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Bilgin B, Adam M, Hekim MG, Bulut F, Ozcan M. Gadolinium-based contrast agents aggravate mechanical and thermal hyperalgesia in a nitroglycerine-induced migraine model in male mice. Magn Reson Imaging 2024; 111:67-73. [PMID: 38604348 DOI: 10.1016/j.mri.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 04/13/2024]
Abstract
In the diagnosis of migraine, which is a neurovascular disease, gadolinium-based contrast agents (GBCAs) are used to rule out more serious conditions. On the other hand, it remains unclear as a scientific gap whether GBCAs may trigger migraine-related pain. The aim of this study was to investigate the effect of GBCAs on mechanical and thermal pain behaviour in a nitroglycerin (NTG)-induced migraine model in mice. NTG (10 mg/kg) was administered intraperitoneally to adult (6-8weeks old) BALB/c mice 2 h before behavioral tests 5 times every other day on days 1st, 3rd, 5th and 9th to induce migraine model (N = 50). As GBCAs, gadobenate dimeglumine (linear-ionic), Gadodiamide (linear-nonionic), and gadobutrol (macrocyclic-nonionic) were delivered intravenously through the tail vein of mice for 5 days on test days. Mechanical pain threshold (plantar and facial withdrawal threshold) was evaluated by plantar von Frey and periorbital von Frey tests on days 1st, 5th, and 9th, and thermal pain threshold (latency) was evaluated by hot plate and cold plate tests on days 3rd and 7th. There was a statistically significant increase in mechanical and thermal hyperalgesia in NTG administered groups compared to the control group. Gadodiamide, gadobutrol and gadobenate dimeglumine administration significantly decreased latency, paw and facial withdrawal threshold (0.18 ± 0.05, 0.17 ± 0.07, 0.16 ± 0.09; 9th day values respectively) compared to NTG group (0.27 ± 0.05). The results of this in vivo study show that GBCAs produce effects that may trigger migraine attacks in migraine. It is recommended that these effects be further investigated and supported by further clinical studies.
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Affiliation(s)
- Batuhan Bilgin
- Gaziantep Islam Science and Technology University Faculty of Medicine, Department of Biophysics, Gaziantep, Turkey.
| | - Muhammed Adam
- Firat University Faculty of Medicine, Department of Biophysics, Elazig, Turkey
| | | | - Ferah Bulut
- Firat University Faculty of Medicine, Department of Biophysics, Elazig, Turkey
| | - Mete Ozcan
- Firat University Faculty of Medicine, Department of Biophysics, Elazig, Turkey
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Yao X, Zhang H, Hu J, Lin X, Sun J, Kang J, Huang Z, Wang G, Tian X, Chen E, Ren K. Effects of Gadolinium Retention in the Brains of Type 2 Diabetic Rats after Repeated Administration of Gadolinium-Based MRI Contrast Agents on Neurobiology and NLRP3 Inflammasome Activation. J Magn Reson Imaging 2024. [PMID: 38400842 DOI: 10.1002/jmri.29313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND The neurotoxic potential of gadolinium (Gd)-based contrast agents (GBCAs) retention in the brains of patients with type 2 diabetes mellitus (T2DM) is unclear. PURPOSE To determine the deposition and clearance of GBCAs in T2DM rats and the mechanism by which Gd enhances nucleotide-binding oligomerization domain-3 (NLRP3) inflammasome activation. STUDY TYPE Cross-sectional, prospective. ANIMAL MODEL 104 T2DM male Wistar rats. FIELD STRENGTH/SEQUENCE 9.4-T, T1-weighted fast spin echo sequence. ASSESSMENT T2DM (male Wistar rats, n = 52) and control group (healthy, male Wistar rats, n = 52) rats received saline, gadodiamide, Gd-diethylenetriaminepentaacetic acid, and gadoterate meglumine for four consecutive days per week for 7 weeks. The distribution and clearance of Gd in the certain brain were assessed by MRI (T1 signal intensity and relaxation rate R1, on the last day of each week), inductively coupled plasma mass-spectroscopy, ultraperformance liquid chromatography mass spectrometry, and transmission electron microscopy. Behavioral tests, histopathological features, and the effects of GBCAs on neuroinflammation were also analyzed. STATISTICAL TESTS One-way analysis of variance, bonferroni method, and unpaired t-test. A P-value <0.05 was considered statistically significant. RESULTS The movement distance and appearance time in the open field test of the T2DM rats in the gadodiamide group were significantly shorter than in the other groups. Furthermore, the expression of NLRP3, Pro-Caspase-1, interleukin-1β (IL-1β), and apoptosis-associated speck-like protein containing a CARD protein in neurons was significantly higher in the gadodiamide group than in the saline group, as shown by Western blot. Gadodiamide also induced differentiation of microglia into M1 type, decreased the neuronal mitochondrial membrane potential, and significantly increased neuronal apoptosis from flow cytometry. DATA CONCLUSION T2DM may affect both the deposition and clearance of GBCAs in the brain. Informed by the T2DM model, gadodiamide could mediate the neuroinflammatory response by NLRP3 inflammasome activation. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Xiang Yao
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Haoran Zhang
- Department of Radiology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xia Men, China
| | - Jingyi Hu
- The Basic Medicine College of Lanzhou University, Lanzhou, China
| | - Xiaoning Lin
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Jin Sun
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Junlong Kang
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Zhichun Huang
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Guangsong Wang
- Department of Radiology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xia Men, China
| | - Xinhua Tian
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - E Chen
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Ke Ren
- Department of Radiology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xia Men, China
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Abstract
ABSTRACT Recent safety concerns surrounding the use of gadolinium-based contrast agents (GBCAs) have spurred research into identifying alternatives to GBCAs for use with magnetic resonance imaging. This review summarizes the molecular and pharmaceutical properties of a GBCA replacement and how these may be achieved. Complexes based on high-spin, divalent manganese (Mn 2+ ) have shown promise as general purpose and liver-specific contrast agents. A detailed description of the complex Mn-PyC3A is provided, describing its physicochemical properties, its behavior in different animal models, and how it compares with GBCAs. The review points out that, although there are parallels with GBCAs in how the chemical properties of Mn 2+ complexes can predict in vivo behavior, there are also marked differences between Mn 2+ complexes and GBCAs.
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Affiliation(s)
- Peter Caravan
- From the Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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van der Molen AJ, Quattrocchi CC, Mallio CA, Dekkers IA. Ten years of gadolinium retention and deposition: ESMRMB-GREC looks backward and forward. Eur Radiol 2024; 34:600-611. [PMID: 37804341 PMCID: PMC10791848 DOI: 10.1007/s00330-023-10281-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 10/09/2023]
Abstract
In 2014, for the first time, visible hyperintensities on unenhanced T1-weighted images in the nucleus dentatus and globus pallidus of the brain were associated with previous Gadolinium-based contrast agent (GBCA) injections and gadolinium deposition in patients with normal renal function. This led to a frenzy of retrospective studies with varying methodologies that the European Society of Magnetic Resonance in Medicine and Biology Gadolinium Research and Educational Committee (ESMRMB-GREC) summarised in 2019. Now, after 10 years, the members of the ESMRMB-GREC look backward and forward and review the current state of knowledge of gadolinium retention and deposition. CLINICAL RELEVANCE STATEMENT: Gadolinium deposition is associated with the use of linear GBCA but no clinical symptoms have been associated with gadolinium deposition. KEY POINTS : • Traces of Gadolinium-based contrast agent-derived gadolinium can be retained in multiple organs for a prolonged time. • Gadolinium deposition is associated with the use of linear Gadolinium-based contrast agents. • No clinical symptoms have been associated with gadolinium deposition.
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Affiliation(s)
- Aart J van der Molen
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands.
| | - Carlo C Quattrocchi
- Centre for Medical Sciences CISMed, University of Trento, 38122, Trento, Italy
| | - Carlo A Mallio
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Operative Research Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Ilona A Dekkers
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands
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Zhuang L, Lian C, Wang Z, Zhang X, Wu Z, Huang R. Breast-lesion assessment using amide proton transfer-weighted imaging and dynamic contrast-enhanced MR imaging. Radiol Oncol 2023; 57:446-454. [PMID: 38038421 PMCID: PMC10690748 DOI: 10.2478/raon-2023-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/01/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Previous studies have indicated that amide proton transfer-weighted imaging (APTWI) could be utilized for differentiating benign and malignant tumors. The APTWI technology has increasingly being applied to breast tumor research in recent years. However, according to the latest literature retrieval, no relevant previous studies compared the value of APTWI and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in distinguishing benign lesions from malignant lesions. In the present study, the application of APTWI and DCE for differentiating the benign and malignant breast lesions was investigated. PATIENTS AND METHODS APTWI was performed on 40 patients (42 lesions) who were enrolled in this prospective study. The lesions were split into two groups, one with malignant breast lesions (n = 28) and the other with benign breast lesions (n = 14), based on the results of the histology. The measured image characteristics (APT value, apparent diffusion coefficient [ADC] value, and time-of-intensity-curve [TIC] type) were compared between the two groups, and the ROC curve was used to quantify the diagnostic performance on the basis of these factors. The correlation between the APT values and the estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 expression levels and histological grades was examined using Spearman's correlation coefficient. RESULTS The measured APT and ADC values showed a strong inter-observer agreement according to the intraclass correlation coefficients (0.954 and 0.825). Compared to benign lesions, malignant lesions had significantly higher APT values (3.18 ± 1.07 and 2.01 ± 0.51, p < 0.001). Based on APTWI, DCE, diffusion-weighted imaging (DWI), and ADC + APTWI, ADC + DCE, and DCE + APTWI, the area-under-the-curve values were 0.915, 0.815, 0.878, 0.921, 0.916, and 0.936, respectively. CONCLUSIONS APTWI is a potentially promising method in differentiating benign and malignant breast lesions, and may it become a great substitute for DCE examination in the future.
