Phosphorus nuclear magnetic resonance: a non-invasive technique for the study of muscle bioenergetics during exercise.

Phosphorus nuclear magnetic resonance (31P NMR) spectroscopy is a non-destructive analytical laboratory technique that, due to recent technical advances, has become applicable to the study of high-energy phosphate metabolism in both animal and human extremity muscles (in vivo). 31P NMR can assay cellular phosphocreatine, ATP, inorganic phosphate, the phosphorylated glycolytic intermediates, and intra-cellular pH in either resting or exercising muscle, in a non-invasive manner. NMR uses non-perturbing levels of radio-frequency energy as its biophysical probe and can therefore safely study intact muscle in a repeated fashion while exerting no artifactual influence on ongoing metabolic processes. Compared with standard tissue biopsy and biochemical assay techniques, NMR possesses the advantages of being non-invasive, allowing serial in situ studies of the same tissue sample, and providing measurements of only active (unbound) metabolites. NMR studies of exercising muscle have yielded information regarding fatigue mechanisms at the cellular level and are helping resolve long-standing questions regarding the metabolic control of glycolysis, oxidative phosphorylation, and post-exercise phosphocreatine re-synthesis. NMR is also being utilized to measure enzymatic reaction rates in vivo. In the near future, other forms of NMR spectroscopy may also permit the non-invasive measurement of tissue glycogen and lactate content.

Compartment syndrome: a quantitative study of high-energy phosphorus compounds using 31P-magnetic resonance spectroscopy.

The purpose of this study was to quantitate the intracellular high-energy phosphate compounds during 6 hours of tissue ischemia in the anterior tibial compartment of beagles subjected to an induced traumatized compartment syndrome. The goal of this work was to provide clinicians with objective criteria to augment clinical judgment regarding surgical intervention in the impending compartment syndrome. A beagle model was utilized in which the Delta pressure (difference between the mean arterial pressure and compartment pressure) could be controlled. The model, in conjunction with 31P-magnetic resonance spectroscopy (MRS), allowed a measure of high-energy phosphate compounds and pH in the compartment at various Delta pressures. The extent of ischemic metabolic insult in the compartment was then quantitated. Our data suggest the following: 1) lower Delta pressures result in a proportionally greater drop in the intracellular phosphocreatine ratio and pH; 2) at lower Delta pressures, there is proportionally greater decline in the percentage recovery post-fasciotomy; 3) blood pressure is extremely important and periods of hypotension may result in increased muscle damage at lower compartment pressures.

The bioenergetics of preservation of limbs before replantation. The rationale for intermediate hypothermia.

Of all tissues of the extremities, muscle is the least tolerant of ischemia. Hypothermia of tissue is considered beneficial for the maintenance of viability of muscle in amputated limbs before surgical replantation, but it has never been established that conventional cooling in an ice bath or its equivalent (temperature of tissue, approximately 1 degree Celsius) is the optimum level of hypothermia for minimizing metabolic derangement in ischemic muscle. In this study, we first defined the time course and level of metabolic derangement of muscle in twenty-eight ischemic hind limbs in cats at 22, 15, 10, 5, and 1 degree Celsius. The levels of adenosine triphosphate and phosphocreatine and the mean intracellular pH of the muscles in the lateral aspect of the thigh in each limb were monitored with phosphorus nuclear magnetic-resonance spectroscopy over time. The excised muscles from six freshly amputated legs of live humans were then similarly studied to determine whether muscles from cats and from humans exhibit comparable bioenergetic responses to hypothermic ischemia. A final series of ten ischemic hind limbs from cats was studied by nuclear magnetic resonance and muscle biopsy for direct biochemical assay of tissue energy metabolites to compare the metabolic benefits of two different methods of preserving limbs: continuous cooling in an ice bath, and a newly devised protocol for the rapid induction and maintenance of so-called intermediate (10 +/- 5 degrees Celsius) hypothermia of tissue. Ischemic skeletal muscle in cats exhibited a paradoxical metabolic response to extreme cold (1 degree Celsius). The rate of metabolic deterioration progressively declined with decreasing temperature of tissue to 10 degrees Celsius. However, at 5 degrees Celsius, no additional benefit was detected, and at 1 degree Celsius, there was a significant acceleration in the rates of degradation of adenosine triphosphate and phosphocreatine and in the production of lactate. The rate of degradation of adenosine triphosphate in human ischemic muscle was also faster at 1 degree Celsius than at 10 degrees Celsius. This paradoxical response is apparently due to a severe inhibition of the calcium pump of the sarcoplasmic reticulum of the muscle cell at temperatures of less than 5 degrees Celsius. The inhibition permits an efflux of calcium to the myofibrils, which stimulates both glycolysis and the degradation of adenosine triphosphate by myofibrillar adenosine triphosphatase.

