Hyperpolarized 13C Magnetic Resonance Treatment Response Monitoring: A New Paradigm for Multiorgan Metabolic Assessment of Pharmacological Interventions?

Abstract

Metformin is one of the most used hyperglycemic control therapeutics in patients with diabetes, although the exact mechanism of action is still not fully understood (1,2). Metformin is the preferred antihyperglycemic drug in patients with type 2 diabetes; its use in patients with type 1 diabetes is limited however (3,4). A potential serious side effect of metformin treatment is lactic acidosis, which has reduced the applicability in renal-impaired patients; however, this has been questioned recently (5,6). These together support further investigations of, first, the exact mechanism of action and, second, the noninvasive methods for monitoring the treatment, in particular the organ-specific modulations imposed by metformin and their complex interorgan interactions, which historically have been especially difficult to assess. This is particularly true in diseases where several organs are simultaneously affected, such as the cardio-renal syndrome, where dysfunction of one organ affects the other and vice versa and where the use of pharmacological interventions in the treatment of one organ can have detrimental effects on the other and vice versa (7,8). Thus the understanding of the organ-specific phenotypic characteristics in diabetes and the therapy-induced alterations is essential …