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Baldrick P. Nonclinical safety testing of imaging agents, contrast agents and radiopharmaceuticals. J Appl Toxicol 2020; 41:95-104. [PMID: 32833236 DOI: 10.1002/jat.4054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 11/11/2022]
Abstract
Drug development includes imaging agents, contrast agents and radiopharmaceuticals; these materials differ from therapeutic drugs in that they are largely used to diagnose and/or monitor diseases and not treat them. Consequently, nonclinical safety testing needs are different. An examination of testing packages supporting clinical entry and/or marketing of these materials has shown a common approach to some study types (eg, imaging, biodistribution and toxicity testing). Recent regulatory guidelines to support development are the United States Food and Drug Administration (FDA)'s "Guidance for Industry Microdose Radiopharmaceutical Diagnostic Drugs: Nonclinical Study Recommendations" and the European Medicines Agency (EMA)'s "Guideline on the Non-Clinical Requirements for Radiopharmaceuticals" (currently draft). It is hoped that these documents will allow developers to only perform nonclinical studies that are necessary to support functionality, follow distribution of the material and examine general safety/toxicity. However, as they are mainly focused on radiopharmaceuticals, companies are likely to apply knowledge of established testing packages to other new imaging agents and/or follow principles given in older regulatory guidelines, namely FDA's "Guidance for Industry Developing Medical Imaging Drug and Biological Products Part I Conducting Safety Assessments". Thus, in some cases, the need for regulatory agency interaction is still vital to avoid development surprises and delays due to an incomplete or badly performed testing package.
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Affiliation(s)
- Paul Baldrick
- Nonclinical Strategic Product Development, Covance Laboratories Ltd, Harrogate, North Yorkshire, UK
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Delayed contrast enhancement of hepatic parenchyma after intravenous sonographic contrast agent: unusual phenomenon. Case report and review of literature. J Ultrasound 2020; 24:3-9. [PMID: 31981154 PMCID: PMC7925801 DOI: 10.1007/s40477-020-00429-y] [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: 10/21/2019] [Accepted: 01/10/2020] [Indexed: 11/10/2022] Open
Abstract
Aim A case of heterogeneous late-phase hepatic enhancement (HLHE) using contrast‐enhanced ultrasound (CEUS) with SonoVue is presented, where HLHE lasted after 50 min of injection. Methods This study aims to review prior literature on this topic, to characterize the features of HLHE in the liver, and to find possible and reliable explanations for this phenomenon. Results From literature, thus far five publications discuss this phenomenon with a total of 21 patients. Conclusion We suggest that phagocytosis of contrast agent microbubbles by macrophages, and lymphocytosis of peripheral blood due to stress conditions of the patients might be in the background of HLHE.
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Bush N, Healey A, Shah A, Box G, Kirkin V, Kotopoulis S, Kvåle S, Sontum PC, Bamber J. Therapeutic Dose Response of Acoustic Cluster Therapy in Combination With Irinotecan for the Treatment of Human Colon Cancer in Mice. Front Pharmacol 2019; 10:1299. [PMID: 31803049 PMCID: PMC6877694 DOI: 10.3389/fphar.2019.01299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction: Acoustic Cluster Therapy (ACT) comprises coadministration of a formulation containing microbubble-microdroplet clusters (PS101) together with a regular medicinal drug and local ultrasound (US) insonation of the targeted pathological tissue. PS101 is confined to the vascular compartment and when the clusters are exposed to regular diagnostic imaging US fields, the microdroplets undergo a phase shift to produce bubbles with a median diameter of 22 µm. Low frequency, low mechanical index US is then applied to drive oscillations of the deposited ACT bubbles to induce biomechanical effects that locally enhance extravasation, distribution, and uptake of the coadministered drug, significantly increasing its therapeutic efficacy. Methods: The therapeutic efficacy of ACT with irinotecan (60 mg/kg i.p.) was investigated using three treatment sessions given on day 0, 7, and 14 on subcutaneous human colorectal adenocarcinoma xenografts in mice. Treatment was performed with three back-to-back PS101+US administrations per session with PS101 doses ranging from 0.40-2.00 ml PS101/kg body weight (n = 8-15). To induce the phase shift, 45 s of US at 8 MHz at an MI of 0.30 was applied using a diagnostic US system; low frequency exposure consisted of 1 or 5 min at 500 kHz with an MI of 0.20. Results: ACT with irinotecan induced a strong, dose dependent increase in the therapeutic effect (R2 = 0.95). When compared to irinotecan alone, at the highest dose investigated, combination treatment induced a reduction in average normalized tumour volume from 14.6 (irinotecan), to 5.4 (ACT with irinotecan, p = 0.002) on day 27. Median survival increased from 34 days (irinotecan) to 54 (ACT with irinotecan, p = 0.002). Additionally, ACT with irinotecan induced an increase in the fraction of complete responders; from 7% to 26%. There was no significant difference in the therapeutic efficacy whether the low frequency US lasted 1 or 5 min. Furthermore, there was no significant difference between the enhancement observed in the efficacy of ACT with irinotecan when PS101+US was administered before or after irinotecan. An increase in early dropouts was observed at higher PS101 doses. Both mean tumour volume (on day 27) and median survival indicate that the PS101 dose response was linear in the range investigated.
