uncover morphological differences in tissue architecture between normal and disease states. Previous work has utilized resin casting to study, for example, architectural and functional defects within the mouse intrahepatic bile duct system that were not reflected in 2-dimensional analysis of the structure1,2, alterations in brain vasculature of a Alzheimer's disease mouse model3, portal vein abnormalities in portal hypertensive and cirrhotic mice4, developmental steps in rat lymphatic maturation between immature and adult lungs5, immediate microvascular changes in the rat liver, pancreas, and kidney in response in to chemical injury6.
Here we present a method of generating a 3-dimensional resin cast of a mouse vascular or ductal network, focusing specifically on the portal vein and intrahepatic bile duct. These casts can be visualized by clearing or macerating the tissue and can then be analyzed. This technique can be applied to virtually any vascular or ductal system and would be directly applicable to any study inquiring into the development, function, maintenance, or injury of a 3-dimensional ductal or vascular structure.

A method of visualizing and quantifying the 3-dimensional structure of mouse hepatic portal vein or intrahepatic bile duct is described. This resin cast technique can also be applied to other ductal or vascular systems and allows for in situ visualization or quantification of a system's intact communicating architecture.

In  organs, the correct architecture of vascular and ductal structures is  indispensable for proper physiological function, and the formation and  ...

Intrauterine Telemetry to Measure Mouse Contractile Pressure In Vivo

A complex integration of molecular and electrical signals is needed to transform a quiescent uterus into a contractile organ at the end of pregnancy. Despite the discovery of key regulators of uterine contractility, this process is still not fully understood. Transgenic mice provide an ideal model in which to study parturition. Previously, the only method to study uterine contractility in the mouse was ex vivo isometric tension recordings, which are suboptimal for several reasons. The uterus must be removed from its physiological environment, a limited time course of investigation is possible, and the mice must be sacrificed. The recent development of radiometric telemetry has allowed for longitudinal, real-time measurements of in vivo intrauterine pressure in mice. Here, the implantation of an intrauterine telemeter to measure pressure changes in the mouse uterus from mid-pregnancy until delivery is described. By comparing differences in pressures between wild type and transgenic mice, the physiological impact of a gene of interest can be elucidated. This technique should expedite the development of therapeutics used to treat myometrial disorders during pregnancy, including preterm labor.

Intrauterine Telemetry to Measure Mouse Contractile Pressure In Vivo

This manuscript provides a protocol for implanting telemeters in the mouse for the purpose of measuring intrauterine pressures during pregnancy.

A complex integration of molecular and electrical signals is needed to transform a quiescent uterus into a contractile organ at the end of pregnancy. ...

Simultaneous PET/MRI Imaging During Mouse Cerebral Hypoxia-ischemia

Dynamic changes in tissue water diffusion and glucose metabolism occur during and after hypoxia in cerebral hypoxia-ischemia reflecting a bioenergetics disturbance in affected cells. Diffusion weighted magnetic resonance imaging (MRI) identifies regions that are damaged, potentially irreversibly, by hypoxia-ischemia. Alterations in glucose utilization in the affected tissue may be detectable by positron emission tomography (PET) imaging of 2-deoxy-2-(18F)fluoro-&#7429;-glucose ([18F]FDG) uptake. Due to the rapid and variable nature of injury in this animal model, acquisition of both modes of data must be performed simultaneously in order to meaningfully correlate PET and MRI data. In addition, inter-animal variability in the hypoxic-ischemic injury due to vascular differences limits the ability to analyze multi-modal data and observe changes to a group-wise approach if data is not acquired simultaneously in individual subjects. The method presented here allows one to acquire both diffusion-weighted MRI and [18F]FDG uptake data in the same animal before, during, and after the hypoxic challenge in order to interrogate immediate physiological changes.

The method presented here uses simultaneous positron emission tomography and magnetic resonance imaging. In the cerebral hypoxia-ischemia model, dynamic changes in diffusion and glucose metabolism occur during and after injury. The evolving and irreproducible damage in this model necessitates simultaneous acquisition if meaningful multi-modal imaging data are to be acquired.

Dynamic changes in tissue water diffusion and glucose metabolism occur during and after hypoxia in cerebral hypoxia-ischemia reflecting a bioenergetics ...

Isolation and Profiling of MicroRNA-containing Exosomes from Human Bile

Exosome research in the last three years has greatly extended the scope towards identification and characterization of biomarkers and their therapeutic uses.
Exosomes have recently been shown to contain microRNAs (miRs). MiRs themselves have arisen as valuable biomarkers for diagnostic purposes. As specimen collection in clinics and hospitals is quite variable, miRNA isolation from whole bile varies substantially. To achieve robust, accurate and reproducible miRNA profiles from collected bile samples in a simple manner required the development of a high-quality protocol to isolate and characterize exosomes from bile. The method requires several centrifugations and a filtration step with a final ultracentrifugation step to pellet the isolated exosomes. Electron microscopy, Western blots, flow cytometry and multi-parameter nanoparticle optical analysis, where available, are crucial characterization steps to validate the quality of the exosomes. For the isolation of miRNA from these exosomes, spiking the lysate with a non-specific, synthetic miRNA from a species like Caenorhabditis elegans, i.e., Cel-miR-39, is important for normalization of RNA extraction efficiency. The isolation of exosome from bile fluid following this method allows the successful miRNA profiling from bile samples stored for several years at -80 &#176;C.

