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Heydarian M, Oak P, Zhang X, Kamgari N, Kindt A, Koschlig M, Pritzke T, Gonzalez-Rodriguez E, Förster K, Morty RE, Häfner F, Hübener C, Flemmer AW, Yildirim AO, Sudheendra D, Tian X, Petrera A, Kirsten H, Ahnert P, Morrell N, Desai TJ, Sucre J, Spiekerkoetter E, Hilgendorff A. Relationship between impaired BMP signalling and clinical risk factors at early-stage vascular injury in the preterm infant. Thorax 2022; 77:1176-1186. [PMID: 35580897 PMCID: PMC9685723 DOI: 10.1136/thoraxjnl-2021-218083] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/11/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic lung disease, that is, bronchopulmonary dysplasia (BPD) is the most common complication in preterm infants and develops as a consequence of the misguided formation of the gas-exchange area undergoing prenatal and postnatal injury. Subsequent vascular disease and its progression into pulmonary arterial hypertension critically determines long-term outcome in the BPD infant but lacks identification of early, disease-defining changes. METHODS We link impaired bone morphogenetic protein (BMP) signalling to the earliest onset of vascular pathology in the human preterm lung and delineate the specific effects of the most prevalent prenatal and postnatal clinical risk factors for lung injury mimicking clinically relevant conditions in a multilayered animal model using wild-type and transgenic neonatal mice. RESULTS We demonstrate (1) the significant reduction in BMP receptor 2 (BMPR2) expression at the onset of vascular pathology in the lung of preterm infants, later mirrored by reduced plasma BMP protein levels in infants with developing BPD, (2) the rapid impairment (and persistent change) of BMPR2 signalling on postnatal exposure to hyperoxia and mechanical ventilation, aggravated by prenatal cigarette smoke in a preclinical mouse model and (3) a link to defective alveolar septation and matrix remodelling through platelet derived growth factor-receptor alpha deficiency. In a treatment approach, we partially reversed vascular pathology by BMPR2-targeted treatment with FK506 in vitro and in vivo. CONCLUSION We identified impaired BMP signalling as a hallmark of early vascular disease in the injured neonatal lung while outlining its promising potential as a future biomarker or therapeutic target in this growing, high-risk patient population.
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Affiliation(s)
- Motaharehsadat Heydarian
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Prajakta Oak
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Xin Zhang
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nona Kamgari
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Alida Kindt
- Division of Analytical Biosciences, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands
| | - Markus Koschlig
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Tina Pritzke
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Erika Gonzalez-Rodriguez
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Kai Förster
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
- Department of Neonatology, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, LMU Hospital, Munich, Germany
| | - Rory E Morty
- Department of Translational Pulmonology, University Hospital Heidelberg, Translational Lung Research Center campus of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Friederike Häfner
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Christoph Hübener
- Department of Obstetrics and Gynecology, Ludwig-Maximilians University, LMU Hospital, Munich, Germany
| | - Andreas W Flemmer
- Department of Neonatology, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, LMU Hospital, Munich, Germany
| | - Ali Oender Yildirim
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Deepti Sudheendra
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, California, USA
| | - Xuefei Tian
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, California, USA
| | - Agnese Petrera
- Research Unit Protein Science and Metabolomics and Proteomics Core, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Holger Kirsten
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), associated partner of the German Center for Lung Research (DZL), University of Leipzig, Leipzig, Germany
| | - Peter Ahnert
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), associated partner of the German Center for Lung Research (DZL), University of Leipzig, Leipzig, Germany
| | - Nick Morrell
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Tushar J Desai
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, California, USA
| | - Jennifer Sucre
- Mildred Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
| | - Edda Spiekerkoetter
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, California, USA
| | - Anne Hilgendorff
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
- Center for Comprehensive Developmental Care (CDeCLMU), Ludwig-Maximilians University, LMU Hospital, Munich, Germany