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Affiliation(s)
- Nigel Bush
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom
| | - Andrew Healey
- CRUK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Anant Shah
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom
| | - Gary Box
- CRUK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Vladimir Kirkin
- CRUK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Jeffrey Bamber
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom
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Reesink KD, Hendrikx T, van Gorp PJ, Hoeks AP, Shiri-Sverdlov R. Ultrasonic Perfluorohexane-Loaded Monocyte Imaging: Toward a Minimally Invasive Technique for Selective Detection of Liver Inflammation in Fatty Liver Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:921-933. [PMID: 28990215 DOI: 10.1002/jum.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 06/06/2017] [Accepted: 07/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To investigate the utility of ultrasonic (US) perfluorohexane (PFH)-loaded monocyte imaging for detection of liver inflammation in fatty liver disease. METHODS C57Bl6 mice were injected intraperitoneally with tumor necrosis factor α and assessed by US PFH-loaded monocyte imaging 3 hours later. Echogenic monocytes were injected intravenously, leading to a transient increase in liver tissue intensity on a US perfusion scan. The contrast wash-out time constant was hypothesized to reflect the degree of inflammation. Next, we evaluated US PFH-loaded monocyte imaging in Ldlr-/- mice fed a 1-week high-fat/high-cholesterol diet as model for early developing nonalcoholic steatohepatitis. Adjunct analyses included tissue markers of liver inflammation. RESULTS Tumor necrosis factor α-injected mice showed a reduced wash-out time constant (mean ± SEM, 0.013 ± 0.003; n = 8) compared to controls (0.054 ± 0.009; n = 7; P = .0006), indicative of increased inflammatory adhesion molecule expression on the endothelium. The Ldlr-/- mice fed the high-fat/high-cholesterol diet showed liver inflammation, as reflected by increased (3- to 4-fold) infiltration of inflammatory cells and increased (3- to 4-fold) gene expression of tumor necrosis factor α, integrin αM, intracellular adhesion molecule, and vascular cell adhesion molecule. However, in these mice, no difference was detected in the wash-out time constant as assessed by US PFH-loaded monocyte imaging (high-fat/high-cholesterol, 0.050 ± 0.017; n = 5; chow, 0.048 ± 0.006; n = 6; P = .91). CONCLUSIONS Our results indicate that US PFH-loaded monocyte imaging is able to detect vascularly expressed inflammatory adhesion molecules in the mouse liver on direct endothelial stimulation. However, in our mouse model of early developing nonalcoholic steatohepatitis, we did not detect inflammation by this method, which may suggest that the time-dependent relationship between parenchymal and endothelial inflammation remains a fundamental issue to be addressed.
