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Ehrengut C, Schindler A, Seehofer D, Ebel S, Steinhoff K, Sabri O, Berg T, Denecke T, Bömmel FVAN, Meyer HJ. The Apparent Diffusion Coefficient of the Paraspinal and Psoas Muscles Are of Prognostic Relevance in Patients With Hepatocellular Carcinoma Undergoing Transarterial Radioembolization. Cancer Diagn Progn 2024; 4:281-287. [PMID: 38707727 PMCID: PMC11062171 DOI: 10.21873/cdp.10321] [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] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 05/07/2024]
Abstract
Background/Aim Transarterial radioembolization (TARE) is a treatment option for early or intermediate stage hepatocellular carcinoma (HCC). Sarcopenia is defined as loss of muscle strength and quality which can be estimated by imaging modalities and has been associated with prognosis and treatment response in HCC patients. Apparent diffusion coefficient (ADC) values derived from diffusion-weighted imaging (DWI) can reflect the tissue composition and might be better to determine muscle changes of sarcopenia than the standard method of computed tomography (CT). The present study sought to elucidate ADC values of the abdominal wall muscles as a prognostic factor in patients undergoing TARE. Patients and Methods A retrospective analysis was performed between 2016 and 2020. Overall, 52 patients, 9 women (17.3%) and 43 men (82.7%), with a mean age of 69±8.5 years were included into the analysis. In every case, the first pre-interventional magnetic resonance imaging (MRI) including DWI was used to measure the ADC values of paraspinal and psoas muscle. The 12-month survival after TARE was used as the primary study outcome. Results Overall, 40 patients (76.9%) of the patient cohort died within the 12-month observation period. Mean overall survival was 10.9 months after TARE for all patients. Mean ADC values for all muscles were 1.31±0.13×10-3mm2/s. The ADC values of the paraspinal muscles were statistically significantly higher compared to the ADC values of the psoas muscles (p=0.0031). A positive correlation was identified between mean ADC and the thrombocyte count (r=0.37, p=0.005) and serum bilirubin (r=-0.30, p=0.03). In the multivariate Cox regression analysis, the mean ADC values of all muscles were associated with the survival after 12 months (HR=0.98, 95% CI=0.97-0.99, p=0.04). Conclusion ADC values of the abdominal wall muscles could be used as a prognostic biomarker in patients with HCC undergoing TARE. These preliminary results should be confirmed by further studies using external validation cohorts and other treatment modalities.
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Affiliation(s)
- Constantin Ehrengut
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Aaron Schindler
- Department of Hepatology, University of Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Karen Steinhoff
- Department of Nuclear Medicine University of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine University of Leipzig, Leipzig, Germany
| | - Thomas Berg
- Department of Hepatology, University of Leipzig, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | | | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
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Weiner J, Kranz M, Klöting N, Kunath A, Steinhoff K, Rijntjes E, Köhrle J, Zeisig V, Hankir M, Gebhardt C, Deuther-Conrad W, Heiker JT, Kralisch S, Stumvoll M, Blüher M, Sabri O, Hesse S, Brust P, Tönjes A, Krause K. Thyroid hormone status defines brown adipose tissue activity and browning of white adipose tissues in mice. Sci Rep 2016; 6:38124. [PMID: 27941950 PMCID: PMC5150531 DOI: 10.1038/srep38124] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 11/07/2016] [Indexed: 12/28/2022] Open
Abstract
The present study aimed to determine the effect of thyroid hormone dysfunction on brown adipose tissue activity and white adipose tissue browning in mice. Twenty randomized female C57BL/6NTac mice per treatment group housed at room temperature were rendered hypothyroid or hyperthyroid. In-vivo small animal 18F-FDG PET/MRI was performed to determine the effects of hypo- and hyperthyroidism on BAT mass and BAT activity. Ex-vivo14C-acetate loading assay and assessment of thermogenic gene and protein expression permitted analysis of oxidative and thermogenic capacities of WAT and BAT of eu-, hyper and hypothyroid mice. 18F-FDG PET/MRI revealed a lack of brown adipose tissue activity in hypothyroid mice, whereas hyperthyroid mice displayed increased BAT mass alongside enhanced 18F-FDG uptake. In white adipose tissue of both, hyper- and hypothyroid mice, we found a significant induction of thermogenic genes together with multilocular adipocytes expressing UCP1. Taken together, these results suggest that both the hyperthyroid and hypothyroid state stimulate WAT thermogenesis most likely as a consequence of enhanced adrenergic signaling or compensation for impaired BAT function, respectively.
