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Milito C, Cinetto F, Megna V, Spadaro G, Quinti I, Liberatore M. The Usefulness of Scintigraphic Studies in the Assessment of Asymptomatic Bowel Disease in Patients with Primary Antibody Diseases. J Clin Med 2020; 9:jcm9040949. [PMID: 32235478 PMCID: PMC7230964 DOI: 10.3390/jcm9040949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 12/03/2022] Open
Abstract
Enteropathy may be the first presentation of immunodeficiency or it may occur during the course of the disease and in association with malabsorption in patients affected by primary antibody diseases. For these patients, immunoglobulin G (IgG) replacement therapy prevents infectious and non-infectious complications. Nonetheless some patients cannot achieve optimal IgG trough levels, even when treated with high Ig doses in absence of protein-losing syndromes. We investigated seven patients affected by common variable immunodeficiencies (CVIDs) and treated with high Ig doses (600–800 mg/kg/month) showing low IgG trough level. Patients underwent abdominal scintigraphy with human polyclonal immunoglobulin G labeled with 99mTc and with white blood cells labeled by 111 Indium-oxinate to investigate asymptomatic bowel inflammation. A concentration of labeled leukocytes in abdominal segments greater than that observed with human polyclonal immunoglobulin G was evident only in one patient. In five patients a slight concentration of both radiopharmaceuticals was reported, due to mild intestinal inflammatory response. These data might be related to mild increase of capillary permeability in the absence of inflammation leukocyte mediated. This study discloses a new cause of IgG-accelerated catabolism due to inflammatory bowel conditions without diarrhea in CVID patients.
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Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy;
- Correspondence: ; Tel.: +39-0649972007
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, 35122 Padova, Italy;
- Internal Medicine I, Ca’ Foncello Hospital, 31100 Treviso, Italy
| | - Valentina Megna
- Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, 0161 Rome, Italy; (V.M.); (M.L.)
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Interdepartmental Center for Research in Basic and Clinical Immunology Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy;
| | - Mauro Liberatore
- Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, 0161 Rome, Italy; (V.M.); (M.L.)
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Liberatore M, Calandri E, Ciccariello G, Fioravanti M, Megna V, Rampin L, Marzola MC, Zerizer I, Al-Nahhas A, Rubello D. The labeled-leukocyte scan in the study of abdominal abscesses. Mol Imaging Biol 2011; 12:563-9. [PMID: 20376569 DOI: 10.1007/s11307-010-0314-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The purpose of the present paper was to review the literature over the last 30 years to assess the value of radionuclide imaging, particularly labeled leukocyte scan, as compared to other imaging modalities in the management of abdominal abscesses. METHODS A systematic review of the published studies in humans cited in PubMed written in English, French, German, Italian, and Spanish was made. RESULTS Ultrasound (US) has lower sensitivity than leukocyte scan (LS), particularly in patients without localizing signs, while CT has higher sensitivity than US, but less than LS. On the other hand, CT had higher specificity than both LS and US. DISCUSSION LS is the more sensitive method to localize abdominal abscesses and may guide dedicated US and CT investigations to improve their diagnostic potential. Further diagnostic evolution is expected from the routine use of hybrid SPECT/CT systems.
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Affiliation(s)
- Mauro Liberatore
- Service of Nuclear Medicine, Department of Radiological Sciences, La Sapienza University of Rome, Rome, Italy
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Joosten LAB, Van De Veerdonk FL, Vonk AG, Boerman OC, Keuter M, Fantuzzi G, Verschueren I, Van Der Poll T, Dinarello CA, Kullberg BJ, Van Der Meer JWM, Netea MG. Differential susceptibility to lethal endotoxaemia in mice deficient in IL-1α, IL-1β or IL-1 receptor type I. APMIS 2010; 118:1000-7. [PMID: 21091783 DOI: 10.1111/j.1600-0463.2010.02684.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of intereukin-1 (IL-1) in mortality caused by endotoxaemia remains controversial. While IL-1 receptor antagonist (IL-1Ra) protects mice from lethal endotoxaemia, mice deficient in IL-1β (IL-1β⁻( /)⁻) display normal susceptibility to lipopolysaccharide (LPS). The aim of this study was to identify the source of these discrepancies. Mice deficient in IL-1α, IL-1β or IL-1R type I were injected intraperitoneally with Escherichia coli or Salmonella typhimurium LPS. Survival of the mice was examined and compared with C57/Bl6 wild-type mice. In addition, serum cytokine concentrations were determined after LPS challenge and in vitro cytokine production by peritoneal macrophages was analysed. Clearance of radioactive IL-1α was examined in IL-1α⁻(/)⁻ and wild-type mice. IL-1β⁻(/)⁻ mice were normally susceptible to endotoxaemia and cytokine production did not differ from that in control mice. Surprisingly, LPS mortality in IL-1α⁻(/)⁻ mice was significantly greater than that in control mice, accompanied by higher interferon-γ release. These effects were mediated by a distorted homeostasis of IL-1RI receptors, as shown by a strongly delayed clearance of IL-1α. In contrast to the IL-1α⁻(/)⁻ and IL-1β⁻(/)⁻ mice, IL-1RI⁻(/)⁻ mice were completely resistant to high doses of LPS. In conclusion, IL-1RI-mediated signals are crucial in mediating mortality occurring as a result of lethal endotoxaemia. Investigation of IL-1-mediated pathways in IL-1 knock-out mice is complicated by a distorted homeostasis of IL-1Rs.
