Weiss R G, Chacko V P, Glickson J D, Gerstenblith G
Department of Medicine, Johns Hopkins Hospital, Baltimore, MD 21205.
Proc Natl Acad Sci U S A. 1989 Aug;86(16):6426-30. doi: 10.1073/pnas.86.16.6426.
13C NMR spectroscopy may offer a unique ability to characterize the metabolic response to graded reduction in coronary flow since it allows repeated, nondestructive identification of products of intermediary metabolism in the same heart. The sensitivity of 13C parameters of glucose metabolism was compared with changes in levels of phosphocreatine, ATP, and pH as determined by 31P NMR in the intact, beating rat heart model during graded reductions in coronary flow. Experiments were performed during 60 min of perfusion with [1-13C]glucose (5 mM) at normal flow (15 ml/min) and at the reduced flow rates of 5 and 2 ml/min. During flow at 5 ml/min, isovolumic developed pressure fell to 51 +/- 4% of control. Although phosphocreatine, ATP, and pH were not changed, [3-13C]lactate was increased (1.46 +/- 0.12 mumol/g of wet weight vs. 0.63 +/- 0.08 during normal flow). In addition, the time to 50% maximum enrichment of [2-13C]glutamate was prolonged (17 +/- 1 min vs. 9 +/- 1 min during normal flow), indicating that glucose-supported flux through the tricarboxylic acid (TCA) cycle was decreased. The relative anaplerotic contribution to citrate synthase-supported TCA flux was increased from 6% to 35%. These 13C metabolic changes could not be reproduced by reduced [1-13C]glucose delivery in the absence of ischemia, although similar reduced TCA flux indices were reproduced in additional hearts when workload was reduced by low calcium (0.7 mM) perfusion. Therefore, the information provided by 13C NMR spectroscopy can be a more sensitive indicator of flow-induced alterations in cardiac metabolism than that provided by the much more commonly used 31P NMR technique.
13C核磁共振波谱法可能具有独特的能力来表征冠状动脉血流逐渐减少时的代谢反应,因为它允许在同一心脏中对中间代谢产物进行重复、无损的识别。在完整的跳动大鼠心脏模型中,当冠状动脉血流逐渐减少时,将葡萄糖代谢的13C参数的敏感性与通过31P核磁共振测定的磷酸肌酸、三磷酸腺苷(ATP)和pH值的变化进行了比较。实验在正常血流(15毫升/分钟)以及血流速率分别降至5毫升/分钟和2毫升/分钟的情况下,用[1-13C]葡萄糖(5毫摩尔)灌注60分钟期间进行。在血流速率为5毫升/分钟时,等容收缩压降至对照值的51±4%。尽管磷酸肌酸、ATP和pH值没有变化,但[3-13C]乳酸增加(湿重为1.46±0.12微摩尔/克,而正常血流时为0.63±0.08微摩尔/克)。此外,[2-13C]谷氨酸达到最大富集量50%的时间延长(正常血流时为9±1分钟,此时为17±1分钟),这表明通过三羧酸(TCA)循环的葡萄糖支持通量降低。对柠檬酸合酶支持的TCA通量的相对回补贡献从6%增加到35%。在没有缺血的情况下,降低[1-13C]葡萄糖供应无法重现这些13C代谢变化,尽管当通过低钙(0.7毫摩尔)灌注降低工作负荷时,在其他心脏中重现了类似的TCA通量降低指标。因此,与更常用的31P核磁共振技术相比,13C核磁共振波谱法提供的信息可能是血流诱导的心脏代谢改变的更敏感指标。