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Factors that influence microdialysis recovery. Comparison of experimental and theoretical microdialysis recoveries in rat liver.

Inhibition of metabolic processes was used to assess the possible change in the recovery of material from a microdialysis probe implanted in vivo in rat liver. Phenacetin and antipyrine were perfused through a microdialysis probe implanted in the liver. Inhibition of phenacetin and antipyrine metabolism was achieved through an iv bolus dose of the cytochrome P450 suicide substrate 1-aminobenzotriazole (1-ABT). 1-ABT inhibited phenacetin clearance by 90%, thus also inhibiting metabolism by 90%. There was no statistical difference in the recovery of phenacetin and antipyrine across the microdialysis membrane in the liver between the control and metabolically inhibited animals. Partial differential equations were developed that describe the transport of analyte from the microdialysis probe and solved by an implicit finite-difference method to aid in the understanding of the above-mentioned microdialysis experiments. Predictions of microdialysis recovery obtained from the numerical model are compared with those found experimentally. The model could predict trends in the data, but not the actual experimental values. This suggests that predictions from this microdialysis model are essentially heuristic and as presently formulated can be used only to show mechanisms that affect recovery, but they cannot be used to accurately predict recovery. Prediction of actual recovery requires knowledge of the values of the parameters that describe chemical properties such as the in vivo diffusion coefficient, metabolism rate constant, and capillary exchange rate constant. For microdialysis experiments performed in the liver, capillary exchange and the rate of liver blood flow appear to be the dominant processes that facilitate net transport from a microdialysis probe rather than metabolic processes. These results indicate that microdialysis recoveries measured after inhibition of a concentration-dependent kinetic process via pharmacological challenge will change only when the kinetic process that is being challenged is large compared to the contribution of all concentration-dependent kinetic processes, including other metabolism routes, capillary exchange, or uptake that remove the analyte from the tissue space. It is concluded that the microdialysis recovery of a substance from the liver is not generally affected by liver metabolism.

Animals↗

Intravasal microdialysis is superior to intramyocardial microdialysis in detecting local ischaemia in experimental porcine myocardial infarction.

OBJECTIVE: A novel application of microdialysis was studied, where myocardial outflow of energy metabolites was monitored by intravasal microdialysis in the myocardial venous outflow during ischaemia and reperfusion. These levels where related to levels monitored by microdialysis catheters placed intramyocardially. METHODS: Microdialysis catheters were introduced into the great cardiac vein (GCV), ischaemic myocardium and non-ischaemic myocardium in 10 anaesthetized pigs. The left anterior descending coronary artery was occluded for 60 min in five pigs and five pigs served as controls. Ischaemia was followed by 120 min of reperfusion. Microdialysis samples were analysed for glucose, lactate, pyruvate and glycerol. Venous lactate and glucose levels were measured by blood samples from the femoral vein. RESULTS: All animals subjected to ischaemia developed myocardial infarction. Lactate, lactate/pyruvate ratio and glycerol increased in the microdialysis samples from the GCV and the catheter placed in ischaemic myocardium while no changes were detected in samples from the catheter placed in the non-ischaemic myocardium. CONCLUSION: In this study, we have demonstrated that intravasal microdialysis catheters rapidly and reliably detect local myocardial ischaemia, while intramyocardially placed microdialysis catheters will not show these changes if placed in a non-ischaemic area.

Animals↗

Monitoring in situ liver metabolism in rats using microdialysis. Comparison of microdialysis mass-transport model predictions to experimental metabolite generation data.

