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Pashkunova-Martic I, Manzano-Szalai K, Friske J, Aszmann O, Theiner S, Klose MHM, Baurecht D, Trattnig S, Keppler BK, Helbich TH. Modified amino-dextrans as carriers of Gd-chelates for retrograde transport and visualization of peripheral nerves by magnetic resonance imaging (MRI). J Inorg Biochem 2021; 222:111495. [PMID: 34098348 DOI: 10.1016/j.jinorgbio.2021.111495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/22/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022]
Abstract
Amino-dextrans (AD) conjugated with gadolinium (Gd3+) were developed as neuro-specific contrast agents (CA) for the visualization of the sciatic nerve in rats by magnetic resonance imaging (MRI). AD with 3, 10, and 70 kDa molecular weights were assessed as carrier molecules known to be transported with various speed by axonal microtubules. Detailed spectroscopic characterizations, analyses by Fast Protein Liquid Chromatography (FPLC), Sodium Dodecyl Sulfate Polyacrylamide Gel Electrophoresis (SDS-PAGE), and inductively coupled plasma-mass spectrometry (ICP-MS), were carried out. For MRI, the paramagnetic Gd3+ ion was coupled as a T1 signal enhancer. The well-established linear chelator, diethylenetriaminepentaacetic acid (DTPA), was used and subsequently replaced by the more stable cyclic chelator 1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA). In addition, a fluorescently labeled AD-DTPA-Gd was prepared to demonstrate an active transport to the spinal cord by histochemistry. After successful synthesis and characterization, molecular migration of the AD-DTPA-Gd in the sciatic nerve of healthy Sprague Dawley rats was monitored by MRI for up to seven days. Enhancement of nerve structures was evaluated by MRI and correlated with ICP-MS analyses. To investigate the distribution of CA along the neuraxis, all animals were sacrificed after the final MRI monitoring. Nerves, spinal ganglions, and corresponding spinal cord sections were harvested, to determine the localization and concentration of the paramagnetic element. This is the first report that demonstrates the active uptake and transport of AD-Gd conjugates within the sciatic nerve. This new concept may serve as a potential diagnostic tool for the direct visualization and monitoring of the continuity of injured nerves.
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Affiliation(s)
- Irena Pashkunova-Martic
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, 1090 Vienna, Austria.
| | - Krisztina Manzano-Szalai
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Joachim Friske
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Lazarettgasse 14, 1090 Vienna, Austria
| | - Oskar Aszmann
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Sarah Theiner
- Institute of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 38, 1090 Vienna, Austria; Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, 1090 Vienna, Austria
| | - Matthias H M Klose
- Institute of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 38, 1090 Vienna, Austria
| | - Dieter Baurecht
- Department of Physical Chemistry, University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Lazarettgasse 14, 1090 Vienna, Austria
| | - Bernhard K Keppler
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, 1090 Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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2
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Goyal A, Wadgera N, Srivastava DN, Ansari MT, Dawar R. Imaging of traumatic peripheral nerve injuries. J Clin Orthop Trauma 2021; 21:101510. [PMID: 34386344 PMCID: PMC8333344 DOI: 10.1016/j.jcot.2021.101510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023] Open
Abstract
Nerves are commonly injured in case of blunt or penetrating trauma to the extremities. Patients with nerve injuries have profound consequences and thus a timely decision for operative management is a very important. Conventionally, management decisions have been based on clinical findings, patient course and electrophysiological studies. However, imaging modalities have an enormous role not only in localizing and grading of the nerve injuries but also in the follow-up of the nerve recovery. High-resolution ultrasound (HUS) is the modality of choice for evaluation of peripheral nerves. Magnetic resonance neurography (MRN) plays a complementary role, enabling better assessment of muscle changes and deeper nerves. Corresponding to the injured layer of the cross-section of the nerve, imaging manifestations differ in different grades of injury. Since imaging cannot detect ultrastructural changes at the microscopic level, thus there may be overlap in the imaging findings. Herewith, we discuss the imaging findings in different grades of nerve injury and propose a simple 3-tier grading for imaging (HUS and MRN) assessment of peripheral nerve injuries.
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Affiliation(s)
- Ankur Goyal
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India,Corresponding author. Department of Radio-diagnosis All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Nagesh Wadgera
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India
| | - Deep Narayan Srivastava
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India
| | - Mohammed Tahir Ansari
- All India Institute of Medical Sciences, Department of Orthopaedics, New Delhi, 110029, India
| | - Rakesh Dawar
- All India Institute of Medical Sciences, Department of Plastic Surgery, New Delhi, 110029, India
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3
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Markiewicz MR, Callahan N, Miloro M. Management of Traumatic Trigeminal and Facial Nerve Injuries. Oral Maxillofac Surg Clin North Am 2021; 33:381-405. [PMID: 34116905 DOI: 10.1016/j.coms.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the area of craniomaxillofacial trauma, neurosensory disturbances are encountered commonly, especially with regard to the trigeminal and facial nerve systems. This article reviews the specific microanatomy of both cranial nerves V and VII, and evaluates contemporary neurosensory testing, current imaging modalities, and available nerve injury classification systems. In addition, the article proposes treatment paradigms for management of trigeminal and facial nerve injuries, specifically with regard to the craniomaxillofacial trauma setting.