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Affiliation(s)
- Leo A B Joosten
- Department of Medicine, Radboud University Nijmegen Medical Center, The Netherlands
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Signore A, Mather SJ, Piaggio G, Malviya G, Dierckx RA. Molecular imaging of inflammation/infection: nuclear medicine and optical imaging agents and methods. Chem Rev 2010; 110:3112-45. [PMID: 20415479 DOI: 10.1021/cr900351r] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- A Signore
- Nuclear Medicine Unit, II Faculty of Medicine and Surgery, Sapienza University of Rome, Rome, Italy.
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Walker RC, Jones-Jackson LB, Martin W, Habibian MR, Delbeke D. New imaging tools for the diagnosis of infection. Future Microbiol 2007; 2:527-54. [DOI: 10.2217/17460913.2.5.527] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infection imaging became widespread in 1971 with the release of 67Ga citrate. Multiphase skeletal scintigraphy and radiolabeled white blood cells (WBCs) have since become the most widespread clinically used agents for the imaging of infection. A wide variety of other radiolabeled probes are under investigation, based on antibodies, cytokines, assorted proteins and other molecules, alone or in various combinations. However, these latter agents, with a few exceptions, are not routinely used clinically. Radiolabeled ciprofloxacin represents the first attempt to develop an infection-specific imaging agent (most infection-imaging probes localized nonspecifically to inflammation as well), but it has not proven superior to radiolabeled WBCs or 18F-fluoro-deoxy-glucose (FDG) PET. Because of the ability to combine exquisite anatomic detail with focal uptake of 18F-FDG, PET–computed tomography has achieved great success in the detection and localization of infection, including in clinically adverse conditions. Despite these advances, at this time an infection-specific imaging agent does not exist.
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Affiliation(s)
- Ronald C Walker
- Associate Professor Vanderbilt University Medical Center, Department of Radiology & Radiological Sciences, 1161 21st Avenue South, CCC-1121 MCN, Nashville, TN 37232-2675, USA
| | - Laurie B Jones-Jackson
- Associate Professor Vanderbilt University Medical Center, Department of Radiology & Radiological Sciences, 1161 21st Avenue South, CCC-1121 MCN, Nashville, TN 37232-2675, USA
| | - William Martin
- Associate Professor Vanderbilt University Medical Center, Department of Radiology & Radiological Sciences, 1161 21st Avenue South, CCC-1121 MCN, Nashville, TN 37232-2675, USA
| | - M Reza Habibian
- Associate Professor Vanderbilt University Medical Center, Department of Radiology & Radiological Sciences, 1161 21st Avenue South, CCC-1121 MCN, Nashville, TN 37232-2675, USA
| | - Dominique Delbeke
- Professor Vanderbilt University Medical Center, Department of Radiology & Radiological Sciences, 1161 21st Avenue South, CCC-1121 MCN, Nashville, TN 37232-2675, USA
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Signore A, Annovazzi A, Corsetti F, Capriotti G, Chianelli M, De Winter F, Scopinaro F. Biological imaging for the diagnosis of inflammatory conditions. BioDrugs 2003; 16:241-59. [PMID: 12196038 DOI: 10.2165/00063030-200216040-00002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Radiopharmaceuticals used for in vivo imaging of inflammatory conditions can be conveniently classified into six categories according to the different phases in which the inflammatory process develops. The trigger of an inflammatory process is a pathogenic insult (phase I) that causes activation of endothelial cells (phase II); there is then an increase of vascular permeability followed by tissue oedema (phase III). Phase IV is characterised by infiltration of polymorphonuclear cells, and a self-limiting regulatory process called apoptosis is observed (phase V). If the inflammatory process persists, late chronic inflammation takes place (phase VI). In some pathological conditions, such as organ-specific autoimmune diseases, chronic inflammation is present early in the disease. The aim of nuclear medicine in the field of inflammation/infection is to develop noninvasive tools for the in vivo detection of specific cells and tissues. This would allow early diagnosis of initial pathophysiological changes that are undetectable by clinical examination or by other diagnostic tools, and could also be used to evaluate the state of activity of the disease during therapy. These potential applications are of great interest in clinical practice. In this review, we describe the various approaches that have been developed in the last 25 years of experience. Recent advances in the diagnosis of inflammatory processes have led to the development of specific radiopharmaceuticals that are intended to allow specific stage-related diagnosis.
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Affiliation(s)
- Alberto Signore
- Department of Clinical Sciences, Nuclear Medicine, 2nd Faculty of Medicine, University of Rome, La Sapienza, Rome, Italy.