The generation of metabolites from two model compounds, phenacetin and acetaminophen, included in the perfusion fluid of a microdialysis probe implanted into rat liver was studied. When 60 microM phenacetin was included in the perfusion fluid using a flow rate of 1.0 microL/min, acetaminophen and acetaminophen sulfate were recovered at concentrations that ranged between 0.4 and 1.6 microM. Acetaminophen sulfate ([AS]gain) diffused back into the microdialysis probe on a micromolar percentage basis of 8.9+/-2.4% (n = 3) when acetaminophen was passed through the probe at a concentration between 11 and 12 microM. When 220-240 microM acetaminophen was passed through the probe, the percentage of acetaminophen sulfate recovered was 4.8+/-1.4% (n = 3) (P < 0.1 compared to the 11 microM group). No acetaminophen glucuronide was detected in the dialysate samples. A mathematical model that describes mass transport in microdialysis sampling was used to predict the concentration of metabolite that could be recovered into the dialysate after the loss of a substrate compound that undergoes metabolism. The model predicts a metabolite recovery of 23.6% using estimates for phenacetin metabolism and 21.5% using estimates for acetaminophen metabolism. The results presented here indicate that microdialysis has potential to be used to study local in situ metabolism and with further refinements of the microdialysis mass-transport model may be used to estimate in vivo metabolic formation rates.

Acetaminophen↗

Clinical microdialysis: the role of on-line measurement and quantitative microdialysis.

The use of microdialysis in the clinic is examined in the light of lessons learnt from microdialysis in freely moving rats. Changes in concentrations of metabolites are an important index of the state of health of tissues. For effective therapeutic intervention rapid assays are essential Enzyme-based on-line assays for glucose and lactate are described. By combining two of these assays simultaneous measurements of glucose and lactate, sampled at 2 min intervals can be obtained. The relation between dialysate concentrations and the true extracellular concentration of an analyte is dependent on conditions in the tissue sampled and cannot be calculated from in vitro probe recoveries. Furthermore, with acute implantation of the probe and possibly rapidly changing tissue conditions, there will be changes in probe recovery in vivo. Quantitative microdialysis allows the measurement of the true extracellular concentration and the probe recovery in vivo. The clinical applicability of a number of quantitative microdialysis methods is discussed, and three approaches highlighted. By increasing membrane length and reducing flow rate recovery in vivo can be increased to 100%. In this case dialysate concentrations equal extracellular ones. By perfusing an inert exogenous compound an index of changes to extracellular volume and hence tissue oedema can be obtained. In the zero net flux method the infusion of a few concentrations of the analyte under study allows the direct determination of both the ECF concentration and the in vivo recovery. The latter can provide valuable information about changes in the physical as well as chemical state of the tissue. This can guide rapid effective therapeutic intervention.

Animals↗

In vivo microdialysis in the rat: low cost and low labor construction of a small diameter, removable, concentric-style microdialysis probe system.

A method for construction of a serviceable and low cost intracerebral microdialysis system is presented. The system includes a probe and its supporting components. The probe is of the concentric design. The supporting components are an implantable guide cannula, a tether, and a swivel. After minimal training, workers can make many probes of consistent performance characteristics in a short time. Because all of the parts are commercially produced, users may obtain custom-made components which are finished with factory precision and accuracy. The user may readily vary probe characteristics such as depth of implant and size of active portion, so that different types of dialysis may be performed in different brain regions. The available choices in tether and swivel configurations make this microdialysis system readily adaptable to diverse testing environments. Excluding labor and startup costs, the costs, the cost per probe is approximately $11.00 (US). Taken together, the system provides a flexible, low cost means for performing in vivo microdialysis in freely moving rats.

Animals↗

Lipo-microdialysis: a new microdialysis method for studying the pharmacokinetics of lipophilic substances.

A new microdialysis method (Lipo-MD) using a lipid emulsion as the perfusate instead of Ringer's solution as in conventional microdialysis (MD) was designed. Recovery profiles of the alkylparabens (APBs) dissolved in Ringer' s solution by Lipo-MD were compared with those by MD in vitro. Recovery of APBs in the perfusate in MD decreased with the increasing lipophilicity of APBs, whereas that in Lipo-MD increased. The enhancement of the relative recovery of APBs by Lipo-MD to MD for methyl-, ethyl-, propyl-, and butylparaben were 2.03, 5.24, 77.0, and 390.7, respectively. The utility of Lipo-MD for determination of lipophilic substances to perform pharmacokinetic study was suggested.