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Affiliation(s)
- Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, 3435 Main Street, 112 Squire Hall, Buffalo, NY 14214, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA; Department of Neurosurgery, Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA; Craniofacial Center of Western New York, John Oishei Children's Hospital, Buffalo, NY, USA.
| | - Nicholas Callahan
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Room 110, 801 S. Paulina Street, Chicago, IL 60612, USA; Department of Otolaryngology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Michael Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Room 110, 801 S. Paulina Street, Chicago, IL 60612, USA
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4
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Tereshenko V, Pashkunova-Martic I, Manzano-Szalai K, Friske J, Bergmeister KD, Festin C, Aman M, Hruby LA, Klepetko J, Theiner S, Klose MHM, Keppler B, Helbich TH, Aszmann OC. MR Imaging of Peripheral Nerves Using Targeted Application of Contrast Agents: An Experimental Proof-of-Concept Study. Front Med (Lausanne) 2020; 7:613138. [PMID: 33363189 PMCID: PMC7759654 DOI: 10.3389/fmed.2020.613138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Current imaging modalities for peripheral nerves display the nerve's structure but not its function. Based on a nerve's capacity for axonal transport, it may be visualized by targeted application of a contrast agent and assessing the distribution through radiological imaging, thus revealing a nerve's continuity. This concept has not been explored, however, may potentially guide the treatment of peripheral nerve injuries. In this experimental proof-of-concept study, we tested imaging through MRI after administering gadolinium-based contrast agents which were then retrogradely transported. Methods: We synthesized MRI contrast agents consisting of paramagnetic agents and various axonal transport facilitators (HSA-DTPA-Gd, chitosan-DTPA-Gd or PLA/HSA-DTPA-Gd). First, we measured their relaxivity values in vitro to assess their radiological suitability. Subsequently, the sciatic nerve of 24 rats was cut and labeled with one of the contrast agents to achieve retrograde distribution along the nerve. One week after surgery, the spinal cords and sciatic nerves were harvested to visualize the distribution of the respective contrast agent using 7T MRI. In vivo MRI measurements were performed using 9.4 T MRI on the 1st, 3rd, and the 7th day after surgery. Following radiological imaging, the concentration of gadolinium in the harvested samples was analyzed using inductively coupled mass spectrometry (ICP-MS). Results: All contrast agents demonstrated high relaxivity values, varying between 12.1 and 116.0 mM-1s-1. HSA-DTPA-Gd and PLA/HSA-DTPA-Gd application resulted in signal enhancement in the vertebral canal and in the sciatic nerve in ex vivo MRI. In vivo measurements revealed significant signal enhancement in the sciatic nerve on the 3rd and 7th day after HSA-DTPA-Gd and chitosan-DTPA-Gd (p < 0.05) application. Chemical evaluation showed high gadolinium concentration in the sciatic nerve for HSA-DTPA-Gd (5.218 ± 0.860 ng/mg) and chitosan-DTPA-Gd (4.291 ± 1.290 ng/mg). Discussion: In this study a novel imaging approach for the evaluation of a peripheral nerve's integrity was implemented. The findings provide radiological and chemical evidence of successful contrast agent uptake along the sciatic nerve and its distribution within the spinal canal in rats. This novel concept may assist in the diagnostic process of peripheral nerve injuries in the future.
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Affiliation(s)
- Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Irena Pashkunova-Martic
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital, Vienna, Austria.,Institute of Inorganic Chemistry, University of Vienna, Vienna, Austria
| | - Krisztina Manzano-Szalai
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Centre for Microbiology and Environmental Systems Science, University of Vienna, Vienna, Austria
| | - Joachim Friske
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital, Vienna, Austria
| | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.,Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Martin Aman
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Hospital Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Laura A Hruby
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Johanna Klepetko
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Sarah Theiner
- Institute of Inorganic Chemistry, University of Vienna, Vienna, Austria
| | | | - Bernhard Keppler
- Institute of Inorganic Chemistry, University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital, Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
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5
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Ha DH. MR Neurography: Current Several Issues for Novice Radiologists. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:81-100. [PMID: 36238129 PMCID: PMC9432089 DOI: 10.3348/jksr.2020.81.1.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/24/2019] [Accepted: 01/08/2020] [Indexed: 11/15/2022]
Abstract
말초신경병증의 진단을 위해 MR neurography의 사용이 점차 증가하고 있다. 고대조도와 고해상도로 말초신경을 직접 영상화한 MR 영상을 MR neurography라고 하고, 지방억제 T2 강조영상과 확산강조영상이 흔히 사용되는 시퀀스이다. 작은 직경, 복잡한 해부학적 구조를 가진 말초신경을 합리적 시간 안에 영상화하기 위해서 최신의 isotropic 3차원 기법, 다양한 고속영상기법, post-processing 영상 기법 등이 사용된다. 이런 발전들로 인해 MR neurography가 유용하게 사용되지만 항상 적절한 MR neurography 영상을 얻을 수 있는 것은 아니다. 적절한 MR neurography 영상을 얻기 위해 영상의학과 의사가 고려해야 할 다음의 몇가지 쟁점들이 있다. 이에는 적절한 표준 프로토콜의 선책, 지방억제 기법의 선택, 해상도와 field of view와 slice thickness 간의 상호 관계의 이해, 적절한 post-processing 영상 기법의 적용, 2차원 영상획득 기법과 3차원 영상획득 기법의 장단점, 근위부 말초신경과 말단부 말초신경의 T2 대조도의 차이, 말초신경에 인접한 정맥이 MR neurography에 미치는 영향, 확산강조영상에서 기하학적 왜곡의 발생과 적절한 b value의 선택 등이다. 이런 쟁점들을 잘 이해하는 것이 경험이 적은 영상의학과 의사가 적절한 MR neurography 영상을 얻고, 말초신경병증을 정확히 평가하는 데 많은 도움이 될 것이다.
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Affiliation(s)
- Dong-ho Ha
- Department of Radiology, Dong-A University, Busan, Korea
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6
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Magnetic Resonance Imaging as a Biomarker in Rodent Peripheral Nerve Injury Models Reveals an Age-Related Impairment of Nerve Regeneration. Sci Rep 2019; 9:13508. [PMID: 31534149 PMCID: PMC6751200 DOI: 10.1038/s41598-019-49850-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/24/2019] [Indexed: 12/12/2022] Open
Abstract
Assessment of myelin integrity in peripheral nerve injuries and pathologies has largely been limited to post-mortem analysis owing to the difficulty in obtaining biopsies without affecting nerve function. This is further encumbered by the small size of the tissue and its location. Therefore, the development of robust, non-invasive methods is highly attractive. In this study, we used magnetic resonance imaging (MRI) techniques, including magnetization transfer ratio (MTR), to longitudinally and non-invasively characterize both the sciatic nerve crush and lysolecithin (LCP) demyelination models of peripheral nerve injury in rodents. Electrophysiological, gene expression and histological assessments complemented the extensive MRI analyses in young and aged animals. In the nerve crush model, MTR analysis indicated a slower recovery in regions distal to the site of injury in aged animals, as well as incomplete recovery at six weeks post-crush when analyzing across the entire nerve surface. Similar regional impairments were also found in the LCP demyelination model. This research underlines the power of MTR for the study of peripheral nerve injury in small tissues such as the sciatic nerve of rodents and contributes new knowledge to the effect of aging on recovery after injury. A particular advantage of the approach is the translational potential to human neuropathies.