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Boerman OC, Rennen H, Oyen WJ, Corstens FH. Radiopharmaceuticals to image infection and inflammation. Semin Nucl Med 2001; 31:286-95. [PMID: 11710771 DOI: 10.1053/snuc.2001.26189] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Scintigraphic imaging of infection and inflammation is a powerful diagnostic tool in the management of patients with infectious or inflammatory diseases. Most infectious and inflammatory foci can be visualized accurately with radiolabeled autologous leukocytes. However, the preparation of this radiopharmaceutical is laborious and requires the handling of potentially contaminated blood. A few radiopharmaceuticals are available that could be used instead of radiolabeled leukocytes to scintigraphically visualize infectious and inflammatory foci, such as 67Ga-citrate and 99mTc-labeled antigranulocyte antibody preparations. Various agents labeled with 99mTc are currently developed for this application. Most of these newly developed agents are ligands that bind receptors on white blood cell subpopulations, ie, monoclonal antibodies, chemotactic peptides, and cytokines. Furthermore, agents are developed that potentially could distinguish between infection and nonmicrobial inflammation. In addition, 18F-fluorodeoxyglucose positron emission tomography imaging was proposed to visualize inflammatory foci when a high spatial resolution is required. In this article, the characteristics and diagnostic potential of established and experimental radiopharmaceuticals for infection and inflammation imaging are reviewed.
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Affiliation(s)
- O C Boerman
- Department of Nuclear Medicine, University Medical Center Nijmegen, The Netherlands
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Affiliation(s)
- J W Park
- Division of Hematology and Oncology, Department of Medicine, University of California, San Franciso, Medical Center, San Franciscos, California 94115, USA
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Signore A, Procaccini E, Annovazzi A, Chianelli M, van der Laken C, Mire-Sluis A. The developing role of cytokines for imaging inflammation and infection. Cytokine 2000; 12:1445-54. [PMID: 11023659 DOI: 10.1006/cyto.2000.0746] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The diagnosis of inflammatory processes is an important goal in medicine. In some cases the diagnosis is easy, based on the clinical history and the physical examination of the patient. Other cases are more difficult to diagnose because they are asymptomatic or with non-specific symptoms. Thus, several imaging techniques have been developed for the diagnosis of inflammatory processes, from the simple X-ray to the more sophisticated computerised tomography, magnetic resonance imaging and nuclear medicine scan. They provide different information and their role in different diseases will be discussed in this review with particular emphasis on the expanding field of the use of radiolabelled cytokines for imaging infection/inflammation. So far, IL-1, IL-1ra, IL-2, IL-6, IL-8, IL-10, IL-12 p40, G-CSF, IFN-gamma and EGF have been radiolabelled for in vivo targetting of different leukocyte subsets with promising results for their clinical use.
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Affiliation(s)
- A Signore
- Nu.M.E.D. Group, Servizio Speciale di Medicina Nucleare, Department of Clinical Sciences, University of Rome 'La Sapienza', Rome, Italy.
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Barrera P, van der Laken CJ, Boerman OC, Oyen WJ, van de Ven MT, van Lent PL, van de Putte LB, Corstens FH. Radiolabelled interleukin-1 receptor antagonist for detection of synovitis in patients with rheumatoid arthritis. Rheumatology (Oxford) 2000; 39:870-4. [PMID: 10952741 DOI: 10.1093/rheumatology/39.8.870] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To investigate the distribution of radiolabelled interleukin-1 receptor antagonist (IL-1ra) in patients with rheumatoid arthritis (RA) and to assess whether this cytokine is suitable for scintigraphic visualization of synovitis. METHODS In patients with active RA, scintigraphy was performed after a single i. v. dose of [(123)I]IL-1ra. Clearance and organ distribution of radiolabelled IL-1ra were studied. To assess whether radiolabelled IL-1ra targets the synovial IL-1 receptors, the scintigraphic images obtained with IL-1ra were compared with those obtained by the use of a non-specific control agent. In addition, autoradiography was performed in mice with antigen-induced arthritis that were injected with either radiolabelled IL-1ra or a size-matched, non-receptor-binding protein. RESULTS Radiolabelled IL-1ra allowed clear visualization of inflamed joints. Specificity in the detection of synovitis was high, whereas a number of painful and swollen joints were not visualized by scintigraphy. The procedure was well tolerated and [(123)I]IL-1ra was rapidly cleared from the circulation (t(1/2)alpha 11 min, t(1/2)beta 612 min) and excreted mainly in the urine. The definition of synovial contours by IL-1ra scintigraphy was not better than that observed with a non-specific agent. Although radiolabelled IL-1ra retained its affinity for IL-1 receptors, no binding to synovium was observed by autoradiography. CONCLUSIONS Radiolabelled IL-1ra allows the visualization of synovitis in patients with RA. However, neither the imaging nor the autoradiographic studies indicate that joint accumulation of radiolabelled IL-1ra is due to specific IL-1 receptor targeting. IL-1ra has proved its therapeutic value in RA, but with the dose schedule in this study it does not behave as a specific radiopharmaceutical that is suitable for scintigraphic detection of inflammation.
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Affiliation(s)
- P Barrera
- Departments of Rheumatology and. Nuclear Medicine, University Hospital, Nijmegen, The Netherlands
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