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Weinfurtner K, Cho J, Ackerman D, Woodard A, Li W, Soulen M, Dagli M, Shamimi-Noori S, Mondschein J, Sudheendra D, Stavropoulos S, Jhala D, Hunt S, Nadolski G, Kaplan D, Siegelman E, Furth E, Gade T. Abstract No. 560 Quality of large-volume percutaneous core biopsies of hepatocellular carcinoma for research applications. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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3
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Sheng M, Mantell M, Vance A, Shamimi-Noori S, Nadolski G, Reddy S, Stavropoulos S, Hunt S, Dagli M, Sudheendra D, Clark T. 03:09 PM Abstract No. 354 Treatment of non-maturing fistula for hemodialysis access via transradial approach: a case-control study. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Currie B, Nadolski G, Mondschein J, Dagli M, Sudheendra D, Stavropoulos S, Soulen M. 03:09 PM Abstract No. 103 Chronic hepatotoxicity in patients with metastatic neuroendocrine tumor: TACE vs. TARE. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Dannewitz Prosseda S, Tian X, Kuramoto K, Boehm M, Sudheendra D, Miyagawa K, Zhang F, Solow-Cordero D, Saldivar JC, Austin ED, Loyd JE, Wheeler L, Andruska A, Donato M, Wang L, Huebner K, Metzger RJ, Khatri P, Spiekerkoetter E. FHIT, a Novel Modifier Gene in Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2019; 199:83-98. [PMID: 30107138 PMCID: PMC6353016 DOI: 10.1164/rccm.201712-2553oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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] [Received: 12/19/2017] [Accepted: 08/14/2018] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pulmonary arterial hypertension (PAH) is characterized by progressive narrowing of pulmonary arteries, resulting in right heart failure and death. BMPR2 (bone morphogenetic protein receptor type 2) mutations account for most familial PAH forms whereas reduced BMPR2 is present in many idiopathic PAH forms, suggesting dysfunctional BMPR2 signaling to be a key feature of PAH. Modulating BMPR2 signaling is therapeutically promising, yet how BMPR2 is downregulated in PAH is unclear. OBJECTIVES We intended to identify and pharmaceutically target BMPR2 modifier genes to improve PAH. METHODS We combined siRNA high-throughput screening of >20,000 genes with a multicohort analysis of publicly available PAH RNA expression data to identify clinically relevant BMPR2 modifiers. After confirming gene dysregulation in tissue from patients with PAH, we determined the functional roles of BMPR2 modifiers in vitro and tested the repurposed drug enzastaurin for its propensity to improve experimental pulmonary hypertension (PH). MEASUREMENTS AND MAIN RESULTS We discovered FHIT (fragile histidine triad) as a novel BMPR2 modifier. BMPR2 and FHIT expression were reduced in patients with PAH. FHIT reductions were associated with endothelial and smooth muscle cell dysfunction, rescued by enzastaurin through a dual mechanism: upregulation of FHIT as well as miR17-5 repression. Fhit-/- mice had exaggerated hypoxic PH and failed to recover in normoxia. Enzastaurin reversed PH in the Sugen5416/hypoxia/normoxia rat model, by improving right ventricular systolic pressure, right ventricular hypertrophy, cardiac fibrosis, and vascular remodeling. CONCLUSIONS This study highlights the importance of the novel BMPR2 modifier FHIT in PH and the clinical value of the repurposed drug enzastaurin as a potential novel therapeutic strategy to improve PAH.
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Affiliation(s)
- Svenja Dannewitz Prosseda
- Division of Pulmonary and Critical Care, Department of Medicine
- Wall Center for Pulmonary Vascular Disease
| | - Xuefei Tian
- Division of Pulmonary and Critical Care, Department of Medicine
- Wall Center for Pulmonary Vascular Disease
| | - Kazuya Kuramoto
- Division of Pulmonary and Critical Care, Department of Medicine
- Wall Center for Pulmonary Vascular Disease
| | - Mario Boehm
- Division of Pulmonary and Critical Care, Department of Medicine
- Wall Center for Pulmonary Vascular Disease
| | | | - Kazuya Miyagawa
- Wall Center for Pulmonary Vascular Disease
- Cardiovascular Institute
- Department of Pediatrics
| | - Fan Zhang
- Wall Center for Pulmonary Vascular Disease
| | | | | | - Eric D. Austin
- Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - James E. Loyd
- Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Lisa Wheeler
- Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Adam Andruska
- Division of Pulmonary and Critical Care, Department of Medicine
| | - Michele Donato
- Biomedical Informatics Research–Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, California
| | - Lingli Wang
- Division of Pulmonary and Critical Care, Department of Medicine
- Wall Center for Pulmonary Vascular Disease
| | - Kay Huebner
- Molecular Genetics and Cancer Biology Program, Ohio State University, Columbus, Ohio
| | | | - Purvesh Khatri
- Biomedical Informatics Research–Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, California
| | - Edda Spiekerkoetter
- Division of Pulmonary and Critical Care, Department of Medicine
- Wall Center for Pulmonary Vascular Disease
- Cardiovascular Institute