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7
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Hill BJ, Padgett KR, Kalra V, Marcillo A, Bowen B, Pattany P, Dietrich D, Quencer R. Gadolinium DTPA Enhancement Characteristics of the Rat Sciatic Nerve after Crush Injury at 4.7T. AJNR Am J Neuroradiol 2017; 39:177-183. [PMID: 29097415 DOI: 10.3174/ajnr.a5437] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/24/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Traumatic peripheral nerve injury is common and results in loss of function and/or neuropathic pain. MR neurography is a well-established technique for evaluating peripheral nerve anatomy and pathology. However, the Gd-DTPA enhancement characteristics of acutely injured peripheral nerves have not been fully examined. This study was performed to determine whether acutely crushed rat sciatic nerves demonstrate Gd-DTPA enhancement and, if so, to evaluate whether enhancement is affected by crush severity. MATERIALS AND METHODS In 26 rats, the sciatic nerve was crushed with either surgical forceps (6- to 20-N compressive force) or a microvascular/microaneurysm clip (0.1-0.6 N). Animals were longitudinally imaged at 4.7T for up to 30 days after injury. T1WI, T2WI, and T1WI with Gd-DTPA were performed. RESULTS Forceps crush injury caused robust enhancement between days 3 and 21, while clip crush injury resulted in minimal-to-no enhancement. Enhancement after forceps injury peaked at 7 days and was seen a few millimeters proximal to, in the region of, and several centimeters distal to the site of crush injury. Enhancement after forceps injury was statistically significant compared with clip injury between days 3 and 7 (P < .04). CONCLUSIONS Gd-DTPA enhancement of peripheral nerves may only occur above a certain crush-severity threshold. This phenomenon may explain the intermittent observation of Gd-DTPA enhancement of peripheral nerves after traumatic injury. The observation of enhancement may be useful in judging the severity of injury after nerve trauma.
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Affiliation(s)
- B J Hill
- From the Departments of Radiology (B.J.H., K.R.P., B.B., P.P., R.Q.)
| | - K R Padgett
- From the Departments of Radiology (B.J.H., K.R.P., B.B., P.P., R.Q.) .,Radiation Oncology (K.R.P.).,Biomedical Engineering (K.R.P.)
| | - V Kalra
- Miller School of Medicine (V.K.), University of Miami, Miami, Florida
| | - A Marcillo
- Miami Project to Cure Paralysis (A.M., D.D.)
| | - B Bowen
- From the Departments of Radiology (B.J.H., K.R.P., B.B., P.P., R.Q.)
| | - P Pattany
- From the Departments of Radiology (B.J.H., K.R.P., B.B., P.P., R.Q.)
| | - D Dietrich
- Miami Project to Cure Paralysis (A.M., D.D.)
| | - R Quencer
- From the Departments of Radiology (B.J.H., K.R.P., B.B., P.P., R.Q.)
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8
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MR T2 value of the tibial nerve can be used as a potential non-invasive and quantitative biomarker for the diagnosis of diabetic peripheral neuropathy. Eur Radiol 2017; 28:1234-1241. [DOI: 10.1007/s00330-017-5043-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 12/19/2022]
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9
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Predicting the Response to Intravenous Immunoglobulins in an Animal Model of Chronic Neuritis. PLoS One 2016; 11:e0164099. [PMID: 27711247 PMCID: PMC5053527 DOI: 10.1371/journal.pone.0164099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 09/20/2016] [Indexed: 11/19/2022] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a disabling autoimmune disorder of the peripheral nervous system (PNS). Intravenous immunoglobulins (IVIg) are effective in CIDP, but the treatment response varies greatly between individual patients. Understanding this interindividual variability and predicting the response to IVIg constitute major clinical challenges in CIDP. We previously established intercellular adhesion molecule (ICAM)-1 deficient non-obese diabetic (NOD) mice as a novel animal model of CIDP. Here, we demonstrate that similar to human CIDP patients, ICAM-1 deficient NOD mice respond to IVIg treatment by clinical and histological measures. Nerve magnetic resonance imaging and histology demonstrated that IVIg ameliorates abnormalities preferentially in distal parts of the sciatic nerve branches. The IVIg treatment response also featured great heterogeneity allowing us to identify IVIg responders and non-responders. An increased production of interleukin (IL)-17 positively predicted IVIg treatment responses. In human sural nerve biopsy sections, high numbers of IL-17 producing cells were associated with younger age and shorter disease duration. Thus, our novel animal model can be utilized to identify prognostic markers of treatment responses in chronic inflammatory neuropathies and we identify IL-17 production as one potential such prognostic marker.
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10
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Robbins NM, Shah V, Benedetti N, Talbott JF, Chin CT, Douglas VC. Magnetic resonance neurography in the diagnosis of neuropathies of the lumbosacral plexus: a pictorial review. Clin Imaging 2016; 40:1118-1130. [PMID: 27454861 DOI: 10.1016/j.clinimag.2016.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/17/2016] [Accepted: 07/07/2016] [Indexed: 11/20/2022]
Abstract
Magnetic resonance neurography (MRN) is an important tool to detect abnormalities of peripheral nerves. This pictorial review demonstrates the MRN features of a variety of neuropathies affecting the lumbosacral plexus (LSP) and lower extremity nerves, drawn from over 1200 MRNs from our institution and supplemented by the literature. Abnormalities can be due to spinal compression, extraspinal compression, malignancy, musculoskeletal disease, iatrogenesis, inflammation, infection, and idiopathic disorders. We discuss indications and limitations of MRN in diagnosing LSP neuropathies. As MRN becomes more widely used, physicians must become familiar with the differential diagnosis of abnormalities detectable with MRN of the LSP.