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Affiliation(s)
- Juliane Weiner
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany
| | - Mathias Kranz
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Research Site Leipzig, Department of Neuroradiopharmaceuticals, Leipzig, Germany
| | - Nora Klöting
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany.,University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Anne Kunath
- German Center for Diabetes Research (DZD), Leipzig, Germany
| | - Karen Steinhoff
- Department of Nuclear Medicine, University Hospital, Leipzig, Germany
| | - Eddy Rijntjes
- Institute of Experimental Endocrinology, Charité University Hospital, Berlin, Germany
| | - Josef Köhrle
- Institute of Experimental Endocrinology, Charité University Hospital, Berlin, Germany
| | - Vilia Zeisig
- Department of Nuclear Medicine, University Hospital, Leipzig, Germany
| | - Mohammed Hankir
- University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Claudia Gebhardt
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany
| | - Winnie Deuther-Conrad
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Research Site Leipzig, Department of Neuroradiopharmaceuticals, Leipzig, Germany
| | - John T Heiker
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany
| | - Susan Kralisch
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany.,University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Michael Stumvoll
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany.,University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Matthias Blüher
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany.,University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Osama Sabri
- University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital, Leipzig, Germany
| | - Swen Hesse
- University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital, Leipzig, Germany
| | - Peter Brust
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Research Site Leipzig, Department of Neuroradiopharmaceuticals, Leipzig, Germany
| | - Anke Tönjes
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany
| | - Kerstin Krause
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany
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Hankir MK, Kranz M, Gnad T, Weiner J, Wagner S, Deuther-Conrad W, Bronisch F, Steinhoff K, Luthardt J, Klöting N, Hesse S, Seibyl JP, Sabri O, Heiker JT, Blüher M, Pfeifer A, Brust P, Fenske WK. A novel thermoregulatory role for PDE10A in mouse and human adipocytes. EMBO Mol Med 2016; 8:796-812. [PMID: 27247380 PMCID: PMC4931292 DOI: 10.15252/emmm.201506085] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Phosphodiesterase type 10A (PDE10A) is highly enriched in striatum and is under evaluation as a drug target for several psychiatric/neurodegenerative diseases. Preclinical studies implicate PDE10A in the regulation of energy homeostasis, but the mechanisms remain unclear. By utilizing small-animal PET/MRI and the novel radioligand [(18)F]-AQ28A, we found marked levels of PDE10A in interscapular brown adipose tissue (BAT) of mice. Pharmacological inactivation of PDE10A with the highly selective inhibitor MP-10 recruited BAT and potentiated thermogenesis in vivo In diet-induced obese mice, chronic administration of MP-10 caused weight loss associated with increased energy expenditure, browning of white adipose tissue, and improved insulin sensitivity. Analysis of human PET data further revealed marked levels of PDE10A in the supraclavicular region where brown/beige adipocytes are clustered in adults. Finally, the inhibition of PDE10A with MP-10 stimulated thermogenic gene expression in human brown adipocytes and induced browning of human white adipocytes. Collectively, our findings highlight a novel thermoregulatory role for PDE10A in mouse and human adipocytes and promote PDE10A inhibitors as promising candidates for the treatment of obesity and diabetes.