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Affiliation(s)
- Koen D Reesink
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht, the Netherlands
| | - Tim Hendrikx
- Department of Molecular Genetics, Nutrition and Toxicology Research Institute Maastricht School for Nutritional Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Patrick J van Gorp
- Department of Molecular Genetics, Nutrition and Toxicology Research Institute Maastricht School for Nutritional Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Arnold P Hoeks
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht, the Netherlands
| | - Ronit Shiri-Sverdlov
- Department of Molecular Genetics, Nutrition and Toxicology Research Institute Maastricht School for Nutritional Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
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Wood SC, Antony S, Brown RP, Chen J, Gordon EA, Hitchins VM, Zhang Q, Liu Y, Maruvada S, Harris GR. Effects of ultrasound and ultrasound contrast agent on vascular tissue. Cardiovasc Ultrasound 2012; 10:29. [PMID: 22805356 PMCID: PMC3493263 DOI: 10.1186/1476-7120-10-29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 06/25/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ultrasound (US) imaging can be enhanced using gas-filled microbubble contrast agents. Strong echo signals are induced at the tissue-gas interface following microbubble collapse. Applications include assessment of ventricular function and virtual histology. AIM While ultrasound and US contrast agents are widely used, their impact on the physiological response of vascular tissue to vasoactive agents has not been investigated in detail. METHODS AND RESULTS In the present study, rat dorsal aortas were treated with US via a clinical imaging transducer in the presence or absence of the US contrast agent, Optison. Aortas treated with both US and Optison were unable to contract in response to phenylephrine or to relax in the presence of acetylcholine. Histology of the arteries was unremarkable. When the treated aortas were stained for endothelial markers, a distinct loss of endothelium was observed. Importantly, terminal deoxynucleotidyl transferase mediated dUTP nick-end-labeling (TUNEL) staining of treated aortas demonstrated incipient apoptosis in the endothelium. CONCLUSIONS Taken together, these ex vivo results suggest that the combination of US and Optison may alter arterial integrity and promote vascular injury; however, the in vivo interaction of Optison and ultrasound remains an open question.
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Affiliation(s)
- Steven C Wood
- Food and Drug Administration, Center for Devices and Radiological Health (CDRH), 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Sible Antony
- Food and Drug Administration, Center for Devices and Radiological Health (CDRH), 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
- School of Medicine and Health Sciences, The George Washington University, 2300, Eye Street, NW, Washington, DC, 20037, USA
| | - Ronald P Brown
- Food and Drug Administration, Center for Devices and Radiological Health (CDRH), 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Jin Chen
- Food and Drug Administration, Center for Drug Evaluation and Research (CDER), 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Edward A Gordon
- Food and Drug Administration, Center for Devices and Radiological Health (CDRH), 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Victoria M Hitchins
- Food and Drug Administration, Center for Devices and Radiological Health (CDRH), 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Qin Zhang
- Food and Drug Administration, Center for Devices and Radiological Health (CDRH), 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Yunbo Liu
- Food and Drug Administration, Center for Devices and Radiological Health (CDRH), 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Subha Maruvada
- Food and Drug Administration, Center for Devices and Radiological Health (CDRH), 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Gerald R Harris
- Food and Drug Administration, Center for Devices and Radiological Health (CDRH), 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
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Hart ML, Much C, Köhler D, Schittenhelm J, Gorzolla IC, Stahl GL, Eltzschig HK. Use of a hanging-weight system for liver ischemic preconditioning in mice. Am J Physiol Gastrointest Liver Physiol 2008; 294:G1431-40. [PMID: 18436620 DOI: 10.1152/ajpgi.00083.2008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Ischemic preconditioning (IP) represents a powerful experimental strategy to identify novel molecular targets to attenuate hepatic injury during ischemia. As a result, murine studies of hepatic IP have become an important field of research. However, murine IP is technically challenging, and experimental details can alter the results. Therefore, we systematically tested a novel model of hepatic IP by using a hanging-weight system for portal triad occlusion. This system has the benefit of applying intermittent hepatic ischemia and reperfusion without manipulation of a surgical clamp or suture, thus minimizing surgical trauma. Systematic evaluation of this model revealed a close correlation of hepatic ischemia time with liver damage as measured by alanine (ALT) and aspartate (AST) aminotransferase serum levels. Using different numbers of IP cycles and times intervals, we found optimal liver protection with four cycles of 3 min ischemia/3 min reperfusion as measured by ALT, AST, lactate dehydrogenase, and interleukin-6. Similarly, ischemia-associated increases in hepatic infarct size, neutrophil infiltration, and histological injury were maximally attenuated with the above regimen. To demonstrate transcriptional consequences of liver IP, we isolated RNA from preconditioned liver and confirmed transcriptional modulation of known target genes (equilibrative nucleoside transporters, acute-phase complement genes). Taken together, these studies confirm highly reproducible liver injury and protection by IP when using the hanging-weight system for hepatic ischemia and intermittent reperfusion. Further studies of murine IP may consider this technique.
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Affiliation(s)
- Melanie L Hart
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Liu P, Gao YH, Tan KB, Liu Z, Zuo S. Grey scale enhancement of rabbit liver and kidney by intravenous injection of a new lipid-coated ultrasound contrast agent. World J Gastroenterol 2004; 10:2369-72. [PMID: 15285021 PMCID: PMC4576290 DOI: 10.3748/wjg.v10.i16.2369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To assess the grey scale enhancement of a new lipid-coated ultrasound contrast agent in solid abdominal organs as liver and kidney.