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Affiliation(s)
- Nathaniel M Robbins
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Vinil Shah
- Department of Radiology and Biomedical Engineering, University of California San Francisco, San Francisco, California, USA
| | - Nancy Benedetti
- Department of Radiology and Biomedical Engineering, University of California San Francisco, San Francisco, California, USA
| | - Jason F Talbott
- Department of Radiology and Biomedical Engineering, University of California San Francisco, San Francisco, California, USA
| | - Cynthia T Chin
- Department of Radiology and Biomedical Engineering, University of California San Francisco, San Francisco, California, USA
| | - Vanja C Douglas
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
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11
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Chhabra A, Carrino JA, Farahani SJ, Thawait GK, Sumner CJ, Wadhwa V, Chaudhary V, Lloyd TE. Whole-body MR neurography: Prospective feasibility study in polyneuropathy and Charcot-Marie-Tooth disease. J Magn Reson Imaging 2016; 44:1513-1521. [PMID: 27126998 DOI: 10.1002/jmri.25293] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/08/2016] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate the feasibility of whole-body magnetic resonance neurography (WBMRN) in polyneuropathy for technical feasibility, distribution of nerve abnormalities, and differentiation. MATERIALS AND METHODS Twenty WBMRN examinations were performed on a 3T scanner over 2 years. Patient demographics including history of hereditary and acquired neuropathy were recorded. The images were evaluated by two independent readers with nerve imaging experience for quality. The nerve signal and size alterations were measured in the brachial plexus, lumbosacral plexus, and femoral and sciatic nerves; diffusion tensor imaging parameters (fractional anisotropy [FA] and apparent diffusion coefficient [ADC]) were determined in plexuses, and tractography was performed. Nonparametric Wilcoxon rank sum test, receiver operating characteristic (ROC) analysis, and intraclass correlation coefficients (ICCs) were obtained. RESULTS Excellent image quality was obtained for the majority of lumbosacral (LS) plexus (18/20) and 50% of brachial plexus (10/20) regions. Qualitatively among cases, the nerve hyperintensity and/or thickening involved the brachial plexus (11/11), LS plexus (7/11), and both plexuses (7/11), with most nerve thickenings observed in Charcot-Marie-Tooth disease type 1. The nerve signal intensity alterations were significantly different for both brachial (P < 0.05) and LS (P < 0.05) plexuses in cases versus controls. The femoral and sciatic nerve size alterations were different (P < 0.05), while signal intensity differences were not significant (P = 0.1-0.97). Transverse dimensions of C8 (4 mm), L5 (6.2 mm) and S1 (5.1 mm) nerve roots, and sciatic nerves (10.2 mm) were the most accurate diagnostic performance measures in distinguishing cases from controls. CONCLUSION WBMRN is feasible for use in the clinical practice for the identification and potential characterization of polyneuropathy. J. Magn. Reson. Imaging 2016;44:1513-1521.
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Affiliation(s)
- Avneesh Chhabra
- Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Musculoskeletal Radiology, Russell H Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - John A Carrino
- Musculoskeletal Radiology, Hospital of Special Surgery, New York, New York, USA
| | - Sahar J Farahani
- Musculoskeletal Radiology, Russell H Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gaurav K Thawait
- Musculoskeletal Radiology, Russell H Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Vibhor Wadhwa
- Musculoskeletal Radiology, Russell H Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Vinay Chaudhary
- Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas E Lloyd
- Neurology, Johns Hopkins University, Baltimore, Maryland, USA
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12
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Abstract
Disorders of peripheral nerve have been traditionally diagnosed and monitored using clinical and electrodiagnostic approaches. The last two decades have seen rapid development of both magnetic resonance imaging (MRI) and ultrasound imaging of peripheral nerve, such that these imaging modalities are increasingly invaluable to the diagnosis of patients with peripheral nerve disorders. Peripheral nerve imaging provides information which is supplementary to clinical and electrodiagnostic diagnosis. Both MRI and ultrasound have particular benefits in specific clinical circumstances and can be considered as complementary techniques. These technologic developments in peripheral nerve imaging will usher in an era of multimodality assessment of peripheral nerve disorders, with clinical evaluations supported by anatomic information from imaging, and functional information from electrodiagnostic studies. Such a multimodality approach will improve the accuracy and efficiency of patient care.
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Affiliation(s)
- Neil G Simon
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Jason Talbott
- Department of Radiology, University of California, San Francisco, CA, USA
| | - Cynthia T Chin
- Department of Radiology, University of California, San Francisco, CA, USA
| | - Michel Kliot
- Department of Neurological Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
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13
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Henry FP, Wang Y, Rodriguez CLR, Randolph MA, Rust EAZ, Winograd JM, de Boer JF, Park BH. In vivo optical microscopy of peripheral nerve myelination with polarization sensitive-optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:046002. [PMID: 25858593 PMCID: PMC4392067 DOI: 10.1117/1.jbo.20.4.046002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/24/2015] [Indexed: 05/19/2023]
Abstract
Assessing nerve integrity and myelination after injury is necessary to provide insight for treatment strategies aimed at restoring neuromuscular function. Currently, this is largely done with electrical analysis, which lacks direct quantitative information. In vivo optical imaging with sufficient imaging depth and resolution could be used to assess the nerve microarchitecture. In this study, we examine the use of polarization sensitive-optical coherence tomography (PS-OCT) to quantitatively assess the sciatic nerve microenvironment through measurements of birefringence after applying a nerve crush injury in a rat model. Initial loss of function and subsequent recovery were demonstrated by calculating the sciatic function index (SFI). We found that the PS-OCT phase retardation slope, which is proportional to birefringence, increased monotonically with the SFI. Additionally, histomorphometric analysis of the myelin thickness and g-ratio shows that the PS-OCT slope is a good indicator of myelin health and recovery after injury. These results demonstrate that PS-OCT is capable of providing nondestructive and quantitative assessment of nerve health after injury and shows promise for continued use both clinically and experimentally in neuroscience.
