The increasing analytical
speed of mass-spectrometry imaging (MSI)
has led to growing interest in the medical field. Acute kidney injury
is a severe disease with high morbidity and mortality. No reliable
cut-offs are known to estimate the severity of acute kidney injury.
Thus, there is a need for new tools to rapidly and accurately assess
acute ischemia, which is of clinical importance in intensive care
and in kidney transplantation. We investigated the value of MSI to
assess acute ischemic kidney tissue in a porcine model. A perfusion
model was developed where paired kidneys received warm (severe) or
cold (minor) ischemia (n = 8 per group). First, ischemic
tissue damage was systematically assessed by two blinded pathologists.
Second, MALDI-MSI of kidney tissues was performed to study the spatial
distributions and compositions of lipids in the tissues. Histopathological
examination revealed no significant difference between kidneys, whereas
MALDI-MSI was capable of a detailed discrimination of severe and mild
ischemia by differential expression of characteristic lipid-degradation
products throughout the tissue within 2 h. In particular, lysolipids,
including lysocardiolipins, lysophosphatidylcholines, and lysophosphatidylinositol,
were dramatically elevated after severe ischemia. This study demonstrates
the significant potential of MSI to differentiate and identify molecular
patterns of early ischemic injury in a clinically acceptable time
frame. The observed changes highlight the underlying biochemical processes
of acute ischemic kidney injury and provide a molecular classification
tool that can be deployed in assessment of acute ischemic kidney injury.