Chromatography, High Pressure Liquid↗

Generation and detection of hydroxyl radical in vivo in rat spinal cord by microdialysis administration of Fenton's reagents and microdialysis sampling.

We developed a double microdialysis fiber technique to generate hydroxyl radicals (OH.) in rat spinal cord. H2O2 and FeCl2/EDTA were pumped through two parallel microdialysis fibers inserted into the spinal cord such that the reactants mix in the tissue to generate OH. by the Fenton reaction. Generated OH. was detected by administering phenylalanine through one fiber and measuring o-, m- and p-hydroxyphenylalanine in collected dialysates by high pressure liquid chromatography and fluorescence detection. The hydroxyphenylalanines are produced by OH. attacking the phenylalanine. OH. generation was also accomplished in in vitro experiments and the results were consistent with in vivo experiments. This novel method to generate and measure OH. radical in vivo overcomes difficulties in studying damage to tissue by short-lived OH.. Although developed to study the role of OH. in spinal cord injury, this method could be used to study other diseases involving OH. damage.

Animals↗

Microdialysis sampling for hepatic metabolism studies. Impact of microdialysis probe design and implantation technique on liver tissue.

Microdialysis sampling of liver tissue was performed using several probe geometries. The extent of tissue damage and response in vivo caused by implantation and indwelling of the probe was evaluated by histological examination of the tissue. A linear probe, implanted using fused silica tubing, was less damaging than other probe designs and implantation procedures tested. A series of time points up to 48 hr after implantation ere histologically examined. Infiltration of inflammatory cells, predominantly polymorphonuclear leukocytes (PMNs), was evident adjacent to the probe membrane after approximately 8 hr. Mixed inflammatory infiltration, mainly PMNs but including some macrophages, was observed in tissue slices 18 hr after implantation. At 48 hr, the mixed inflammatory infiltration was still present, with some degeneration of PMNs. In implantations of longer than 12 hr, some necrosis appeared at eh implantation site. The rate of delivery of phenol via the probe was stable for at least 30 hr, despite changes in the surrounding tissue.

Animals↗

Brain microdialysis study of the effects of hazardous chemicals on the central nervous system. 1. Changes in monoamine metabolites induced by cerebral methyl bromide administration measured by two-probe microdialysis (TPMD) method.

The two-probe microdialysis (TPMD) method, in which two probes were applied simultaneously to the rat head, was developed to directly investigate the effects of chemicals on the brain. The first and the second probes were implanted into the right striatum and the left ventricle, respectively. Chemicals were dissolved in the perfusion fluid and given into the brain by diffusion through the ventricle probe. Monoamine metabolites were recovered through the striatum probe to investigate changes in neurotransmitter substances. Both intraperitoneal and intraventricular administration of haloperidol (a dopamine receptor blocker) increased 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA, dopamine metabolites) concentrations in the striatum. On the other hand, apomorphine (a dopamine receptor stimulant), which was given both intraperitoneally and intraventricularly, decreased striatal DOPAC and HVA concentrations. 5-Hydroxyindoleacetic acid (5HIAA, a serotonin metabolite) concentration was not affected by these drugs. Regarding changes in monoamine neurotransmitters, systemic and intraventricular administration produced similar effects. These findings indicate that the drugs were effectively incorporated into the brain by the TPMD method and the drug effect was observed in the opposite brain hemisphere. In the same procedure as used in the administration of haloperidol and apomorphine, methyl bromide was given into the rat brain. DOPAC and HVA in the striatum were increased by methyl bromide given by the TPMD method. These changes were the same as observed in the homogenate of rat brain exposed to methyl bromide. 5HIAA was reduced by intraventricular administration by the TPMD method, and this change in 5HIAA was not observed in the exposure experiments. We could detect the direct effects of methyl bromide on the brain by the TPMD method.

3,4-Dihydroxyphenylacetic Acid↗

[Microdialysis: a method to construct a microdialysis probe and its applications].