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Affiliation(s)
- Francis P. Henry
- Massachusetts General Hospital Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts 02114, United States
- Massachusetts General Hospital Harvard Medical School, Plastic Surgery Research Laboratory, No. 15 Parkman Street, WACC 435, Boston, Massachusetts 02114, United States
| | - Yan Wang
- Massachusetts General Hospital Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts 02114, United States
- University of California, Department of Bioengineering, Bourns A247, 900 University Avenue, Riverside, California 92521, United States
| | - Carissa L. R. Rodriguez
- University of California, Department of Bioengineering, Bourns A247, 900 University Avenue, Riverside, California 92521, United States
| | - Mark A. Randolph
- Massachusetts General Hospital Harvard Medical School, Plastic Surgery Research Laboratory, No. 15 Parkman Street, WACC 435, Boston, Massachusetts 02114, United States
| | - Esther A. Z. Rust
- Massachusetts General Hospital Harvard Medical School, Plastic Surgery Research Laboratory, No. 15 Parkman Street, WACC 435, Boston, Massachusetts 02114, United States
| | - Jonathan M. Winograd
- Massachusetts General Hospital Harvard Medical School, Plastic Surgery Research Laboratory, No. 15 Parkman Street, WACC 435, Boston, Massachusetts 02114, United States
| | - Johannes F. de Boer
- Massachusetts General Hospital Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts 02114, United States
- VU University Amsterdam, Department of Physics and Astronomy, De Boelelaan 1081, Amsterdam 1081 HV, The Netherlands
| | - B. Hyle Park
- University of California, Department of Bioengineering, Bourns A247, 900 University Avenue, Riverside, California 92521, United States
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14
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Rangavajla G, Mokarram N, Masoodzadehgan N, Pai SB, Bellamkonda RV. Noninvasive imaging of peripheral nerves. Cells Tissues Organs 2015; 200:69-77. [PMID: 25766202 DOI: 10.1159/000369451] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 12/19/2022] Open
Abstract
Recent developments in the field of peripheral nerve imaging extend the capabilities of imaging modalities to assist in the diagnosis and treatment of patients with peripheral nerve maladies. Methods such as magnetic resonance imaging (MRI) and its derivative diffusion tensor imaging (DTI), ultrasound (US) and positron emission tomography (PET) are capable of assessing nerve structure and function following injury and relating the state of the nerve to electrophysiological and histological analysis. Of the imaging methods surveyed here, each offered unique and interesting advantages related to the field. MRI offered the opportunity to visualize immune activity on the injured nerve throughout the course of the regeneration process, and DTI offered numerical characterization of the injury and the ability to develop statistical bases for diagnosing injury. US extends imaging to the treatment phase by enabling more precise analgesic applications following surgery, and PET represents a novel method of assessing nerve injury through analysis of relative metabolism rates in injured and healthy tissue. Exciting new possibilities to enhance and extend the abilities of imaging methods are also discussed, including innovative contrast agents, some of which enable multimodal imaging approaches and present opportunities for treatment application.
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15
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Wang D, Zhang X, Lu L, Li H, Zhang F, Chen Y, Shen J. Assessment of diabetic peripheral neuropathy in streptozotocin-induced diabetic rats with magnetic resonance imaging. Eur Radiol 2014; 25:463-71. [PMID: 25204416 DOI: 10.1007/s00330-014-3423-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/12/2014] [Accepted: 08/28/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the role of magnetic resonance (MR) imaging and quantitative T2 value measurements in the assessment of diabetic peripheral neuropathy (DPN). METHODS Sequential MR imaging, T2 measurement, and quantitative sensory testing of sciatic nerves were performed in streptozotocin-induced diabetic rats (n = 6) and normal control rats (n = 6) over a 7-week follow-up period. Histological assessment was obtained from 48 diabetic rats and 48 control rats once weekly for 7 weeks (n = 6 for each group at each time point). Nerve signal abnormalities were observed, and the T2 values, mechanical withdrawal threshold (MWT), and histological changes were measured and compared between diabetic and control animals. RESULTS Sciatic nerves in the diabetic rats showed a gradual increase in T2 values beginning at 2 weeks after the induction (P = 0.014), while a decrease in MWT started at 3 weeks after the induction (P = 0.001). Nerve T2 values had a similar time course to sensory functional deficit in diabetic rats. Histologically, sciatic nerves of diabetic rats demonstrated obvious endoneural oedema from 2 to 3 weeks after the induction, followed by progressive axonal degeneration, Schwann cell proliferation, and coexistent disarranged nerve regeneration. CONCLUSION Nerve T2 measurement is potentially useful in detecting and monitoring diabetic neuropathy. KEY POINTS • Sciatic nerves in diabetic rats showed a gradual increase in T2 values • Nerve T2 values were negatively correlated with sensory function impairment • Longitudinal T2 values can be used to monitor the disease progress • Nerve degeneration contributed mainly to progressive prolongation of nerve T2 values.