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Affiliation(s)
- Lulu Zhuang
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
- Shantou University, Shantou University Medical College, Shantou, China
| | - Chun Lian
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
- Shantou University, Shantou University Medical College, Shantou, China
| | - Zehao Wang
- Shantou University, Shantou University Medical College, Shantou, China
| | - Ximin Zhang
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
- Shantou University, Shantou University Medical College, Shantou, China
| | - Zhigang Wu
- Clinical & Technical Support, Philips Healthcare (Shenzhen) Ltd., China
| | - Rong Huang
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
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Gay Depassier J, Crombé A, Jambon E, Bernhard JC, Le Bras Y, Grenier N, Marcelin C. What is the benefit of gadolinium-chelate injection for the diagnosis of local recurrence of clear cell renal cell carcinoma after percutaneous thermal ablation with MRI? Diagn Interv Imaging 2023; 104:584-593. [PMID: 37442753 DOI: 10.1016/j.diii.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE The purpose of this study was to compare the diagnostic capabilities of contrast-enhanced (CE)-MRI to those of non-CE-MRI to diagnose local recurrence of clear cell renal cell carcinoma (ccRCC) after percutaneous thermal ablation (TA). MATERIALS AND METHODS This institutional, review board-approved, case-control, single-center retrospective study included all consecutive adult patients with at least two post-TA MRIs showing local recurrence of ccRCC after TA validated by multidisciplinary board. 'Control' patients without recurrence were randomly-selected with a case:control ratio of 2/3. Four senior radiologists reviewed in a double-blinded fashion non-CE sequences of last two consecutive MRI examinations (non-CE-MRIs), assessed the presence of recurrence of ccRCC, then reviewed the CE sequences (CE-MRI) and determined again the presence of a recurrence. Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity and accuracy were compared for each reader for non-CE-MRI and CE-MRI. RESULTS Fifty-one patients (41 men; mean age, 77.5 years) who underwent percutaneous TA for ccRCC were included. There were a total of 21 recurrences and 35 scars. Whoever the reader, AUROC was not significantly different (mean, 0.86 with-CE-MRI vs. 0.81 with non-CE-MRI; P values ranging between 0.08 and 0.98), neither sensitivity (mean, 76.2% with CE-MRI vs. 71.4% with non-CE-MRI; P values ranging between 0.06 and >0.99), nor accuracy (85.8% with CE-MRI vs. 80.8% with non-CE-MRI; P values ranging between 0.07 and >0.99). Change in specificity depended on the reader with a significant increase for one reader (+20%; P = 0.02) and a significant decrease for another reader (-17.2%; P = 0.03). CONCLUSION Non-CE MRI has good diagnostic performance for the follow-up of patients with ccRCC treated using percutaneous TA, questioning the systematic use of GBCA injection.
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Affiliation(s)
- Julien Gay Depassier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France
| | - Amandine Crombé
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251 & Bordeaux University, 33400, Talence, France
| | - Eva Jambon
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France
| | - Jean-Christophe Bernhard
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Deparment of Urology, Hôpital Pellegrin, 33400 Bordeaux, France
| | - Yann Le Bras
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France
| | - Nicolas Grenier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251 & Bordeaux University, 33400, Talence, France
| | - Clément Marcelin
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France; Bordeaux Institute of Oncology, BRIC U1312, INSERM, Université de Bordeaux, 33000 Bordeaux, France.
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Peng Y, Li Y, Li L, Xie M, Wang Y, Butch CJ. Coating influence on inner shell water exchange: An underinvestigated major contributor to SPIONs relaxation properties. Nanomedicine 2023; 54:102713. [PMID: 37839694 DOI: 10.1016/j.nano.2023.102713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/15/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
Superparamagnetic iron oxide nanoparticles (SPIONs) are heavily studied as potential MRI contrast enhancing agents. Every year, novel coatings are reported which yield large increases in relaxivity compared to similar particles. However, the reason for the increased performance is not always well understood mechanistically. In this review, we attempt to relate these advances back to fundamental models of relaxivity, developed for chelated metal ions, primarily gadolinium. We focus most closely on the three-shell model which considers the relaxation of surface-bound, entrained, and bulk water molecules as three distinct contributions to total relaxation. Because SPIONs are larger, more complex, and entrain significantly more water than gadolinium-based contrast agents, we consider how to adapt the application of classical models to SPIONs in a predictive manner. By carefully considering models and previous results, a qualitative model of entrained water interactions emerges, based primarily on the contributions of core size, coating thickness, density, and hydrophilicity.
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Affiliation(s)
- Yusong Peng
- Department of Material Science and Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China
| | - Yunlong Li
- Department of Material Science and Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China
| | - Li Li
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China
| | - Manman Xie
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China; School of Medical Imaging, Xuzhou Medical University, Xuzhou 221006, China.
| | - Yiqing Wang
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China.
| | - Christopher J Butch
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, China.
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Parillo M, Mallio CA, Van der Molen AJ, Rovira À, Ramalho J, Ramalho M, Gianolio E, Karst U, Radbruch A, Stroomberg G, Clement O, Dekkers IA, Nederveen AJ, Quattrocchi CC. Skin Toxicity After Exposure to Gadolinium-Based Contrast Agents in Normal Renal Function, Using Clinical Approved Doses: Current Status of Preclinical and Clinical Studies. Invest Radiol 2023; 58:530-538. [PMID: 37185158 DOI: 10.1097/rli.0000000000000973] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The aim of this study was to summarize the current preclinical and clinical evidence on the association between exposure to gadolinium (Gd) compounds and skin toxicity in a setting similar to clinical practice. MATERIALS AND METHODS A search of MEDLINE and PubMed references from January 2000 to December 2022 was performed using keywords related to gadolinium deposition and its effects on the skin, such as "gadolinium," "gadolinium-based contrast agents," "skin," "deposition," and "toxicity." In addition, cross-referencing was added when appropriate. For preclinical in vitro studies, we included all the studies that analyzed the response of human dermal fibroblasts to exposure to various gadolinium compounds. For preclinical animal studies and clinical studies, we included only those that analyzed animals or patients with preserved renal function (estimated glomerular filtration rate >30 mL/min/1.73 m 2 ), using a dosage of gadolinium-based contrast agents (GBCAs) similar to that commonly applied (0.1 mmol/kg). RESULTS Forty studies were selected. Preclinical findings suggest that Gd compounds can produce profibrotic responses in the skin in vitro, through the activation and proliferation of dermal fibroblasts and promoting their myofibroblast differentiation. Gadolinium influences the process of collagen production and the collagen content of skin, by increasing the levels of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1. Preclinical animal studies show that Gd can deposit in the skin with higher concentrations when linear GBCAs are applied. However, these deposits decrease over time and are not associated with obvious macroscopic or histological modifications. The clinical relevance of GBCAs in inducing small fiber neuropathy remains to be determined. Clinical studies show that Gd is detectable in the skin and hair of subjects with normal renal function in higher concentrations after intravenous administration of linear compared with macrocyclic GBCA. However, these deposits decrease over time and are not associated with cutaneous or histological modifications. Also, subclinical dermal involvement related to linear GBCA exposure may be detectable on brain MRI. There is no conclusive evidence to support a causal relationship between GBCA administration at the clinical dose and cutaneous manifestations in patients with normal renal function. CONCLUSIONS Gadolinium can produce profibrotic responses in the skin, especially acting on fibroblasts, as shown by preclinical in vitro studies. Gadolinium deposits are detectable in the skin even in subjects with normal renal function with higher concentrations when linear GBCAs are used, as confirmed by both preclinical animal and human studies. There is no proof to date of a cause-effect relationship between GBCA administration at clinical doses and cutaneous consequences in patients with normal renal function. Multiple factors, yet to be determined, should be considered for sporadic patients with normal renal function who develop clinical skin manifestations temporally related to GBCA administration.