This paper describes a removable microdialysis probe constructed inexpensively and easily from a commercially available iv catheter placement unit and flexible fused silica tubing. The probe is characterized in in vitro recovery tests. As an example of its applications, experimental results measuring extracellular dopamine concentrations in the nucleus accumbens of rats during intracranial self-stimulation behavior are reported.

Animals↗

Human microdialysis.

Microdialysis has been used extensively in animal studies for decades and in human pharmacokinetic studies for about 10 years. Microdialysis is based on the passive diffusion of a compound along its concentration gradient from the tissue through the membrane into the dialysate. Microdialysis samples from the interstitial space which is a defined, anatomical compartment; there is no net loss of body fluid; the sample is "purified" and no enzymatic degradation takes place because proteins do not pass through the probe membrane into the dialysate; microdialysis data relate to the intact molecule; time resolution is high compared to biopsy and skin blister techniques; radioabelling or induction of a magnetic response is not needed; microdialysis is also an alternative method to determine protein binding of a compound in vivo; microdialysis can readily be set up in clinical research units without expensive infrastructure. Microdialysis has been used to measure tissue concentrations of endogenous compounds and to investigate the tissue penetration of drugs in a variety of tissues in humans in vivo in both healthy volunteers and patients. Microdialysis data have also been used in PK-PD modelling and to obtain concentration-response relationships locally in tissues in vivo. There are also studies combining microdialysis with imaging techniques, e.g. PET. Microdialysis data may be used in early studies to select the appropriate compound, to optimise dosing regimens and to investigate the kinetic and dynamic consequences in the tissues of drug-drug and drug-disease interactions. Microdialysis can also be used in late phase studies to provide tissue concentration data in support of therapeutic efficacy trials or to create a niche for an already marketed drug. FDA and CPMP documents emphasise the value and importance of human tissue drug concentration data and support the use of microdialysis in humans to obtain such information. Microdialysis can satisfy regulatory requirements by providing data on drug concentrations in a well-defined anatomical tissue compartment at or close to the effect target site. Microdialysis is a versatile technique because of its multifaceted utility, low cost, ease of use, adaptability to different types of compounds and its feasibility for a number of organs and tissues. Equipment and probes for use in various organs have been commercially available for years.

Animals↗

Percutaneous implantation of cerebral microdialysis catheters by twist-drill craniostomy in neurocritical patients: description of the technique and results of a feasibility study in 97 patients.

Cerebral microdialysis is increasingly used to monitor several types of neurocritical patients. This study presents the technique used in our unit for percutaneous implantation of cerebral microdialysis catheters using a small twist-drill craniostomy that can be performed in the intensive care unit (ICU). We also present the results of this technique in 89 head-injured patients and in eight patients with a malignant middle cerebral artery (MCA) infarction. One hundred and twenty-two cerebral microdialysis catheters were implanted in the 97 patients included in this study. One cerebral microdialysis catheter was implanted in the less damaged hemisphere of 67 head-injured patients with a diffuse brain injury. An additional microdialysis catheter was inserted in the pericontusional parenchyma of 22 patients with brain contusions. In five of the eight patients with a malignant MCA infarction, only one microdialysis probe was inserted in the penumbral zone. In the remaining three patients, two cerebral microdialysis catheters were implanted in the same hemisphere (one in the ischemic core and the other in the penumbra). Technical problems were detected in 18 (15%) of the 122 microdialysis catheters implanted and were more frequent during the initial period of using microdialysis in our unit. In four patients (3% of implanted catheters), follow-up computed tomography (CT) scans showed a small intracerebral blood collection (always <or=1 cc) around the microdialysis catheter. There were no microdialysis-related infections. In conclusion, percutaneous insertion of single or multiple microdialysis catheters in neurocritical patients by using twist drill craniostomy is feasible, fast, and safe.

Adolescent↗

Continuous monitoring of cerebral metabolism in traumatic brain injury: a focus on cerebral microdialysis.