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Affiliation(s)
- Dongye Wang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 51012, China
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16
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Li HJ, Zhang X, Zhang F, Wen XH, Lu LJ, Shen J. Enhanced repair effect of toll-like receptor 4 activation on neurotmesis: assessment using MR neurography. AJNR Am J Neuroradiol 2014; 35:1608-14. [PMID: 24874529 DOI: 10.3174/ajnr.a3977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Alternative use of molecular approaches is promising for improving nerve regeneration in surgical repair of neurotmesis. The purpose of this study was to determine the role of MR imaging in assessment of the enhanced nerve regeneration with toll-like receptor 4 signaling activation in surgical repair of neurotmesis. MATERIALS AND METHODS Forty-eight healthy rats in which the sciatic nerve was surgically transected followed by immediate surgical coaptation received intraperitoneal injection of toll-like receptor 4 agonist lipopolysaccharide (n = 24, study group) or phosphate buffered saline (n = 24, control group) until postoperative day 7. Sequential T2 measurements and gadofluorine M-enhanced MR imaging and sciatic functional index were obtained over an 8-week follow-up period, with histologic assessments performed at regular intervals. T2 relaxation times and gadofluorine enhancement of the distal nerve stumps were measured and compared between nerves treated with lipopolysaccharide and those treated with phosphate buffered saline. RESULTS Nerves treated with lipopolysaccharide injection achieved better functional recovery and showed more prominent gadofluorine enhancement and prolonged T2 values during the degenerative phase compared with nerves treated with phosphate buffered saline. T2 values in nerves treated with lipopolysaccharide showed a more rapid return to baseline level than did gadofluorine enhancement. Histology exhibited more macrophage recruitment, faster myelin debris clearance, and more pronounced nerve regeneration in nerves treated with toll-like receptor 4 activation. CONCLUSIONS The enhanced nerve repair with toll-like receptor 4 activation in surgical repair of neurotmesis can be monitored by using gadofluorine M-enhanced MR imaging and T2 relaxation time measurements. T2 relaxation time seems more sensitive than gadofluorine M-enhanced MR imaging for detecting such improved nerve regeneration.
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Affiliation(s)
- H J Li
- From the Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - X Zhang
- From the Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - F Zhang
- From the Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - X H Wen
- From the Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - L J Lu
- From the Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - J Shen
- From the Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China.
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17
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Ohana M, Moser T, Moussaouï A, Kremer S, Carlier R, Liverneaux P, Dietemann JL. Current and future imaging of the peripheral nervous system. Diagn Interv Imaging 2014; 95:17-26. [DOI: 10.1016/j.diii.2013.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Mardiguian S, Serres S, Ladds E, Campbell SJ, Wilainam P, McFadyen C, McAteer M, Choudhury RP, Smith P, Saunders F, Watt G, Sibson NR, Anthony DC. Anti-IL-17A treatment reduces clinical score and VCAM-1 expression detected by in vivo magnetic resonance imaging in chronic relapsing EAE ABH mice. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 182:2071-81. [PMID: 23602647 PMCID: PMC3703548 DOI: 10.1016/j.ajpath.2013.02.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 02/13/2013] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
Abstract
IL-17 is argued to play an important role in the multiple sclerosis-like disease experimental autoimmune encephalitis (EAE). We investigated the therapeutic effects of anti-IL-17A in a chronic relapsing EAE ABH mouse model using conventional scoring, quantitative behavioral outcomes, and a novel vascular cell adhesion molecule 1 (VCAM-1)-targeted magnetic resonance imaging (MRI) contrast agent [anti-VCAM-microparticles of iron oxide (MPIO)] to identify conventionally undetectable neuropathology. Mice were administered prophylactic or treatment regimens of anti-IL-17A or IgG and two injections of anti-VCAM-MPIO before undergoing T2*-weighted three-dimensional and gadolinium-diethylenetriamine pentaacetic acid T1-weighted MRI. Rotarod, inverted screen, and open field motor function tests were performed, conventional clinical scores calculated, and central IL-17A mRNA expression quantified during acute disease, remission, and relapse. Prophylactic anti-IL-17A prevents acute disease and relapse and is associated with reduced clinical and functional severity. Treatment regimens delay relapse, improve functional scores, and are associated with reduced VCAM-MPIO lesions during remission. No significant alteration was detectable in levels of gadolinium-diethylenetriamine pentaacetic acid- or VCAM-MPIO-positive lesions during relapse. Prophylactic and treatment anti-IL-17A were therapeutically effective in chronic relapsing EAE, improving clinical and quantifiable functional outcomes. IL-17A expression seems significant during acute disease but less important chronically. Disease-related immunoneuropathology is more sensitively detected using VCAM-MPIO MRI, which may, therefore, be used to monitor therapy meaningfully.
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MESH Headings
- Acute Disease
- Animals
- Antibodies, Monoclonal/therapeutic use
- Brain/metabolism
- Contrast Media
- Drug Evaluation, Preclinical/methods
- Encephalomyelitis, Autoimmune, Experimental/metabolism
- Encephalomyelitis, Autoimmune, Experimental/pathology
- Encephalomyelitis, Autoimmune, Experimental/therapy
- Female
- Gadolinium DTPA
- Gene Expression Regulation
- Interleukin-17/antagonists & inhibitors
- Interleukin-17/biosynthesis
- Interleukin-17/genetics
- Magnetic Resonance Imaging/methods
- Mice
- Mice, Biozzi
- Motor Activity
- RNA, Messenger/genetics
- Remission Induction
- Secondary Prevention
- Severity of Illness Index
- Treatment Outcome
- Vascular Cell Adhesion Molecule-1/metabolism
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Affiliation(s)
- Silvy Mardiguian
- CR-UK/MRC Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom
| | - Sébastien Serres
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Emma Ladds
- Clinical Medical School, Magdalen College, University of Oxford, Oxford, United Kingdom
| | - Sandra J. Campbell
- CR-UK/MRC Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom
| | - Panop Wilainam
- CR-UK/MRC Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom
| | - Charles McFadyen
- CR-UK/MRC Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom
| | - Martina McAteer
- Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Robin P. Choudhury
- Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul Smith
- Department of Pharmacology, UCB Pharma S.A., Great Abingdon, United Kingdom
| | - Fay Saunders
- Department of Antibody Biology, UCB Pharma S.A., Slough, United Kingdom
| | - Gillian Watt
- Department of Pharmacology, UCB Pharma S.A., Slough, United Kingdom
| | - Nicola R. Sibson
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Daniel C. Anthony
- CR-UK/MRC Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom
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19
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Fledrich R, Stassart RM, Sereda MW. Murine therapeutic models for Charcot-Marie-Tooth (CMT) disease. Br Med Bull 2012; 102:89-113. [PMID: 22551516 DOI: 10.1093/bmb/lds010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION OR BACKGROUND Charcot-Marie-Tooth (CMT) disease represents a broad group of inherited motor and sensory neuropathies which can originate from various genetic aberrations, e.g. mutations, deletions and duplications. SOURCES OF DATA We performed a literature review on murine animal models of CMT disease with regard to experimental therapeutic approaches. Hereby, we focussed on the demyelinating subforms of CMT (CMT1). PubMed items were CMT, animal model, demyelination and therapy. AREAS OF AGREEMENT Patients affected by CMT suffer from slowly progressive, distally pronounced muscle atrophy caused by an axonal loss. The disease severity is highly variable and impairments may result in wheelchair boundness. No therapy is available yet. AREAS OF CONTROVERSY Numerous rodent models for the various CMT subtypes are available today. The selection of the correct animal model for the specific CMT subtype provides an important prerequisite for the successful translation of experimental findings in patients. GROWING POINTS Despite more than 20 years of remarkable progress in CMT research, the disease is still left untreatable. There is a growing number of experimental therapeutic strategies that may be translated into future clinical trials in patients with CMT. AREAS TIMELY FOR DEVELOPING RESEARCH The slow disease progression and insensitive outcome measures hamper clinical therapy trials in CMT. Biomarkers may provide powerful tools to monitor therapeutic efficacy. Recently, we have shown that transcriptional profiling can be utilized to assess and predict the disease severity in a transgenic rat model and in affected humans.