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Affiliation(s)
- Marco Parillo
- From the Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo A Mallio
- From the Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Aart J Van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joana Ramalho
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Eliana Gianolio
- Department of Molecular Biotechnologies and Health Science, University of Turin, Turin, Italy
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Münster
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Gerard Stroomberg
- RIWA-Rijn-Association of River Water Works, Nieuwegein, the Netherlands
| | - Olivier Clement
- Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, Service de Radiologie, Paris, France
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Krämer HH, Bücker P, Jeibmann A, Richter H, Rosenbohm A, Jeske J, Baka P, Geber C, Wassenberg M, Fangerau T, Karst U, Schänzer A, van Thriel C. Gadolinium contrast agents: dermal deposits and potential effects on epidermal small nerve fibers. J Neurol 2023:10.1007/s00415-023-11740-z. [PMID: 37138180 DOI: 10.1007/s00415-023-11740-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
Small fiber neuropathy (SFN) affects unmyelinated and thinly myelinated nerve fibers causing neuropathic pain with distal distribution and autonomic symptoms. In idiopathic SFN (iSFN), 30% of the cases, the underlying aetiology remains unknown. Gadolinium (Gd)-based contrast agents (GBCA) are widely used in magnetic resonance imaging (MRI). However, side-effects including musculoskeletal disorders and burning skin sensations were reported. We investigated if dermal Gd deposits are more prevalent in iSFN patients exposed to GBCAs, and if dermal nerve fiber density and clinical parameters are likewise affected. 28 patients (19 females) with confirmed or no GBCA exposure were recruited in three German neuromuscular centers. ISFN was confirmed by clinical, neurophysiological, laboratory and genetic investigations. Six volunteers (two females) served as controls. Distal leg skin biopsies were obtained according to European recommendations. In these samples Gd was quantified by elemental bioimaging and intraepidermal nerve fibers (IENF) density via immunofluorescence analysis. Pain phenotyping was performed in all patients, quantitative sensory testing (QST) only in a subset (15 patients; 54%). All patients reported neuropathic pain, described as burning (n = 17), jabbing (n = 16) and hot (n = 11) and five QST scores were significantly altered. Compared to an equal distribution significantly more patients reported GBCA exposures (82%), while 18% confirmed no exposures. Compared to unexposed patients/controls significantly increased Gd deposits and lower z-scores of the IENF density were confirmed in exposed patients. QST scores and pain characteristics were not affected. This study suggests that GBCA exposure might alter IENF density in iSFN patients. Our results pave the road for further studies investigating the possible role of GBCA in small fiber damage, but more investigations and larger samples are needed to draw firm conclusions.
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Affiliation(s)
- Heidrun H Krämer
- Department of Neurology, Justus Liebig University of Giessen, 35392, Giessen, Germany
| | - Patrick Bücker
- Institute of Inorganic and Analytical Chemistry, University of Münster, 48149, Münster, Germany
| | - Astrid Jeibmann
- Institute of Neuropathology, University Hospital Münster, 48149, Münster, Germany
| | - Henning Richter
- Clinic for Diagnostic Imaging, Diagnostic Imaging Research Unit (DIRU),Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland
| | | | - Johanna Jeske
- Department of Neurology, Justus Liebig University of Giessen, 35392, Giessen, Germany
| | - Panoraia Baka
- Department of Neurology, University Medical Center, 55101, Mainz, Germany
| | - Christian Geber
- Department of Neurology, University Medical Center, 55101, Mainz, Germany
- DRK Pain Center Mainz, 55131, Mainz, Germany
| | - Matthias Wassenberg
- Department of Neurology, Justus Liebig University of Giessen, 35392, Giessen, Germany
| | - Tanja Fangerau
- Department of Neurology, University of Ulm, 89081, Ulm, Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, 48149, Münster, Germany
| | - Anne Schänzer
- Institute of Neuropathology, Justus Liebig University Giessen, 35392, Giessen, Germany.
| | - Christoph van Thriel
- IfADo-Leibniz Research Centre for Working Environment and Human Factors, 44139, Dortmund, Germany.
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Jammoul M, Abou-Kheir W, Lawand N. How Safe Is Gadobutrol? Examining the Effect of Gadolinium Deposition on the Nervous System. Radiation 2023. [DOI: 10.3390/radiation3020007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
This study aimed to evaluate the safety of gadobutrol, a gadolinium-based contrast agent used in medical imaging, by investigating its effect on the nervous system under physiological and inflammatory conditions. Male Sprague Dawley rats were divided randomly into four groups, including gadobutrol, saline, LPS + gadobutrol, and LPS + saline, and were given intraperitoneal injections of gadobutrol (2.5 mmol/kg) or saline for 20 days. Weekly sensorimotor and cognitive behavioral tests were performed over 4 weeks, and Gd concentration in nervous tissues was analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Lactate dehydrogenase (LDH) activity was measured to evaluate cytotoxicity, and electromyography (EMG) recordings from the gastrocnemius muscle were also obtained to examine signal transmission in sciatic nerves. The results indicated that gadobutrol did not induce significant behavioral changes under normal conditions. However, when administered along with LPS, the combination led to behavioral dysfunction. ICP-MS analysis revealed a higher concentration of Gd in the cerebrum and spinal cord of gadobutrol + LPS-treated rats, while peripheral nerves showed lower concentrations. In addition, there was a significant increase in LDH activity in the hippocampus of the gadobutrol group. EMG responses to electrical stimulation of the sciatic nerve demonstrated a decreased threshold of nociceptive reflexes in the gadobutrol group. Overall, while gadobutrol may be considered safe under normal physiological conditions, the findings suggest that its safety may be compromised under inflammatory conditions.
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Affiliation(s)
- Maya Jammoul
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Wassim Abou-Kheir
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Nada Lawand
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
- Department of Neurology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
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Bonafè R, Coppo A, Queliti R, Bussi S, Maisano F, Kirchin MA, Tedoldi F. Gadolinium retention in a rat model of subtotal renal failure: are there differences among macrocyclic GBCAs? Eur Radiol Exp 2023; 7:7. [PMID: 36855001 PMCID: PMC9975137 DOI: 10.1186/s41747-023-00324-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/11/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Gd levels are higher in tissues of animals with compromised renal function, but studies to compare levels after exposure to different macrocyclic gadolinium-based contrast agents (GBCAs) are lacking. We compared Gd levels in tissues of subtotally nephrectomised (SN) rats after repeated exposure to macrocyclic GBCAs. METHODS Sprague-Dawley SN male rats (19 per group) received 16 injections of gadoteridol, gadobutrol, or gadoterate meglumine at 0.6 mmol Gd/kg 4 times/weeks over 4 weeks. A control group of healthy male rats (n = 10) received gadoteridol at the same dosage. Plasma urea and creatinine levels were monitored. Blood, cerebrum, cerebellum, liver, femur, kidney(s), skin and peripheral nerves were harvested for Gd determination by inductively coupled plasma-mass spectrometry at 28 and 56 days after the end of treatment. RESULTS Plasma urea and creatinine levels were roughly twofold higher in SN rats than in healthy rats at all timepoints. At day 28, Gd levels in the peripheral nerves of gadobutrol- or gadoterate-treated SN animals were 5.4 or 7.2 times higher than in gadoteridol-treated animals (p < 0.001). Higher Gd levels after administration of gadobutrol or gadoterate versus gadoteridol were also determined in kidneys (p ≤ 0.002), cerebrum (p ≤ 0.001), cerebellum (p ≤ 0.003), skin (p ≥ 0.244), liver (p ≥ 0.053), and femur (p ≥ 0.271). At day 56, lower Gd levels were determined both in SN and healthy rats for all GBCAs and tissues, except the femur. CONCLUSIONS Gd tissue levels were lower following gadoteridol exposure than following gadobutrol or gadoterate exposure.
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Affiliation(s)
- Roberta Bonafè
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
| | - Alessandra Coppo
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
| | - Roberta Queliti
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
| | - Simona Bussi
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
| | - Federico Maisano
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
| | - Miles A. Kirchin
- grid.476177.40000 0004 1755 9978Bracco Imaging SpA, Global Medical & Regulatory Affairs, Milan, Italy
| | - Fabio Tedoldi
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
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12
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Quattrocchi CC, Parillo M, Spani F, Landi D, Cola G, Dianzani C, Perrella E, Marfia GA, Mallio CA. Skin Thickening of the Scalp and High Signal Intensity of Dentate Nucleus in Multiple Sclerosis: Association With Linear Versus Macrocyclic Gadolinium-Based Contrast Agents Administration. Invest Radiol 2023; 58:223-230. [PMID: 36729383 DOI: 10.1097/rli.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to assess the presence of detectable changes of skin thickness on clinical brain magnetic resonance imaging (MRI) scans in patients with MS, history of multiple gadolinium-based contrast agents (GBCAs) administrations, and evidence of gadolinium deposition in the brain. MATERIALS AND METHODS In this observational cross-sectional study, 71 patients with MS who underwent conventional brain MRI with an imaging protocol including enhanced 3D volumetric interpolated breath-hold examination (VIBE) T1-weighted with fat saturation were assessed. Patients with bilateral isointense dentate nucleus on unenhanced T1-weighted images were assigned to group A (controls without MRI evidence of gadolinium deposition), and patients with visually hyperintense dentate nuclei were assigned to group B. Qualitative and quantitative assessment of the skin thickness were performed. RESULTS Group A included 27 patients (median age, 33 years [IQR, 27-46]; 20 women), and group B included 44 patients (median age, 42 years [IQR, 35-53]; 29 women). Qualitative and quantitative assessment of the skin revealed significant differences between group A and group B. The average skin-to-scalp thickness ratios was significantly higher in group B than in group A (mean ± standard deviation = 0.52 ± 0.02 in group B vs 0.41 ± 0.02 in group A, P < 0.0001) and showed a positive correlation with the total number of enhanced MRI scans ( r = 0.39; 95% confidence interval, 0.17-0.57, P < 0.01). CONCLUSIONS Brain MRI detects increased skin thickness of the scalp in patients with MS and dentate nucleus high signal intensity on unenhanced T1-weighted images and shows positive association with previous exposures to linear GBCAs rather than macrocyclic GBCAs.