Optimizing tourniquet application and release times in extremity surgery. A biochemical and ultrastructural study.

Despite numerous studies investigating the pathophysiology of tourniquet ischemia, definitive data at the cellular level have been lacking and no consensus regarding safe tourniquet-application times in extremity surgery has emerged. In light of the particular vulnerability of skeletal muscle to ischemic injury, we determined the degree of muscular metabolic derangement and cell damage produced by seven different protocols of tourniquet application and release, each providing three hours of total tourniquet time. We performed thirty-six experiments on canine hind limbs, comparing the following time-patterns of tourniquet application: I--three sequential one-hour periods, II--two sequential one and one-half-hour periods, III--two hours followed by one hour, and IV--a single continuous three-hour application. Five and fifteen-minute reperfusion intervals between ischemic periods were compared for the first three time-patterns, creating a total of seven different tourniquet protocols. Muscular metabolic derangement and cell injury were evaluated by monitoring changes in the cellular bioenergetic state (high-energy phosphate profile), cell pH, post-ischemic leakage of creatine phosphokinase, and ultrastructural cell degeneration. At the intracellular level, the metabolic recovery of muscle during reperfusion was much faster than previous studies focusing on extracellular parameters have indicated. In all instances complete intracellular bioenergetic recovery occurred within five minutes after tourniquet release. The use of one or more five-minute reperfusion intervals significantly reduced the degree of ischemic cell injury, as indicated by a decrease in creatine phosphokinase leakage and myofibrillar destruction. No additional benefit was derived by extending the reperfusion periods to fifteen minutes. The longest period of continuous ischemia in each tourniquet-application protocol bore the closest relationship with the amount of cell damage produced. Within the spectrum of observed pathological changes, time-patterns I and II produced comparatively little muscle damage.

Muscle ischemia and hypothermia: a bioenergetic study using 31phosphorus nuclear magnetic resonance spectroscopy.

UNLABELLED: Following traumatic limb amputation it is common clinical practice to maintain the ischemic tissues in a hypothermic state until surgical reimplantation. Of all extremity tissues, muscle is the most sensitive to ischemia; it is therefore imperative that reperfusion be established before diffuse muscle necrosis. Although it has been shown both clinically and experimentally that hypothermia prolongs the viability of ischemic skeletal muscle, the presumed mechanism by which this occurs has not been confirmed at the cellular level. This study was undertaken to quantify the effect of conventional iced-saline hypothermia on anaerobic cell metabolism and high-energy phosphate depletion in traumatically devascularized muscle. METHODS: Phosphorus nuclear magnetic resonance spectroscopy (31P NMR) was employed to noninvasively monitor cellular phosphocreatine (PCr), ATP, and intracellular pH over time in ischemic cat hindlimb muscle under room temperature (22 degrees C) and 1 degree C hypothermic conditions. RESULTS: Muscular PCr depletion was significantly retarded by tissue hypothermia but the rate of ATP depletion was not. A progressive, severe cellular acidosis was observed in the room-temperature muscle. Iced tissue cooling produced a dramatic initial rise in cell pH which significantly reduced the absolute degree of subsequent acidotic changes. SIGNIFICANCE: These findings question our understanding of hypothermic tissue preservation, which has generally been assumed to work on the basis of decreased tissue metabolism, thus conserving critical cellular ATP levels. The empirical benefit derived by cooling muscle in an iced medium may actually be related to the cellular alkalinization produced by tissue cooling, as this significantly mitigates the profound acidosis that would otherwise occur.