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Affiliation(s)
- Robert Fledrich
- Research Group 'Molecular and Translational Neurology', Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Göttingen, Germany
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20
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Duan XH, Cheng LN, Zhang F, Liu J, Guo RM, Zhong XM, Wen XH, Shen J. In vivo MRI monitoring nerve regeneration of acute peripheral nerve traction injury following mesenchymal stem cell transplantation. Eur J Radiol 2011; 81:2154-60. [PMID: 21726973 DOI: 10.1016/j.ejrad.2011.06.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/03/2011] [Accepted: 06/09/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the continuous process of nerve regeneration in acute peripheral nerve traction injury treated with mesenchymal stem cells (MSCs) transplantation using MRI. MATERIALS AND METHODS 1 week after acute nerve traction injury was established in the sciatic nerve of 48 New Zealand white rabbits, 5×10(5) MSCs and vehicle alone were grafted to the acutely distracted sciatic nerves each in 24 animals. Serial MRI and T1 and T2 measurements of the injured nerves were performed with a 1.5-T scanner and functional recovery was recorded over a 10-week follow-up period, with histological assessments performed at regular intervals. RESULTS Compared with vehicle control, nerves grafted with MSCs had better functional recovery and showed improved nerve regeneration, with a sustained increase of T1 and T2 values during the phase of regeneration. CONCLUSION MRI could be used to monitor the enhanced nerve regeneration in acute peripheral nerve traction injury treated with MSC transplantation, reflected by a prolonged increase in T1 and T2 values of the injured nerves.
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Affiliation(s)
- Xiao-Hui Duan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
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21
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Abstract
The blood-nerve barrier (BNB) separates the endoneurium from the endovascular space and the epineurial connective tissue. An intact BNB is very important for integrity and functions of the nerve fibers within the endoneurial space. Disruption of the BNB which leads to functional and structural impairment of the peripheral nerve plays an important role in many disorders of the peripheral nerve like Wallerian degeneration, inflammatory nerve disorders, and demyelination. So far, this increased BNB permeability can only be assessed ex vivo. Assessing BNB disruption in vivo would be of great value for studying disorders of the peripheral nervous system. Gadofluorine M (Gf), a new amphiphilic contrast agent for MRI, accumulates in rat nerves with increased permeability of the BNB. After application of Gf, T1-weighted MR images show contrast enhancement of nerves with a disrupted BNB. This new tool of assessing BNB permeability in vivo is described.
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Affiliation(s)
- Carsten Wessig
- Department of Neurology, University of Würzburg, Würzburg, Germany
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22
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L’imagerie du nerf et du muscle dans les atteintes nerveuses périphériques associée à l’électroneuromyographie : le couple idéal ? Rev Med Interne 2010; 31:287-94. [DOI: 10.1016/j.revmed.2009.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 03/11/2009] [Indexed: 11/18/2022]
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23
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Liu Q, Duan H, Dai Y, Niu Y, Chen H, Liu Q, Bin P, Zheng Y. The effect of 2,5-hexanedione on permeability of blood-nerve barrier in rats. Hum Exp Toxicol 2010; 29:497-506. [PMID: 20051453 DOI: 10.1177/0960327109357213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To explore the effect of 2,5-hexanedione on permeability of blood-nerve barrier, adult Wistar rats were administered with 400 mg x kg(-1) x d(- 1) 2,5-hexanedione to establish animal model of 2,5-hexnedione neuropathy. Evans blue was injected through left femoral vein of the rats after the model had been established. The distribution of fluorescence in sciatic-tibial nerve was observed and assessed. For the transverse sections of sciatic-tibial nerves, the average fluorescence intensity of proximal section was stronger (p < .01) than those of intermediate and distal sections and the average fluorescence intensity of intermediate section was stronger (p < .01) than that of distal section in the intoxicated group. In the control, the weak fluorescence was shown, and average fluorescence intensity of distal section was stronger (p < .05) than that of proximal section. The average fluorescence intensity of proximal, intermediate and distal sections in the intoxicated group was stronger (p < .01) than those of the corresponding sections in the control. For the longitudinal sections of sciatic-tibial nerves, fluorescence was observed in both proximal and distal sections in the intoxicated group. The fluorescence intensity of distal section in the control was weak and almost no fluorescence was shown in the proximal section. The permeability of blood-nerve barrier could be increased by 2,5-hexanedione.