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Affiliation(s)
- Carlo C Quattrocchi
- From the Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Campus Bio-Medico di Roma
| | - Marco Parillo
- From the Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Campus Bio-Medico di Roma
| | - Federica Spani
- From the Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Campus Bio-Medico di Roma
| | | | - Gaia Cola
- Unit of Neurology, Policlinico Tor Vergata
| | | | - Eleonora Perrella
- Pathology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | | | - Carlo A Mallio
- From the Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Campus Bio-Medico di Roma
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13
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Hama Y, Tate E. MRI findings of iatrogenic extravasation of gadolinium-based contrast agents in patients with cancer. Acta Radiol 2022; 64:1439-1442. [PMID: 36221814 DOI: 10.1177/02841851221129152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) findings after subcutaneous extravasation of gadolinium-based contrast agent (GBCA) have not been investigated in detail. PURPOSE To present the MRI findings of iatrogenic extravasation and to evaluate the characteristic findings. MATERIAL AND METHODS In this retrospective study of 16,039 patients with cancer, 11 patients had significant extravasation of macrocyclic GBCA, and 7 of the 11 had MRI of the injection site. Characteristic MRI findings as well as symptoms and changes over time were evaluated. RESULTS The forearms or antecubital fossa felt cold in all seven cases, and 3 (43%) patients felt pain at the injection sites. Fat-suppressed T1-weighted images showed a mosaic pattern of the extravasate with mixed high and low signal in the subcutaneous tissue in 7 (100%) cases. Contrast enhancement of the fascia toward the proximal portion was observed in 3 (43%) cases. There was no subfascial deep extension. On T2-weighted images, GBCAs were observed as low-signal fluid collection on the fascia, with linear spread to the dermis and subcutaneous tissue. Four patients underwent daily MRI scans, all of whom had their contrast disappeared within three days. CONCLUSION Macrocyclic GBCA disappears from subcutaneous tissue quickly after extravasation and is unlikely to cause serious sequelae.
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Affiliation(s)
- Yukihiro Hama
- Department of Radiology, Tokyo-Edogawa Cancer Centre, Edogawa Hospital, Tokyo, Japan
| | - Etsuko Tate
- Department of Radiology, Tokyo-Edogawa Cancer Centre, Edogawa Hospital, Tokyo, Japan
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Huang X, Jiang R, Xu X, Wang W, Sun Y, Li L, Shi H, Liu S. Gadolinium retention in the ischemic cerebrum: Implications for pain, neuron loss, and neurological deficits. Magn Reson Med 2022; 89:384-395. [DOI: 10.1002/mrm.29443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Xin‐Xin Huang
- Department of Interventional Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Run‐Hao Jiang
- Department of Interventional Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Xiao‐Quan Xu
- Department of Interventional Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Wei Wang
- Department of Interventional Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Yu‐Qin Sun
- Neuroprotective Drug Discovery Key Laboratory, Jiangsu Key Laboratory of Neurodegeneration Nanjing Medical University Nanjing China
| | - Lei Li
- Neuroprotective Drug Discovery Key Laboratory, Jiangsu Key Laboratory of Neurodegeneration Nanjing Medical University Nanjing China
| | - Hai‐Bin Shi
- Department of Interventional Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Sheng Liu
- Department of Interventional Radiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
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Michaely HJ, Aringhieri G, Cioni D, Neri E. Current Value of Biparametric Prostate MRI with Machine-Learning or Deep-Learning in the Detection, Grading, and Characterization of Prostate Cancer: A Systematic Review. Diagnostics (Basel) 2022; 12:799. [PMID: 35453847 PMCID: PMC9027206 DOI: 10.3390/diagnostics12040799] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023] Open
Abstract
Prostate cancer detection with magnetic resonance imaging is based on a standardized MRI-protocol according to the PI-RADS guidelines including morphologic imaging, diffusion weighted imaging, and perfusion. To facilitate data acquisition and analysis the contrast-enhanced perfusion is often omitted resulting in a biparametric prostate MRI protocol. The intention of this review is to analyze the current value of biparametric prostate MRI in combination with methods of machine-learning and deep learning in the detection, grading, and characterization of prostate cancer; if available a direct comparison with human radiologist performance was performed. PubMed was systematically queried and 29 appropriate studies were identified and retrieved. The data show that detection of clinically significant prostate cancer and differentiation of prostate cancer from non-cancerous tissue using machine-learning and deep learning is feasible with promising results. Some techniques of machine-learning and deep-learning currently seem to be equally good as human radiologists in terms of classification of single lesion according to the PIRADS score.
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Jiang Z, Xia B, Ren F, Bao B, Xing W, He T, Li Z. Boosting Vascular Imaging-Performance and Systemic Biosafety of Ultra-Small NaGdF 4 Nanoparticles via Surface Engineering with Rationally Designed Novel Hydrophilic Block Co-Polymer. Small Methods 2022; 6:e2101145. [PMID: 35107219 DOI: 10.1002/smtd.202101145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/03/2021] [Indexed: 06/14/2023]
Abstract
Revealing the anatomical structures, functions, and distribution of vasculature via contrast agent (CA) enhanced magnetic resonance imaging (MRI) is crucial for precise medical diagnosis and therapy. The clinically used MRI CAs strongly rely on Gd-chelates, which exhibit low T1 relaxivities and high risks of nephrogenic systemic fibrosis (NSF) for patients with renal dysfunction. It is extremely important to develop high-performance and safe CAs for MRI. Herein, it is reported that ultra-small NaGdF4 nanoparticles (UGNs) can serve as an excellent safe MRI CA via surface engineering with rationally designed novel hydrophilic block co-polymer (BPn ). By optimizing the polymer molecular weights, the polymer-functionalized UGNs (i.e., UGNs-BP14 ) are obtained to exhibit remarkably higher relaxivity (11.8 mm-1 s-1 at 3.0 T) than Gd-DTPA (3.6 mm-1 s-1 ) due to their ultracompact and abundant hydrophilic surface coating. The high performance of UGNs-BP14 enables us to sensitively visualize microvasculature with a small diameter of ≈0.17 mm for up to 2 h, which is the thinnest blood vessel and the longest time window for low field (1.0 T) MR angiography ever reported, and cannot be achieved by using the clinically used Gd-DTPA under the same conditions. More importantly, renal clearable UGNs-BP14 show lower risks of inducing NSF in comparison with Gd-DTPA due to their negligible release of Gd3+ ions after modification with the novel hydrophilic block copolymer. The study presents a novel avenue for boosting imaging-performance and systemic biosafety of UGNs as a robust MRI CA with great potential in precise diagnosis of vasculature-related diseases.
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Affiliation(s)
- Zhilin Jiang
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, P. R. China
| | - Bin Xia
- School of Chemistry and Chemical Engineering, Anhui Province Key Laboratory of Advanced Catalytic Materials and Reaction Engineering, Hefei University of Technology, Hefei, Anhui, 230009, P. R. China
| | - Feng Ren
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, P. R. China
| | - Bolin Bao
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, P. R. China
- Department of Radiology, Affiliated Hospital 3, Soochow University, Changzhou, 213003, P. R. China
| | - Wei Xing
- Department of Radiology, Affiliated Hospital 3, Soochow University, Changzhou, 213003, P. R. China
| | - Tao He
- School of Chemistry and Chemical Engineering, Anhui Province Key Laboratory of Advanced Catalytic Materials and Reaction Engineering, Hefei University of Technology, Hefei, Anhui, 230009, P. R. China
| | - Zhen Li
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, 215123, P. R. China
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Davies J, Siebenhandl-Wolff P, Tranquart F, Jones P, Evans P. Gadolinium: pharmacokinetics and toxicity in humans and laboratory animals following contrast agent administration. Arch Toxicol 2022; 96:403-429. [PMID: 34997254 PMCID: PMC8837552 DOI: 10.1007/s00204-021-03189-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
Abstract
Gadolinium-based contrast agents (GBCAs) have transformed magnetic resonance imaging (MRI) by facilitating the use of contrast-enhanced MRI to allow vital clinical diagnosis in a plethora of disease that would otherwise remain undetected. Although over 500 million doses have been administered worldwide, scientific research has documented the retention of gadolinium in tissues, long after exposure, and the discovery of a GBCA-associated disease termed nephrogenic systemic fibrosis, found in patients with impaired renal function. An understanding of the pharmacokinetics in humans and animals alike are pivotal to the understanding of the distribution and excretion of gadolinium and GBCAs, and ultimately their potential retention. This has been well studied in humans and more so in animals, and recently there has been a particular focus on potential toxicities associated with multiple GBCA administration. The purpose of this review is to highlight what is currently known in the literature regarding the pharmacokinetics of gadolinium in humans and animals, and any toxicity associated with GBCA use.