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Nadolski G, Kalbasi A, Soulen M, Hunt S, Dagli M, Mondschein J, Sudheendra D, Stavropoulos S, Apisarnthanarax S, Hoteit M, Ben-Josef E. 4:12 PM Abstract No. 41 Interim analysis of pilot randomized trial of transarterial chemoembolization with or without stereotactic body radiation therapy for hepatocellular carcinoma patients awaiting liver transplantation. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Spiekerkoetter E, Sung YK, Sudheendra D, Scott V, Del Rosario P, Bill M, Haddad F, Long-Boyle J, Hedlin H, Zamanian RT. Randomised placebo-controlled safety and tolerability trial of FK506 (tacrolimus) for pulmonary arterial hypertension. Eur Respir J 2017; 50:50/3/1602449. [DOI: 10.1183/13993003.02449-2016] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/07/2017] [Indexed: 11/05/2022]
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Habibollahi P, Hunt S, Gade T, Shin B, Dagli M, Mondschein J, Sudheendra D, Stavropoulos S, Soulen M, Nadolski G. Neoadjuvant locoregional therapy and long-term outcomes of patients with hepatocellular carcinoma listed for orthotopic liver transplantation. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Barraza J, Currie B, Nadolski G, Gade T, Mondschein J, Dagli M, Sudheendra D, Stavropoulos S, Soulen M. Delayed hepatotoxicity of Y-90 radioembolization. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abousoud O, Hunt S, Gade T, Mondschein J, Dagli M, Sudheendra D, Stavropoulos S, Soulen M, Nadolski G. Comparison of infection rates in patients with prior biliary interventions undergoing hepatic embolotherapy treated with single-drug moxifloxacin versus multi-drug antibiotic prophylaxis. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Chick J, Stavropoulos S, Mondschein J, Sudheendra D, Nadolski G, Watts M, Trerotola S. 16F sheath with endobronchial forceps improves reported retrieval success of “closed cell” IVC filter designs. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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12
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Spiekerkoetter E, Sung YK, Sudheendra D, Bill M, Aldred MA, van de Veerdonk MC, Vonk Noordegraaf A, Long-Boyle J, Dash R, Yang PC, Lawrie A, Swift AJ, Rabinovitch M, Zamanian RT. Low-Dose FK506 (Tacrolimus) in End-Stage Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2015; 192:254-7. [PMID: 26177174 DOI: 10.1164/rccm.201411-2061le] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Yon K Sung
- 1 Stanford University Stanford, California
| | | | | | | | | | | | - Janel Long-Boyle
- 4 University of California, San Francisco San Francisco, California
| | | | | | - Allan Lawrie
- 5 University of Sheffield Sheffield, United Kingdom
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Levy J, Shlansky-Goldberg R, Stavropoulos W, Trerotola S, Mondschein J, Dagli M, Sudheendra D, Teitelbaum U, Mick R, Soulen M. Is percutaneous biliary drainage effective in lowering serum bilirubin for chemotherapy? J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Yan Y, Sudheendra D, Dagli M, Stavropoulos W, Clark T, Soulen M, Mondschein J, Asmar M, Trerotola S. Effect of central venous angioplasty on hemodialysis access circuit flow. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Spiekerkoetter E, Tian X, Cai J, Hopper RK, Sudheendra D, Li CG, El-Bizri N, Sawada H, Haghighat R, Chan R, Haghighat L, de Jesus Perez V, Wang L, Reddy S, Zhao M, Bernstein D, Solow-Cordero DE, Beachy PA, Wandless TJ, Ten Dijke P, Rabinovitch M. FK506 activates BMPR2, rescues endothelial dysfunction, and reverses pulmonary hypertension. J Clin Invest 2013; 123:3600-13. [PMID: 23867624 DOI: 10.1172/jci65592] [Citation(s) in RCA: 311] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/16/2013] [Indexed: 12/12/2022] Open
Abstract
Dysfunctional bone morphogenetic protein receptor-2 (BMPR2) signaling is implicated in the pathogenesis of pulmonary arterial hypertension (PAH). We used a transcriptional high-throughput luciferase reporter assay to screen 3,756 FDA-approved drugs and bioactive compounds for induction of BMPR2 signaling. The best response was achieved with FK506 (tacrolimus), via a dual mechanism of action as a calcineurin inhibitor that also binds FK-binding protein-12 (FKBP12), a repressor of BMP signaling. FK506 released FKBP12 from type I receptors activin receptor-like kinase 1 (ALK1), ALK2, and ALK3 and activated downstream SMAD1/5 and MAPK signaling and ID1 gene regulation in a manner superior to the calcineurin inhibitor cyclosporine and the FKBP12 ligand rapamycin. In pulmonary artery endothelial cells (ECs) from patients with idiopathic PAH, low-dose FK506 reversed dysfunctional BMPR2 signaling. In mice with conditional Bmpr2 deletion in ECs, low-dose FK506 prevented exaggerated chronic hypoxic PAH associated with induction of EC targets of BMP signaling, such as apelin. Low-dose FK506 also reversed severe PAH in rats with medial hypertrophy following monocrotaline and in rats with neointima formation following VEGF receptor blockade and chronic hypoxia. Our studies indicate that low-dose FK506 could be useful in the treatment of PAH.