PURPOSE OF REVIEW: This review highlights recent advances in cerebral microdialysis as a tool for neurochemical monitoring of patients with traumatic brain injury. RECENT FINDINGS: Progress in microdialysis research has come from validation studies of microdialysis biomarkers and clinical outcome in large cohorts of traumatic brain injury patients and by combining microdialysis with other methods, such as positron emission tomography, magnetic resonance spectroscopy, brain tissue oximetry and electrophysiology. The combination of rapid-sampling microdialysis and electrocorticography has revealed complex, transient fluctuations of microdialysis glucose and lactate and depolarization-like events that may affect the secondary injury process. The use of microdialysis to monitor global cerebral metabolic events (related to intracranial hypertension or reduced cerebral perfusion pressure for example) as opposed to focal events in peri-lesional brain tissue need to be clearly distinguished and the microdialysis catheter location verified by neuroimaging to ensure proper data interpretation. Differences in microdialysis biomarker levels between grey and white matter following traumatic brain injury need clarification. SUMMARY: Microdialysis is established as a neurochemical research tool in neurointensive care, particularly in combination with other monitoring methods, and contributes to a growing knowledge of secondary injury mechanisms in traumatic brain injury. The value of microdialysis as a tool in routine neurointensive care decision-making remains unclear.

Brain Injuries↗

Microdialysis sampling for the investigation of dermal drug transport.

Microdialysis perfusion in vivo has the potential to be a powerful sampling technique in dermal and transdermal drug delivery studies. Characterization of a commercially available microdialysis probe in vitro considering relevant physiological parameters is a vital first step in the evaluation of microdialysis as a dermal sampling technique. In previous microdialysis studies, analyte concentration and neutrality have been implicated in altering microdialysis recovery. The recovery of a model compound 5-fluorouracil (5-FU) was investigated at several pH values and donor concentrations. The relative recovery of 5-FU by the microdialysis probe was affected by pH but not by donor concentration. To confirm further that the changing concentration and pH profile presented by the flux of 5-FU was not significantly altering microdialysis recovery, an experiment comparing direct and microdialysis sampling of a Franz diffusion cell receptor compartment was performed. Although the 5-FU concentration (0-686 ng/ml) and pH (7.40-7.24) changed substantially, the recovery of 5-FU was not adversely affected. To demonstrate the feasibility of dermal microdialysis, the flux of a commercial preparation of 5-fluorouracil was monitored utilizing a microdialysis probe implanted in excised rat skin in vitro. The results from the dermally implanted probe demonstrate the potential of the technique while establishing the limitations of the current microdialysis system.

Animals↗

Combination of microdialysis and glucose sensor for continuous on line measurement of the subcutaneous glucose concentration: theory and practical application.

The microdialysis technique can be used to get dialysates of the subcutaneous tissue, which can be continuously measured by an amperometric glucose sensor. In order to get further insight into the microdialysis procedure, we used a steady-state theory for microdialysis to predict the recovery of glucose in the dialysate and compared the results to experimental data obtained by a combination of the microdialysis technique with continuous amperometric glucose sensing. The recovery of glucose obtained in vitro for two different microdialysis probes was close to the theoretical predictions. When quantifying the predictions of the model with regard to the spatial concentration profile in the subcutaneous tissue, it appeared, that the presence of the microdialysis probe depressed the concentration of glucose for 0.2 mm from the probe surface. In a 24 hour in vivo experiment, there were less fluctuations in the sensor signal when the patient was lying in bed compared to the time, when the patient could move freely. In conclusion, the combination of microdialysis and glucose sensor seems to be a promising approach to a continuously functioning glucose sensing system. However, the microdialysis procedure itself disturbs the surrounding of the probe leading to a concentration gradient of glucose. This might explain some differences between the course of blood glucose and the course of subcutaneous glucose, measured by the combination of microdialysis and an amperometric glucose sensor. Further developments of such systems should aim at implanting microdialysis devices which have a minimal influence upon the tissue metabolism.

Biosensing Techniques↗

Cerebral microdialysis of patients with severe traumatic brain injury exhibits highly individualistic patterns as visualized by cluster analysis with self-organizing maps.