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Affiliation(s)
- Julie Davies
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK.
| | | | | | - Paul Jones
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK
| | - Paul Evans
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK
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18
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Goetzl EJ, Maecker HT, Rosenberg-Hasson Y, Koran LM. Altered Functional Mitochondrial Protein Levels in Plasma Neuron-Derived Extracellular Vesicles of Patients With Gadolinium Deposition. Front Toxicol 2022; 3:797496. [PMID: 35295151 PMCID: PMC8915819 DOI: 10.3389/ftox.2021.797496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 01/25/2023] Open
Abstract
The retention of the heavy metal, gadolinium, after a Gadolinium-Based Contrast Agent-assisted MRI may lead to a symptom cluster termed Gadolinium Deposition Disease. Little is known of the disorder's underlying pathophysiology, but a recent study reported abnormally elevated serum levels of pro-inflammatory cytokines compared to normal controls. As a calcium channel blocker in cellular plasma and mitochondrial membranes, gadolinium also interferes with mitochondrial function. We applied to sera from nine Gadolinium Deposition Disease and two Gadolinium Storage Condition patients newly developed methods allowing isolation of plasma neuron-derived extracellular vesicles that contain reproducibly quantifiable levels of mitochondrial proteins of all major classes. Patients' levels of five mitochondrial functional proteins were statistically significantly lower and of two significantly higher than the levels in normal controls. The patterns of differences between study patients and controls for mitochondrial dynamics and mitochondrial proteins encompassing neuronal energy generation, metabolic regulation, ion fluxes, and survival differed from those seen for patients with first episode psychosis and those with Major Depressive Disorder compared to their controls. These findings suggest that mitochondrial dysfunction due to retained gadolinium may play a role in causing Gadolinium Deposition Disease. Larger samples of both GDD and GSC patients are needed to allow not only testing the repeatability of our findings, but also investigation of relationships of specific mitochondrial protein deficiencies or excesses and concurrent cytokine, genetic, or other factors to GDD's neurological and cognitive symptoms. Studies of neuronal mitochondrial proteins as diagnostic markers or indicators of treatment effectiveness are also warranted.
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Affiliation(s)
- Edward J. Goetzl
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Holden T. Maecker
- Human Immune Monitoring Center, Microbiology and Immunology, Stanford University Medical Center, Stanford, CA, United States
| | - Yael Rosenberg-Hasson
- Human Immune Monitoring Center, Microbiology and Immunology, Stanford University Medical Center, Stanford, CA, United States
| | - Lorrin M. Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, United States,*Correspondence: Lorrin M. Koran,
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Anklam E, Bahl MI, Ball R, Beger RD, Cohen J, Fitzpatrick S, Girard P, Halamoda-Kenzaoui B, Hinton D, Hirose A, Hoeveler A, Honma M, Hugas M, Ishida S, Kass GEN, Kojima H, Krefting I, Liachenko S, Liu Y, Masters S, Marx U, McCarthy T, Mercer T, Patri A, Pelaez C, Pirmohamed M, Platz S, Ribeiro AJS, Rodricks JV, Rusyn I, Salek RM, Schoonjans R, Silva P, Svendsen CN, Sumner S, Sung K, Tagle D, Tong L, Tong W, van den Eijnden-van-Raaij J, Vary N, Wang T, Waterton J, Wang M, Wen H, Wishart D, Yuan Y, Slikker Jr. W. Emerging technologies and their impact on regulatory science. Exp Biol Med (Maywood) 2022; 247:1-75. [PMID: 34783606 PMCID: PMC8749227 DOI: 10.1177/15353702211052280] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There is an evolution and increasing need for the utilization of emerging cellular, molecular and in silico technologies and novel approaches for safety assessment of food, drugs, and personal care products. Convergence of these emerging technologies is also enabling rapid advances and approaches that may impact regulatory decisions and approvals. Although the development of emerging technologies may allow rapid advances in regulatory decision making, there is concern that these new technologies have not been thoroughly evaluated to determine if they are ready for regulatory application, singularly or in combinations. The magnitude of these combined technical advances may outpace the ability to assess fit for purpose and to allow routine application of these new methods for regulatory purposes. There is a need to develop strategies to evaluate the new technologies to determine which ones are ready for regulatory use. The opportunity to apply these potentially faster, more accurate, and cost-effective approaches remains an important goal to facilitate their incorporation into regulatory use. However, without a clear strategy to evaluate emerging technologies rapidly and appropriately, the value of these efforts may go unrecognized or may take longer. It is important for the regulatory science field to keep up with the research in these technically advanced areas and to understand the science behind these new approaches. The regulatory field must understand the critical quality attributes of these novel approaches and learn from each other's experience so that workforces can be trained to prepare for emerging global regulatory challenges. Moreover, it is essential that the regulatory community must work with the technology developers to harness collective capabilities towards developing a strategy for evaluation of these new and novel assessment tools.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Reza M Salek
- International Agency for Research on Cancer, France
| | | | | | | | | | | | | | - Li Tong
- Universities of Georgia Tech and Emory, USA
| | | | | | - Neil Vary
- Canadian Food Inspection Agency, Canada
| | - Tao Wang
- National Medical Products Administration, China
| | | | - May Wang
- Universities of Georgia Tech and Emory, USA
| | - Hairuo Wen
- National Institutes for Food and Drug Control, China
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Maecker HT, Siebert JC, Rosenberg-Hasson Y, Koran LM, Ramalho M, Semelka RC. Dynamic Serial Cytokine Measurements During Intravenous Ca-DTPA Chelation in Gadolinium Deposition Disease and Gadolinium Storage Condition: A Pilot Study. Invest Radiol 2022; 57:71-76. [PMID: 34120127 PMCID: PMC8664920 DOI: 10.1097/rli.0000000000000803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The aim of this study was to investigate the feasibility of measuring early changes in serum cytokine levels after intravenous diethylenetriaminepentaacetic acid (Ca-DTPA) chelation in patients manifesting either gadolinium deposition disease (GDD) or gadolinium storage condition (GSC) and the possible usefulness of this method in further research. METHODS Four patients with recent-onset GDD (≤1 year) and 2 patients with long-standing GSC (4 and 9 years) underwent chelation with intravenous bolus administration of Ca-DTPA. Multiple blood draws were performed to measure serum cytokines: at T = 0 (before Ca-DTPA injection) and 1, 5, 10, 30, 60 minutes, and 24 hours after Ca-DTPA injection. Patients rated the severity of GDD symptom flare at 24 hours. The 24-hour urine Gd amounts were measured prechelation and for the 24 hours after chelation. Serum samples were analyzed blind to whether patients had GDD or GSC but with knowledge of the time points characterizing each sample. RESULTS Urine samples for both GDD and GSC patients showed increases in Gd postchelation. All GDD patients experienced flare reactions postchelation; the 2 GSC patients did not. Two cytokines, EGF and sCD40L, peaked at 30 minutes postchelation in at least 4 of the 6 participants. Three cytokines, ENA78/CXCL5, EOTAXIN/CCL11, and LEPTIN, peaked at 24 hours in at least 4 of the 6 participants. Two participants were high outliers for a large number of cytokines across time points. No clear distinction between GDD and GSC was apparent from the cytokine patterns, although differences were present. CONCLUSIONS This pilot study describes precise temporal resolution (in the range of minutes) after a cytokine-inciting event. Select cytokines exhibited peak values at different time points. At this preliminary stage of investigation, peak cytokine release seems to reflect the amount of Gd mobilized rather than the severity of the patient symptomatic reaction. Too few subjects were studied to support statistical analysis between GDD and GSC groups, although differences were observed through visual data analysis.
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Affiliation(s)
- Holden T Maecker
- From the Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA
| | | | - Yael Rosenberg-Hasson
- From the Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA
| | - Lorrin M Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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Queler SC, Tan ET, Geannette C, Prince M, Sneag DB. Ferumoxytol-enhanced vascular suppression in magnetic resonance neurography. Skeletal Radiol 2021; 50:2255-2266. [PMID: 33961070 DOI: 10.1007/s00256-021-03804-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate ferumoxytol-enhanced vascular suppression for visualizing branch nerves of the brachial plexus in magnetic resonance (MR) neurography. MATERIALS AND METHODS Signal simulations were performed to determine ferumoxytol's effect on nerve-, fat-, and blood-to-muscle contrast and to optimize pulse sequence parameters. Prospective, in vivo assessment included 10 subjects with chronic anemia who underwent a total of 19 (9 bilateral) pre- and post-infusion brachial plexus exams using three-dimensional (3D), T2-weighted short-tau inversion recovery (T2-STIR) sequences at 3.0 T. Two musculoskeletal radiologists qualitatively rated sequences for the degree of vascular suppression and brachial plexus branch nerve conspicuity. Nerve-to-muscle, -fat, and -vessel contrast ratios were measured. RESULTS Quantitative nerve/muscle and nerve/small vessel contrast ratios (CRs) increased with ferumoxytol (p < 0.05). Qualitative vascular suppression and suprascapular nerve visualization improved following ferumoxytol administration for both raters (p < .05). Pre- and post-ferumoxytol exams demonstrated moderate to near-perfect inter-rater agreement for nerve visualization and diagnostic confidence for the suprascapular and axillary nerves but poor to no agreement for the long thoracic nerve. CONCLUSION Ferumoxytol in T2-weighted brachial plexus MR neurography provides robust vascular suppression and aids visualization of the suprascapular nerve in volunteers without neuropathy.