Bile fluid is a valuable source of extracellular vesicles/exosomes that contain potentially important biomarkers. This protocol represents a robust method to isolate exosomes from human bile for further analyses including miRNA profiling.

Exosome research in the last three years has greatly extended the scope towards identification and characterization of biomarkers and their therapeutic ...

In Vivo Tracking of Edema Development and Microvascular Pathology in a Model of Experimental Cerebral Malaria Using Magnetic Resonance Imaging

Cerebral malaria is a sign of severe malarial disease and is often a harbinger of death. While aggressive management can be life-saving, the detection of cerebral malaria can be difficult. We present an experimental mouse model of cerebral malaria that shares multiple features of the human disease, including edema and microvascular pathology. Using magnetic resonance imaging (MRI), we can detect and track the blood-brain barrier disruption, edema development, and subsequent brain swelling. We describe multiple MRI techniques that can visualize these pertinent pathological changes. Thus, we show that MRI represents a valuable tool to visualize and track pathological changes, such as edema, brain swelling, and microvascular pathology, in vivo.

In Vivo Tracking of Edema Development and Microvascular Pathology in a Model of Experimental Cerebral Malaria Using Magnetic Resonance Imaging

We describe a mouse model of experimental cerebral malaria and show how inflammatory and microvascular pathology can be tracked in vivo using magnetic resonance imaging.

Cerebral malaria is a sign of severe malarial disease and is often a harbinger of death. While aggressive management can be life-saving, the detection of ...

Ileectomy-induced Bile Overaccumulation in Mouse Intestine

Intestinal resection is a common therapeutic approach for human diseases such as obesity, inflammatory bowel disease, Crohn's disease, and colon cancer that often results in severe short bowel syndrome-like adverse effects including bile acid diarrhea, dehydration, electrolyte disturbances, and nutrient malabsorption. Here we introduce a murine ileal resection model, termed ileectomy, to evaluate tissue communication and the maintenance of systemic homeostasis. After ileal resection, circulating blood is permanently devoid of the ileum-specific endocrine hormone fibroblast growth factor 15 (FGF15), which releases its endocrinal inhibition of bile acid synthesis in the liver. In combination with the increased production and abolished reabsorption of bile acids after removing the ileum, mice that underwent surgery suffer from bile salt overaccumulation in the intestine and associated diarrhea, morbidity, and mortality. Novel usage of the surgery model introduced in this study may provide mechanistic and functional insights into ileal control of systemic metabolic regulation in physiology and disease.

Small intestine-dependent bile acid reabsorption and feedback inhibition of hepatic bile acid synthesis is important for systemic homeostasis and health. In this study, we describe a mouse model for ileal resection to evaluate ileectomy-induced bile malabsorption, overaccumulation, and toxicity in mouse intestine.

Intestinal resection is a common therapeutic approach for human diseases such as obesity, inflammatory bowel disease, Crohn's disease, and colon cancer ...

Cardiac Magnetic Resonance Imaging at 7 Tesla

CMR at an ultra-high field (magnetic field strength B0&#160;&#8805; 7 Tesla) benefits from the signal-to-noise ratio (SNR) advantage inherent at higher magnetic field strengths and potentially provides improved signal contrast and spatial resolution. While promising results have been achieved, ultra-high field CMR is challenging due to energy deposition constraints and physical phenomena such as transmission field non-uniformities and magnetic field inhomogeneities. In addition, the magneto-hydrodynamic effect renders the synchronization of the data acquisition with the cardiac motion difficult. The challenges are currently addressed by explorations into novel magnetic resonance technology. If all impediments can be overcome, ultra-high field CMR may generate new opportunities for functional CMR, myocardial tissue characterization, microstructure imaging or metabolic imaging. Recognizing this potential, we show that multi-channel radio frequency (RF) coil technology tailored for CMR at 7 Tesla together with higher order B0 shimming and a backup signal for cardiac triggering facilitates high fidelity functional CMR. With the proposed setup, cardiac chamber quantification can be accomplished in examination times similar to those achieved at lower field strengths. To share this experience and to support the dissemination of this expertise, this work describes our setup and protocol tailored for functional CMR at 7 Tesla.

The sensitivity gain inherent to ultrahigh field magnetic resonance holds promise for high spatial resolution imaging of the heart. Here, we describe a protocol customized for functional cardiovascular magnetic resonance (CMR) at 7 Tesla using an advanced multi-channel radio-frequency coil, magnetic field shimming and a triggering concept.

CMR at an ultra-high field (magnetic field strength B0&#160;&#8805; 7 Tesla) benefits from the signal-to-noise ratio (SNR) advantage inherent at higher ...