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Affiliation(s)
- Edda Spiekerkoetter
- The Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, California 94305-5162, USA
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Yan Y, Clark T, Mondschein J, Shlansky-Goldberg R, Soulen M, Stavropoulos S, Farrelly C, Sudheendra D, Chittams J, Trerotola S. Outcomes of percutaneous interventions in transposed hemodialysis fistulae. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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17
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Sudheendra D, Bartynski WS. Direct fluoroscopic drainage of symptomatic post-traumatic syringomyelia. A case report and review of the literature. Interv Neuroradiol 2008; 14:461-4. [PMID: 20557748 PMCID: PMC3313816 DOI: 10.1177/159101990801400414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/13/2008] [Accepted: 09/14/2008] [Indexed: 11/15/2022] Open
Abstract
SUMMARY First described in 1928, percutaneous aspiration of syringomyelia is infrequently performed to aid in diagnosis and surgical management. We describe a case of post traumatic syringomyelia successfully treated with direct fluoroscopic drainage with substantial resolution of syrinx-related neurologic symptoms. The patient is a 36-year-old man involved in a motorcycle accident who sustained multiple vertebral fractures resulting in dense paraplegia below T4, ultimately treated with multilevel laminectomy and pedicle screw fixation. The patient began to experience phantom leg paresthesias and muscle spasm felt to be related to an extensive spinal cord syrinx extending to the conus. Syrinx drainage was accomplished fluoroscopically at the level of the conus by percuntaneous needle drainage after cord localization with intrathecal myelographic contrast. Clear spinal fluid was drained from the syrinx cavity without complication. Immediately during and after drainage, the patient recognized a decrease in phantom pelvic and lower extremity paresthesias with significantly reduced spasticity. Syrinx collapse was documented with post-drainage CT imaging. Sustained relief of paresthesias and muscle spasms was achieved with gradual syrinx and symptom return requiring subsequent drainages performed at nine, 22 and 37 months following the initial drainage. In addition to confirming the symptomatic nature of syringomyelia in those with atypical symptoms, fluoroscopically guided drainage of syrinx can in select instances provide sustained relief. This modality may have additional advantages including serving as an adjunctive maneuver to improve operative access to the subarachnoid space by collapsing the cord, and serving as a temporizing measure for those patients who are poor surgical candidates. Maneuvers such as fluoroscopic table angulation provide an additional benefit in both the localization and drainage of syringomyelia and thus may be preferred over other minimally invasive procedures such as CT-guided drainage.
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Affiliation(s)
- D Sudheendra
- University of Pittsburgh Medical Center, Radiology Dept; Pittsburgh, PA, USA
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Sudheendra D, Barth M, Hegde U, Wilson W, Libutti S, Wood B. Radiofrequency ablation of lymphoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6710] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. Sudheendra
- National Insts of Health, Bethesda, MD; Beth Israel Deaconess Medcl Ctr, Boston, MA; Univ of Connecticut Health Ctr, Farmington, CT
| | - M. Barth
- National Insts of Health, Bethesda, MD; Beth Israel Deaconess Medcl Ctr, Boston, MA; Univ of Connecticut Health Ctr, Farmington, CT
| | - U. Hegde
- National Insts of Health, Bethesda, MD; Beth Israel Deaconess Medcl Ctr, Boston, MA; Univ of Connecticut Health Ctr, Farmington, CT
| | - W. Wilson
- National Insts of Health, Bethesda, MD; Beth Israel Deaconess Medcl Ctr, Boston, MA; Univ of Connecticut Health Ctr, Farmington, CT
| | - S. Libutti
- National Insts of Health, Bethesda, MD; Beth Israel Deaconess Medcl Ctr, Boston, MA; Univ of Connecticut Health Ctr, Farmington, CT
| | - B. Wood
- National Insts of Health, Bethesda, MD; Beth Israel Deaconess Medcl Ctr, Boston, MA; Univ of Connecticut Health Ctr, Farmington, CT
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