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Affiliation(s)
- Sophie C Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Christian Geannette
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Martin Prince
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, 535 E. 70th St., New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
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22
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Richter H, Bücker P, Martin LF, Dunker C, Fingerhut S, Xia A, Karol A, Sperling M, Karst U, Radbruch A, Jeibmann A. Gadolinium Tissue Distribution in a Large-Animal Model after a Single Dose of Gadolinium-based Contrast Agents. Radiology 2021; 301:637-642. [PMID: 34546128 DOI: 10.1148/radiol.2021210553] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There is an ongoing scientific debate about the degree and clinical importance of gadolinium deposition in the brain and other organs after administration of gadolinium-based contrast agents (GBCAs). While most published data focus on gadolinium deposition in the brain, other organs are rarely investigated. Purpose To compare gadolinium tissue concentrations in various organs 10 weeks after one injection (comparable to a clinically applied dose) of linear and macrocyclic GBCAs in a large-animal model. Materials and Methods In this prospective animal study conducted from March to May 2018, 36 female Swiss-Alpine sheep (age range, 4-10 years) received one injection (0.1 mmol/kg) of macrocyclic GBCAs (gadobutrol, gadoteridol, and gadoterate meglumine), linear GBCAs (gadodiamide and gadobenate dimeglumine), or saline. Ten weeks after injection, sheep were sacrificed and tissues were harvested. Gadolinium concentrations were quantified with inductively coupled plasma mass spectrometry (ICP-MS). Histologic staining was performed. Data were analyzed with nonparametric tests. Results At 10 weeks after injection, linear GBCAs resulted in highest mean gadolinium concentrations in the kidney (502 ng/g [95% CI: 270, 734]) and liver (445 ng/g [95% CI: 202, 687]), while low concentrations were found in the deep cerebellar nuclei (DCN) (30 ng/g [95% CI: 20, 41]). Tissue concentrations of linear GBCAs were three to 21 times higher compared with those of macrocyclic GBCAs. Administered macrocyclic GBCAs resulted in mean gadolinium concentrations of 86 ng/g (95% CI: 31, 141) (P = .08) in the kidney, 21 ng/g (95% CI: 4, 39) (P = .15) in liver tissue, and 10 ng/g (95% CI: 9, 12) (P > .99) in the DCN, which were not significantly elevated when compared with concentrations in control animals. No histopathologic alterations were observed irrespective of tissue concentrations within any examined organ. Conclusion Ten weeks after one injection of a clinically relevant dose of gadolinium-based contrast agents, the liver and kidney appeared to be reservoirs of gadolinium; however, despite gadolinium presence, no tissue injury was detected. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Clément in this issue.
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Affiliation(s)
- Henning Richter
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services (H.R.), Clinic for Zoo Animals, Exotic Pets and Wildlife (L.F.M.), and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease (A.K.), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (P.B., C.D., S.F., M.S., U.K.); Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany (A.R.); and Institute of Neuropathology, University Hospital Münster, Münster, Germany (A.X., A.J.)
| | - Patrick Bücker
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services (H.R.), Clinic for Zoo Animals, Exotic Pets and Wildlife (L.F.M.), and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease (A.K.), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (P.B., C.D., S.F., M.S., U.K.); Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany (A.R.); and Institute of Neuropathology, University Hospital Münster, Münster, Germany (A.X., A.J.)
| | - Louise Françoise Martin
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services (H.R.), Clinic for Zoo Animals, Exotic Pets and Wildlife (L.F.M.), and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease (A.K.), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (P.B., C.D., S.F., M.S., U.K.); Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany (A.R.); and Institute of Neuropathology, University Hospital Münster, Münster, Germany (A.X., A.J.)
| | - Calvin Dunker
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services (H.R.), Clinic for Zoo Animals, Exotic Pets and Wildlife (L.F.M.), and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease (A.K.), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (P.B., C.D., S.F., M.S., U.K.); Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany (A.R.); and Institute of Neuropathology, University Hospital Münster, Münster, Germany (A.X., A.J.)
| | - Stefanie Fingerhut
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services (H.R.), Clinic for Zoo Animals, Exotic Pets and Wildlife (L.F.M.), and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease (A.K.), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (P.B., C.D., S.F., M.S., U.K.); Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany (A.R.); and Institute of Neuropathology, University Hospital Münster, Münster, Germany (A.X., A.J.)
| | - Anna Xia
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services (H.R.), Clinic for Zoo Animals, Exotic Pets and Wildlife (L.F.M.), and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease (A.K.), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (P.B., C.D., S.F., M.S., U.K.); Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany (A.R.); and Institute of Neuropathology, University Hospital Münster, Münster, Germany (A.X., A.J.)
| | - Agnieszka Karol
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services (H.R.), Clinic for Zoo Animals, Exotic Pets and Wildlife (L.F.M.), and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease (A.K.), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (P.B., C.D., S.F., M.S., U.K.); Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany (A.R.); and Institute of Neuropathology, University Hospital Münster, Münster, Germany (A.X., A.J.)
| | - Michael Sperling
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services (H.R.), Clinic for Zoo Animals, Exotic Pets and Wildlife (L.F.M.), and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease (A.K.), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (P.B., C.D., S.F., M.S., U.K.); Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany (A.R.); and Institute of Neuropathology, University Hospital Münster, Münster, Germany (A.X., A.J.)
| | - Uwe Karst
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services (H.R.), Clinic for Zoo Animals, Exotic Pets and Wildlife (L.F.M.), and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease (A.K.), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (P.B., C.D., S.F., M.S., U.K.); Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany (A.R.); and Institute of Neuropathology, University Hospital Münster, Münster, Germany (A.X., A.J.)
| | - Alexander Radbruch
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services (H.R.), Clinic for Zoo Animals, Exotic Pets and Wildlife (L.F.M.), and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease (A.K.), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (P.B., C.D., S.F., M.S., U.K.); Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany (A.R.); and Institute of Neuropathology, University Hospital Münster, Münster, Germany (A.X., A.J.)
| | - Astrid Jeibmann
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services (H.R.), Clinic for Zoo Animals, Exotic Pets and Wildlife (L.F.M.), and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease (A.K.), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (P.B., C.D., S.F., M.S., U.K.); Clinical Neuroimaging, German Center for Neurodegenerative Diseases, Bonn, Germany (A.R.); and Institute of Neuropathology, University Hospital Münster, Münster, Germany (A.X., A.J.)
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23
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Kong Y, Zhang S, Wang J, Han C, Yu N, Liu Q, Wang W, Xu K. Potential toxicity evaluation and comparison within multiple mice organs after repeat injections of linear versus macrocyclic gadolinium-based contrast agents: A comprehensive and time course study. Toxicol Lett 2021; 350:152-161. [PMID: 34311048 DOI: 10.1016/j.toxlet.2021.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
As nephrogenic systemic fibrosis (NSF) and increased signal intensities in deep cerebellar nuclei (DCN) were successively discovered in renal insufficiency patients and healthy persons after gadolinium-based contrast agents (GBCAs) exposure, an awareness of potential toxicity with GBCAs exposure has been heightening. Herein, we performed a multi-organ/tissue toxicity assessment after different GBCAs administration with a large number of samples, and long-term, time-course schedule investigation. ICR mice were randomized to five exposure groups (n = 42/group) and received intravenous injection of GBCAs (2.5 mmol Gd/kg) or saline four time a week for 5 consecutive weeks. Gadolinium concentration detection, sensory tests, histological and hematological analyses were performed at corresponding timepoints (4th or 6th or 10th week). Our results showed that (i) gadodiamide could cause reversible vacuolar changes in the renal tubular epithelial cells, which appeared at 6th week and recovered at 10th week, and severe skin lesion in mice tail with consecutive injection for 10 weeks, that (ii) linear GBCAs (gadodiamide and gadopentetate dimeglumine) markedly elevated heat hyperalgesia and white blood cells of mice at 6th week and most of these changes could recovery at 10th week, and that (iii) linear GBCAs exhibited more gadolinium retention in multi-organ/tissue versus macrocyclic GBCAs and in most case, linear GBCAs showed faster accumulation and regression speed in examined tissues than macrocyclic GBCAs excepting gadodiamide in skin which showed slowest regression speed. Collectively, macrocyclic GBCAs presents more stable, lower propensity to release Gd and safer profiles versus linear GBCAs.
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Affiliation(s)
- Ying Kong
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China
| | - Shuai Zhang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China; School of Medical Imaging, Xuzhou Medical University, Jiangsu, Xuzhou, 221004, PR China
| | - Jiali Wang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China
| | - Cuiping Han
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China; School of Medical Imaging, Xuzhou Medical University, Jiangsu, Xuzhou, 221004, PR China
| | - Nana Yu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China
| | - Qi Liu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China
| | - Wentao Wang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China
| | - Kai Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China.