METHODS: Size distribution and concentration of the lipid-coated contrast microbubbles were analyzed by a Coulter counter. Two-dimensional (2D) second harmonic imaging of the hepatic parenchyma, the inferior vena cava and the right kidney of the rabbits were acquired before and after contrast agent injection. Images were further quantified by histogram in Adobe Photoshop 6.0. Time-intensity curves of hepatic parenchyma, inferior vena cava and renal cortex were generated from the original grey scale.
RESULTS: The 2D images of hepatic parenchyma and cortex of the kidney were greatly enhanced after injection and the peak time could last more than 50 min.
CONCLUSION: This new lipid ultrasound contrast agent could significantly enhance the grey scale imaging of the hepatic parenchyma and the renal cortex for more than 50 min.
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Affiliation(s)
- Ping Liu
- Department of Ultrasound, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
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Wong KK, Huang I, Kim YR, Tang H, Yang ES, Kwong KK, Wu EX. In vivo study of microbubbles as an MR susceptibility contrast agent. Magn Reson Med 2004; 52:445-52. [PMID: 15334560 DOI: 10.1002/mrm.20181] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The potential application of gas microbubbles as a unique intravascular susceptibility contrast agent for MRI has not been fully explored. In this study, the MR susceptibility effect of an ultrasound microbubble contrast agent, Optison, was studied with rat liver imaging at 7 T. Optison suspension in two different doses (0.15 mL/kg and 0.4 mL/kg) was injected into rats, and induced transverse relaxation rate increases (deltaR2*) of 29.1 +/- 1.6 s(-1) (N = 2) and 61.5 +/- 12.9 s(-1) (N = 6), respectively, in liver tissue. Liver uptake of intact albumin microbubbles was observed 10 min after injection. Eight of the 16 rats studied showed no susceptibility enhancement. This is probably attributable to the intravascular microbubble growth due to transmural CO2 supersaturation in the cecum and colon in small animals that causes microbubble aggregation and trapping in the inferior vena cava (IVC). In vitro deltaR2* measurements of Optison suspension at different concentrations are also reported.
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Affiliation(s)
- Kelvin K Wong
- Jockey Club MRI Engineering Center, University of Hong Kong
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Rasmussen H, Dirven HAAM, Grant D, Johnsen H, Midtvedt T. Etiology of cecal and hepatic lesions in mice after administration of gas-carrier contrast agents used in ultrasound imaging. Toxicol Appl Pharmacol 2003; 188:176-84. [PMID: 12729717 DOI: 10.1016/s0041-008x(03)00101-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aim of the study was to investigate the etiology of cecal and hepatic lesions in mice and rats after intravenous administration of gas-carrier contrast agents (GCAs). A modified fluorescein flowmetry technique and 24 h necropsy were used in mice (conventional and germ free), rats, and guinea pigs after GCA administration. Different diets and oral nonabsorbable antibiotics were used. Nonfluorescence, edema, congestion, hemorrhage, and mucosal erosion in cecum and colon and nonfluorescent areas in the liver were observed from 16 min after GCA administration in conventional mice on standard diet. Numerous gas bubbles (>50 microm) were observed in the vasculature around the nonfluorescent areas of cecum and colon and in mesenteric vessels draining to the portal vein. Acute inflammation, edema, hemorrhage, and ulceration of the cecum and colon and liver necrosis were seen 24 h after GCA administration in conventional mice on standard diet. When mice were maintained on either a diet with glucose as the only carbohydrate source or on a standard diet supplemented with antibiotics, uniform fluorescence and no organ lesions were observed after GCA administration. Uniform fluorescence and no organ lesions were observed in germ-free mice, rats, and guinea pigs dosed with GCAs and in control animals (mice, rats, and guinea pigs) dosed with sucrose. The results indicate that intravascular growth of GCA microbubbles occurs in the cecal and colonic wall of mice, leading to occlusive ischemia and necrosis in these intestinal segments and secondary gas embolisation in the liver. Transmural gas supersaturation in the cecal wall may explain the intravascular bubble growth in mice.
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Affiliation(s)
- H Rasmussen
- Research and Development, Amersham Health AS, N-0401, Oslo, Norway.
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