OBJECTIVE: To analyze patterns of cerebral microdialysis in patients with traumatic brain injury and, with a neural network methodology, investigate pattern relationships to intracranial pressure and cerebral perfusion pressure. DESIGN: Retrospective. SETTING: University hospital, adult neurosurgical intensive care unit. PATIENTS: Twenty-six patients with severe traumatic brain injury. All consecutive traumatic brain injured patients (Glasgow Coma Scale < or =8) with microdialysis monitoring, analyzing glutamate, lactate, pyruvate, and glucose in both penumbral and nonpenumbral tissue. INTERVENTIONS: None; patients received the unit's standard neurointensive care procedure. MEASUREMENTS AND MAIN RESULTS: We used 2084 hrs of complete microdialysis data sets (eight markers) to train Kohonen self-organizing maps. The self-organizing map algorithm is a data-clustering method that reduces high-dimensional information to a two-dimensional representation on a grid (map), retaining local relationships in the data. Maps were colored (overlaid) for intracranial pressure, cerebral perfusion pressure, and outcome, to explore relationships with underlying microdialysis patterns. The maps exhibited a striking clustering of patients, with unique microdialysis patterns that were recognizable throughout the analysis period. This also held true for most microdialysis patterns characteristic of ischemia. These patients with ischemic patterns can have good outcomes, suggesting a disparity between microdialysis values and severity of traumatic brain injury. CONCLUSION: Using an artificial neural network-like clustering technique, Kohonen self-organizing maps, we have shown that cerebral microdialysis, in traumatic brain injury, exhibits strikingly individualistic patterns that are identifiable throughout the analysis period. Because patients form their own clusters, microdialysis patterns, during periods of increased intracranial pressure or decreased cerebral perfusion pressure, will be found within these clusters. Consequently, no common pattern of microdialysis can be seen among patients within the range of our data. We suggest that these individualistic patterns reflect not only metabolic states of traumatic brain injury but also local gradients seen with small volume sampling. Future investigation should focus on relating these patterns, and movement within and from clusters, to metabolic states of the complex pathophysiology of traumatic brain injury.

Adolescent↗

Acute focal neurological deficits in aneurysmal subarachnoid hemorrhage: relation of clinical course, CT findings, and metabolite abnormalities monitored with bedside microdialysis.

BACKGROUND AND PURPOSE: We sought (1) to identify early metabolic markers for the development of (ir)reversible neurological deficits and cerebral infarction in subarachnoid hemorrhage (SAH) patients by using the microdialysis technique and (2) to evaluate the influence of intracerebral hemorrhage (ICH) on microdialysis parameters. METHODS: We performed a prospective study of 44 SAH patients with acute focal neurological deficits (AFND) occurring acutely with SAH (due to ICH) or directly after surgery (due to clip stenosis, thromboembolism, or early edema). Fifty-one nonischemic SAH patients served as a control group. A microdialysis catheter was inserted into the vascular territory of the aneurysm after clipping. The microdialysates were analyzed hourly for extracellular glucose, lactate, lactate/pyruvate ratio, glutamate, and glycerol with a bedside analyzer. Microdialysis-related CT findings were evaluated for the presence of ICH and cerebral infarction. Reversibility of neurological symptoms after 4 weeks and 6- and 12-month outcomes were assessed. RESULTS: In patients with AFND, cerebral metabolism was severely disturbed when microdialysis started compared with controls (P<0.005). Infarction on CT was associated with pathological microdialysis parameters (P<0.002) and development of a fixed deficit (P<0.003), while the presence of ICH alone was not. A secondary neurological deterioration of AFND patients (n=11) was reflected by preceding (0 to 20 hours) changes of microdialysate concentrations. CONCLUSIONS: In the presence of ICH, pathological microdialysis values may indicate reversible tissue damage. Extreme microdialysis values and pathological microdialysis concentrations that further deteriorate 2-fold are highly indicative of the development of cerebral infarction and permanent neurological deficits. Therefore, the analysis of relative changes of microdialysis parameters is crucial for the detection of ischemia in SAH patients.

Acute Disease↗