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24
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Shi H, Fang Y, Huang L, Gao L, Lenahan C, Okada T, Travis ZD, Xie S, Tang H, Lu Q, Liu R, Tang J, Cheng Y, Zhang JH. Activation of Galanin Receptor 1 with M617 Attenuates Neuronal Apoptosis via ERK/GSK-3β/TIP60 Pathway After Subarachnoid Hemorrhage in Rats. Neurotherapeutics 2021; 18:1905-1921. [PMID: 34086200 PMCID: PMC8609084 DOI: 10.1007/s13311-021-01066-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
Subarachnoid hemorrhage (SAH) is a devastating cerebrovascular disease. Neuronal apoptosis plays an important pathological role in early brain injury after SAH. Galanin receptor 1 (GalR1) activation was recently shown to be anti-apoptotic in the setting of ischemic stroke. This study aimed to explore the anti-neuronal apoptosis effect of GalR1 activation after SAH, as well as the underlying mechanisms. GalR1 CRISPR and GalR1 selective agonist, M617, was administered, respectively. Extracellular-signal-regulated kinase (ERK) inhibitor (U0126) and glycogen synthase kinase 3-beta (GSK3-β) CRISPR were administered to investigate the involvement of the ERK/GSK3-β pathway in GalR1-mediated neuroprotection after SAH. Outcome assessments included neurobehavioral tests, western blot, and immunohistochemistry. The results showed that endogenous ligand galanin (Gal) and GalR1 were markedly increased in the ipsilateral brain hemisphere at 12 h and 24 h after SAH. GalR1 were expressed mainly in neurons, but expression was also observed in some astrocytes and microglia. GalR1 CRISPR knockdown exacerbated neurological deficits and neuronal apoptosis 24 h after SAH. Moreover, activation of GalR1 with M617 significantly improved short- and long-term neurological deficits but decreased neuronal apoptosis after SAH. Furthermore, GalR1 activation dysregulated the protein levels of phosphorylated ERK and GSK-3β, but downregulated the phosphorylated Tat-interactive protein 60 (TIP60) and cleaved caspase-3 at 24 h after SAH. GalR1 CRISPR, U0126, and GSK-3β CRISPR abolished the beneficial effects of GalR1 activation at 24 h after SAH in rats. Collectively, the present study demonstrated that activation of GalR1 using M617 attenuated neuronal apoptosis through the ERK/GSK-3β/TIP60 pathway after SAH in rats. GalR1 may serve as a promising therapeutic target for SAH patients.
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Affiliation(s)
- Hui Shi
- Department of Neurosurgery, Chongqing Medical University, Yongchuan Hospital, Yongchuan, Chongqing, China
| | - Yuanjian Fang
- Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lei Huang
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Ling Gao
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Cameron Lenahan
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Takeshi Okada
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Zachary D Travis
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Shucai Xie
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Hong Tang
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Qin Lu
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Rui Liu
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Jiping Tang
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Yuan Cheng
- Department of Neurosurgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - John H Zhang
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA.
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
- Department of Neurosurgery and Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA, USA.
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25
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Kobayashi M, Levendovszky SR, Hippe DS, Hasegawa M, Murata N, Murata K, Marshall DA, Gonzalez-Cuyar LF, Maravilla KR. Comparison of Human Tissue Gadolinium Retention and Elimination between Gadoteridol and Gadobenate. Radiology 2021; 300:559-569. [PMID: 34128720 DOI: 10.1148/radiol.2021204320] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Linear gadolinium-based contrast agents (GBCAs) are known to be retained at higher levels of gadolinium than macro-cyclic GBCAs. However, very little is known regarding their relative elimination rates and retained fraction of injected gadolinium. Purpose To quantify and compare gadolinium retention and elimination rates in human brain tissue, skin, and bone obtained from cadavers exposed to single-agent administration of either gadoteridol (macrocyclic GBCA) or gadobenate dimeglumine (linear GBCA). Materials and Methods Autopsy cases from August 2014 to July 2019 of patients exposed to a single type of GBCA, either gadoteridol or gadobenate dimeglumine, either single or multiple doses, were included. Gadolinium levels in the brain, skin, and bone were analyzed with inductively coupled plasma mass spectrometry. Linear regression was used to compare gadolinium retention between agents and estimate elimination rates of the retained gadolinium using the time between last injection and death. Results Twenty-eight cadavers with gadoteridol exposure and nine with gadobenate dimeglumine exposure were identified (22 men; age range, 19-83 years). The median gadolinium retention of gadobenate dimeglumine was 3.0-6.5 times higher than that of gadoteridol in the brain (P < .02), 4.4 times higher in bone (P = .002), and 2.9 times higher in skin (P = .05). Gadolinium retention in the globus pallidus (GP), dentate nucleus (DN), white matter (WM), bone, and skin decreased with time elapsed from last administration to death in both the gadobenate dimeglumine (GP: -3% per twofold increase in time, P = .69; DN: -2%, P = .83; WM: -20%, P = .01; bone: -22%, P = .07; skin: -47%, P < .001) and gadoteridol (GP: -17%, P = .11; DN: -16%, P = .15; WM: -30%, P < .001; bone: -11%, P = .16; skin: -24%, P = .01) groups (P values for elimination are compared with a null hypothesis of no elimination). Conclusion The linear agent gadobenate dimeglumine retains several-fold higher levels of gadolinium in the brain and bone compared with the macrocyclic agent gadoteridol. Nonzero elimination of retained gadolinium was detected in the white matter and skin for both agents. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Tweedle in this issue.
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Affiliation(s)
- Masahiro Kobayashi
- From the Department of Radiology (M.K., D.S.H., M.H., N.M., K.M., K.R.M.), Integrated Brain Imaging Center, Department of Radiology (S.R.L.), Department of Neurologic Surgery (K.R.M.), and Magnetic Resonance Research Laboratory (K.R.M.), University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195; Departments of Radiology (M.K.) and Neurology (K.M.), Toho University Omori Medical Center, Tokyo, Japan; Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan (M.H., N.M.); and Department of Pathology, University of Washington School of Medicine, Seattle, Wash (D.A.M., L.F.G.)
| | - Swati Rane Levendovszky
- From the Department of Radiology (M.K., D.S.H., M.H., N.M., K.M., K.R.M.), Integrated Brain Imaging Center, Department of Radiology (S.R.L.), Department of Neurologic Surgery (K.R.M.), and Magnetic Resonance Research Laboratory (K.R.M.), University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195; Departments of Radiology (M.K.) and Neurology (K.M.), Toho University Omori Medical Center, Tokyo, Japan; Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan (M.H., N.M.); and Department of Pathology, University of Washington School of Medicine, Seattle, Wash (D.A.M., L.F.G.)
| | - Daniel S Hippe
- From the Department of Radiology (M.K., D.S.H., M.H., N.M., K.M., K.R.M.), Integrated Brain Imaging Center, Department of Radiology (S.R.L.), Department of Neurologic Surgery (K.R.M.), and Magnetic Resonance Research Laboratory (K.R.M.), University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195; Departments of Radiology (M.K.) and Neurology (K.M.), Toho University Omori Medical Center, Tokyo, Japan; Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan (M.H., N.M.); and Department of Pathology, University of Washington School of Medicine, Seattle, Wash (D.A.M., L.F.G.)
| | - Makoto Hasegawa
- From the Department of Radiology (M.K., D.S.H., M.H., N.M., K.M., K.R.M.), Integrated Brain Imaging Center, Department of Radiology (S.R.L.), Department of Neurologic Surgery (K.R.M.), and Magnetic Resonance Research Laboratory (K.R.M.), University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195; Departments of Radiology (M.K.) and Neurology (K.M.), Toho University Omori Medical Center, Tokyo, Japan; Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan (M.H., N.M.); and Department of Pathology, University of Washington School of Medicine, Seattle, Wash (D.A.M., L.F.G.)
| | - Nozomu Murata
- From the Department of Radiology (M.K., D.S.H., M.H., N.M., K.M., K.R.M.), Integrated Brain Imaging Center, Department of Radiology (S.R.L.), Department of Neurologic Surgery (K.R.M.), and Magnetic Resonance Research Laboratory (K.R.M.), University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195; Departments of Radiology (M.K.) and Neurology (K.M.), Toho University Omori Medical Center, Tokyo, Japan; Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan (M.H., N.M.); and Department of Pathology, University of Washington School of Medicine, Seattle, Wash (D.A.M., L.F.G.)
| | - Kiyoko Murata
- From the Department of Radiology (M.K., D.S.H., M.H., N.M., K.M., K.R.M.), Integrated Brain Imaging Center, Department of Radiology (S.R.L.), Department of Neurologic Surgery (K.R.M.), and Magnetic Resonance Research Laboratory (K.R.M.), University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195; Departments of Radiology (M.K.) and Neurology (K.M.), Toho University Omori Medical Center, Tokyo, Japan; Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan (M.H., N.M.); and Department of Pathology, University of Washington School of Medicine, Seattle, Wash (D.A.M., L.F.G.)
| | - Desiree A Marshall
- From the Department of Radiology (M.K., D.S.H., M.H., N.M., K.M., K.R.M.), Integrated Brain Imaging Center, Department of Radiology (S.R.L.), Department of Neurologic Surgery (K.R.M.), and Magnetic Resonance Research Laboratory (K.R.M.), University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195; Departments of Radiology (M.K.) and Neurology (K.M.), Toho University Omori Medical Center, Tokyo, Japan; Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan (M.H., N.M.); and Department of Pathology, University of Washington School of Medicine, Seattle, Wash (D.A.M., L.F.G.)
| | - Luis F Gonzalez-Cuyar
- From the Department of Radiology (M.K., D.S.H., M.H., N.M., K.M., K.R.M.), Integrated Brain Imaging Center, Department of Radiology (S.R.L.), Department of Neurologic Surgery (K.R.M.), and Magnetic Resonance Research Laboratory (K.R.M.), University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195; Departments of Radiology (M.K.) and Neurology (K.M.), Toho University Omori Medical Center, Tokyo, Japan; Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan (M.H., N.M.); and Department of Pathology, University of Washington School of Medicine, Seattle, Wash (D.A.M., L.F.G.)
| | - Kenneth R Maravilla
- From the Department of Radiology (M.K., D.S.H., M.H., N.M., K.M., K.R.M.), Integrated Brain Imaging Center, Department of Radiology (S.R.L.), Department of Neurologic Surgery (K.R.M.), and Magnetic Resonance Research Laboratory (K.R.M.), University of Washington, 1959 NE Pacific St, Box 357115, Seattle, WA 98195; Departments of Radiology (M.K.) and Neurology (K.M.), Toho University Omori Medical Center, Tokyo, Japan; Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan (M.H., N.M.); and Department of Pathology, University of Washington School of Medicine, Seattle, Wash (D.A.M., L.F.G.)