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Affiliation(s)
- Qingjun Liu
- National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
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24
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Müller T. Role of intraspinal steroid application in patients with multiple sclerosis. Expert Rev Neurother 2009; 9:1279-87. [PMID: 19769444 DOI: 10.1586/ern.09.60] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Clinical trials on patients with progressive multiple sclerosis (MS) have shown no clear evidence of an effective symptomatic treatment with improving disability. Immunomodulatory compounds efficaciously reduce the relapse rate. Numerous earlier papers exist on the pros and cons and/or on the efficacy of intrathecal administration of differing dosages of various conventional released steroids. Furthermore, this treatment approach was nearly abondoned owing to a debate on side effects and a missing proven superiority over intravenous systemic high dosage steroid administration. However, recent open-label studies in progressive MS patients with predominant spinal symptomatology investigated the repeated intraspinal application of the sustained-release compound triamcinolone acetonide (TCA). A distinct improvement of walking distance and MS scores in the short term and stabilization of this beneficial effect after repeat TCA application every 6-12 weeks was found. Moreover, patients with a relapse with acute onset of painful sensations showed a marked pain improvement after repeated TCA application following prior unsuccessful treatment with intravenous steroids. The available data from open studies ask for the performance of a randomized clinical trial, comparing intravenous with intrathecal steroid administration, to confirm the higher efficacy of the more invasive therapy with repeated lumbar puncture.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St Joseph Hospital, Berlin-Weissensee, Gartenstrasse 1, 13088 Berlin, Germany.
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25
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Lehmann HC, Zhang J, Mori S, Sheikh KA. Diffusion tensor imaging to assess axonal regeneration in peripheral nerves. Exp Neurol 2009; 223:238-44. [PMID: 19879260 DOI: 10.1016/j.expneurol.2009.10.012] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 10/14/2009] [Accepted: 10/16/2009] [Indexed: 11/17/2022]
Abstract
Development of outcome measures to assess ongoing nerve regeneration in the living animal that can be translated to human can provide extremely useful tools for monitoring the effects of therapeutic interventions to promote nerve regeneration. Diffusion tensor imaging (DTI), a magnetic resonance based technique, provides image contrast for nerve tracts and can be applied serially on the same subject with potential to monitor nerve fiber content. In this study, we examined the use of ex vivo high-resolution DTI for imaging intact and regenerating peripheral nerves in mice and correlated the MRI findings with electrophysiology and histology. DTI was done on sciatic nerves with crush, without crush, and after complete transection in different mouse strains. DTI measures, including fractional anisotropy (FA), parallel diffusivity, and perpendicular diffusivity were acquired and compared in segments of uninjured and crushed/transected nerves and correlated with morphometry. A comparison of axon regeneration after sciatic nerve crush showed a comparable pattern of regeneration in different mice strains. FA values were significantly lower in completely denervated nerve segments compared to uninjured sciatic nerve and this signal was restored toward normal in regenerating nerve segments (crushed nerves). Histology data indicate that the FA values and the parallel diffusivity showed a positive correlation with the total number of regenerating axons. These studies suggest that DTI is a sensitive measure of axon regeneration in mouse models and provide basis for further development of imaging technology for application to living animals and humans.
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Affiliation(s)
- Helmar C Lehmann
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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26
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Spatial diversity of blood-brain barrier alteration and macrophage invasion in experimental autoimmune encephalomyelitis: a comparative MRI study. Exp Neurol 2009; 220:207-11. [PMID: 19733560 DOI: 10.1016/j.expneurol.2009.08.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 08/07/2009] [Accepted: 08/28/2009] [Indexed: 11/20/2022]
Abstract
Inflammation plays a central role in the development of numerous disorders of the central nervous system (CNS) such as multiple sclerosis (MS). For a long time it was assumed that recruitment of macrophages into the CNS and breakdown of the blood-brain barrier (BBB) are closely linked. In the present study we challenge this concept. We used small superparamagnetic iron oxide particles (SPIO)-enhanced T2-weighted (T2-w) magnetic resonance imaging (MRI) on a routine 1.5 T MRI unit to follow macrophage infiltration in experimental autoimmune encephalomyelitis (EAE), the animal model of MS. After an initial SPIO-enhanced MRI, gadofluorine M (Gf), an experimental contrast agent which proved to be more sensitive in detecting BBB leakage than gadolinium (Gd)-DTPA (Bendszus, M., Ladewig, G., Jestaedt, L., Misselwitz, B., Solymosi, L., Toyka, K.V., Stoll, G., Gadofluorine-M enhancement allows more sensitive detection of inflammatory CNS lesions than T2-w imaging: a quantitative MRI study. Brain 2008; 1-12), was applied to the same animals followed by a second scan. Areas with SPIO-induced signal loss on T2-w MRI indicative of recent macrophage infiltration were matched with areas showing Gf enhancement as a measure of BBB disturbance. Overall 87 EAE lesions showed iron-related signal loss, while 57 lesions showed Gf enhancement. By direct comparison we could detect concomitant SPIO-induced signal loss and Gf enhancement only in a small minority of lesions. In conclusion, our findings show macrophage infiltration in the CNS during EAE in areas with a closed BBB for humoral factors. This holds true despite the use of a more sensitive MR contrast agent for BBB disruption than Gd-DTPA. Our experimental observations may have implications for disease monitoring in MS patients by MRI which guides treatment decisions.
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Takagi T, Nakamura M, Yamada M, Hikishima K, Momoshima S, Fujiyoshi K, Shibata S, Okano HJ, Toyama Y, Okano H. Visualization of peripheral nerve degeneration and regeneration: Monitoring with diffusion tensor tractography. Neuroimage 2009; 44:884-92. [DOI: 10.1016/j.neuroimage.2008.09.022] [Citation(s) in RCA: 203] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 09/15/2008] [Accepted: 09/17/2008] [Indexed: 12/16/2022] Open
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Unger EC. Can a newer MR contrast agent be used to monitor disease progression in muscular dystrophy? Radiology 2008; 250:1-3. [PMID: 19092081 DOI: 10.1148/radiol.2501081665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Evan C Unger
- Department of Radiology, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA.
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