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Maecker HT, Siebert JC, Rosenberg-Hasson Y, Koran LM, Ramalho M, Semelka RC. Acute Chelation Therapy-Associated Changes in Urine Gadolinium, Self-reported Flare Severity, and Serum Cytokines in Gadolinium Deposition Disease. Invest Radiol 2021; 56:374-384. [PMID: 33449576 PMCID: PMC8087628 DOI: 10.1097/rli.0000000000000752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to determine the following in patients who have undergone magnetic resonance imaging with gadolinium-based contrast agents (GBCAs) and meet the proposed diagnostic criteria for gadolinium deposition disease (GDD): (1) the effectiveness of chelation therapy (CT) with intravenous Ca-diethylenetriaminepentaacetic acid in removing retained gadolinium (Gd) and factors affecting the amount removed; (2) the frequency of CT-induced Flare, that is, GDD diagnostic symptom worsening, and factors affecting Flare intensity; (3) whether, as reported in a separate cohort, GDD patients' serum cytokine levels differ significantly from those in healthy normal controls and change significantly in response to CT; and (4) whether urine Gd, Flare reaction, and serum cytokine findings in GDD patients are mimicked in non-ill patients described as having gadolinium storage condition (GSC). MATERIALS AND METHODS Twenty-one GDD subjects and 3 GSC subjects underwent CT. Patients provided pre-CT and post-CT 24-hour urine samples for Gd content determination along with pre-CT and 24-hour post-CT serum samples for cytokine analysis. Patients rated potential Flare 24 hours after CT. Pre-CT and post-CT 24-hour urine Gd analyses and Luminex serum cytokine assays were performed blind to patients' GDD and GSC status and all other data except age and sex. Serum cytokine levels in a healthy normal control group of age- and sex-matched subjects drawn from Stanford influenza vaccination studies were measured once, contemporaneously with those of GDD and GSC patients, using the same Luminex assay. RESULTS Urine Gd amounts increased post-CT by 4 times or more after 87% of the 30 CT sessions. The most important factors appeared to be the time since the last GBCA dose and the cumulative dose received. Urine Gd amounts for GDD and GSC patients fell in the same ranges. All GDD patients, and no GSC patient, reported a Flare 24 hours post-CT. Linear regression found that Flare intensity was significantly predicted by a model including pre- and post-CT Gd amounts and the number of GBCA-enhanced magnetic resonance imaging. Post-CT, multiple cytokines showed strong positive relationships with GDD patients' Flare intensity in multivariable models. The pre-CT serum levels of 12 cytokines were significantly different in GDD patients compared with healthy flu vaccine controls. The small number of GSC patients precluded analogous statistical testing. Post-CT, GDD patients' serum levels of 20 cytokines were significantly decreased, and 2 cytokines significantly increased. These cytokines did not exhibit the same change pattern in the 3 GSC patients. The small number of GSC patients precluded statistical comparisons of GSC to GDD patients' results. CONCLUSIONS In this preliminary study, 24-hour urine Gd content increased markedly and similarly in GDD and GSC patients after Ca-diethylenetriaminepentaacetic acid CT. Post-CT Flare reaction developed only in GDD patients. The current study is the second finding significantly different serum cytokine levels in GDD patients compared with healthy normal controls. These differences and the difference between GDD and GSC patients' Flare and cytokine responses to CT suggest some inflammatory, immunologic, or other physiological differences in patients with GDD. Further research into the treatment and physiological underpinnings of GDD is warranted.
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Affiliation(s)
- Holden T Maecker
- From the Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA
| | | | - Yael Rosenberg-Hasson
- From the Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA
| | - Lorrin M Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
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Bäuerle T, Saake M, Uder M. Gadolinium-based contrast agents: What we learned from acute adverse events, nephrogenic systemic fibrosis and brain retention. ROFO-FORTSCHR RONTG 2020; 193:1010-1018. [PMID: 33348385 DOI: 10.1055/a-1328-3177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Radiologists have been administering gadolinium-based contrast agents (GBCA) in magnetic resonance imaging for several decades, so that there is abundant experience with these agents regarding allergic-like reactions, nephrogenic systemic fibrosis (NSF) and gadolinium retention in the brain. METHODS This review is based on a selective literature search and reflects the current state of research on acute adverse effects of GBCA, NSF and brain retention of gadolinium. RESULTS Due to the frequent use of GBCA, data on adverse effects of these compounds are available in large collectives. Allergic-like reactions occurred rarely, whereas severe acute reactions were very rarely observed. Systemic changes in NSF also occur very rarely, although measures to avoid NSF resulted in a significantly reduced incidence of NSF. Due to gadolinium retention in the body after administration of linear MR contrast agents, only macrocyclic preparations are currently used with few exceptions. Clear clinical correlates of gadolinium retention in the brain could not be identified so far. Although the clinical added value of GBCA is undisputed, individual risks associated with the injection of GBCA should be identified and the use of non-contrast enhanced MR techniques should be considered. Alternative contrast agents such as iron oxide nanoparticles are not clinically approved, but are currently undergoing clinical trials. CONCLUSION GBCA have a very good risk profile with a low rate of adverse effects or systemic manifestations such as NSF. Gadolinium retention in the brain can be minimized by the use of macrocyclic GBCA, although clear clinical correlates due to gadolinium retention in the brain following administration of linear GBCA could not be identified yet. KEY POINTS · Acute adverse effects are predominantly mild/moderate, rarely severe reactions occur.. · International guidelines resulted in significant reduction of nephrogenic systemic fibrosis.. · Application of macrocyclic contrast agents minimizes gadolinium retention in the brain.. CITATION FORMAT · Bäuerle T, Saake M, Uder M. Gadolinium-based contrast agents: What we learned from acute adverse events, nephrogenic systemic fibrosis and brain retention. Fortschr Röntgenstr 2021; 193: 1010 - 1018.
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Affiliation(s)
- Tobias Bäuerle
- Institute of Radiology, University Medical Center, Erlangen, Germany
| | - Marc Saake
- Institute of Radiology, University Medical Center, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Medical Center, Erlangen, Germany
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Takakuwa N, Isa K, Onoe H, Takahashi J, Isa T. Contribution of the Pulvinar and Lateral Geniculate Nucleus to the Control of Visually Guided Saccades in Blindsight Monkeys. J Neurosci 2021; 41:1755-68. [PMID: 33443074 DOI: 10.1523/JNEUROSCI.2293-20.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/23/2020] [Accepted: 12/09/2020] [Indexed: 01/16/2023] Open
Abstract
After damage to the primary visual cortex (V1), conscious vision is impaired. However, some patients can respond to visual stimuli presented in their lesion-affected visual field using residual visual pathways bypassing V1. This phenomenon is called "blindsight." Many studies have tried to identify the brain regions responsible for blindsight, and the pulvinar and/or lateral geniculate nucleus (LGN) are suggested to play key roles as the thalamic relay of visual signals. However, there are critical problems regarding these preceding studies in that subjects with different sized lesions and periods of time after lesioning were investigated; furthermore, the ability of blindsight was assessed with different measures. In this study, we used double dissociation to clarify the roles of the pulvinar and LGN by pharmacological inactivation of each region and investigated the effects in a simple task with visually guided saccades (VGSs) using monkeys with a unilateral V1 lesion, by which nearly all of the contralesional visual field was affected. Inactivating either the ipsilesional pulvinar or LGN impaired VGS toward a visual stimulus in the affected field. In contrast, inactivation of the contralesional pulvinar had no clear effect, but inactivation of the contralesional LGN impaired VGS to the intact visual field. These results suggest that the pulvinar and LGN play key roles in performing the simple VGS task after V1 lesioning, and that the visuomotor functions of blindsight monkeys were supported by plastic changes in the visual pathway involving the pulvinar, which emerged after V1 lesioning.SIGNIFICANCE STATEMENT Many studies have been devoted to understanding the mechanism of mysterious symptom called "blindsight," in which patients with damage to the primary visual cortex (V1) can respond to visual stimuli despite loss of visual awareness. However, there is still a debate on the thalamic relay of visual signals. In this study, to pin down the issue, we tried double dissociation in the same subjects (hemi-blindsight macaque monkeys) and clarified that the lateral geniculate nucleus (LGN) plays a major role in simple visually guided saccades in the intact state, while both pulvinar and LGN critically contribute after the V1 lesioning, suggesting that plasticity in the visual pathway involving the pulvinar underlies the blindsight.
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Affiliation(s)
- Alexander Radbruch
- From the Centre of Neurology-Radiology, University Hospital Bonn, Venusberg Campus 1, Bonn 53127, Germany
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