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Affiliation(s)
- Mohammed K Hankir
- Integrated Research and Treatment Centre for Adiposity Diseases, University Hospital University of Leipzig, Leipzig, Germany
| | - Mathias Kranz
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf Neuroradiopharmaceuticals, Leipzig, Germany
| | - Thorsten Gnad
- Institute of Pharmacology and Toxicology, University Hospital University of Bonn, Bonn, Germany
| | - Juliane Weiner
- Integrated Research and Treatment Centre for Adiposity Diseases, University Hospital University of Leipzig, Leipzig, Germany
| | - Sally Wagner
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf Neuroradiopharmaceuticals, Leipzig, Germany
| | - Winnie Deuther-Conrad
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf Neuroradiopharmaceuticals, Leipzig, Germany
| | - Felix Bronisch
- Integrated Research and Treatment Centre for Adiposity Diseases, University Hospital University of Leipzig, Leipzig, Germany
| | - Karen Steinhoff
- Department of Nuclear Medicine, University Hospital University of Leipzig, Leipzig, Germany
| | - Julia Luthardt
- Department of Nuclear Medicine, University Hospital University of Leipzig, Leipzig, Germany
| | - Nora Klöting
- Integrated Research and Treatment Centre for Adiposity Diseases, University Hospital University of Leipzig, Leipzig, Germany
| | - Swen Hesse
- Integrated Research and Treatment Centre for Adiposity Diseases, University Hospital University of Leipzig, Leipzig, Germany Department of Nuclear Medicine, University Hospital University of Leipzig, Leipzig, Germany
| | | | - Osama Sabri
- Integrated Research and Treatment Centre for Adiposity Diseases, University Hospital University of Leipzig, Leipzig, Germany Department of Nuclear Medicine, University Hospital University of Leipzig, Leipzig, Germany
| | - John T Heiker
- Integrated Research and Treatment Centre for Adiposity Diseases, University Hospital University of Leipzig, Leipzig, Germany
| | - Matthias Blüher
- Integrated Research and Treatment Centre for Adiposity Diseases, University Hospital University of Leipzig, Leipzig, Germany
| | - Alexander Pfeifer
- Institute of Pharmacology and Toxicology, University Hospital University of Bonn, Bonn, Germany
| | - Peter Brust
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf Neuroradiopharmaceuticals, Leipzig, Germany
| | - Wiebke K Fenske
- Integrated Research and Treatment Centre for Adiposity Diseases, University Hospital University of Leipzig, Leipzig, Germany
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Krause K, Weiner J, Hönes S, Klöting N, Rijntjes E, Heiker JT, Gebhardt C, Köhrle J, Führer D, Steinhoff K, Hesse S, Moeller LC, Tönjes A. The Effects of Thyroid Hormones on Gene Expression of Acyl-Coenzyme A Thioesterases in Adipose Tissue and Liver of Mice. Eur Thyroid J 2015; 4:59-66. [PMID: 26601074 PMCID: PMC4640296 DOI: 10.1159/000437304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 11/17/2014] [Revised: 06/29/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Thyroid hormones (TH) exert pleiotropic effects on glucose and lipid homeostasis. However, it is as yet unclear how TH regulate lipid storage and utilization in order to adapt to metabolic needs. Acyl-CoA thioesterases (ACOTs) have been proposed to play a regulatory role in the metabolism of fatty acids. OBJECTIVES We investigated the interaction between thyroid dysfunction and Acot expression in adipose tissues and livers of thyrotoxic and hypothyroid mice. METHODS Ten-week-old female C57BL/6NTac mice (n = 10/group) were made hyperthyroid by the application of L-thyroxine (2 µg/ml in drinking water) for 4 weeks. Hypothyroidism was induced in 10-week-old mice by feeding an iodine-free chow supplemented with 0.15% PTU for 4 weeks. We measured mRNA expression levels of Acot8, 11 and 13 in the liver and epididymal and inguinal white and brown adipose tissues (BAT). Furthermore, we investigated hepatic Acot gene expression in TRα- and TRβ-deficient mice. RESULTS We showed that the expression of Acot8, 11 and 13 is predominantly stimulated by a thyrotoxic state in the epididymal white adipose tissue. In contrast, hypothyroidism predominantly induces the expression of Acot8 in BAT in comparison with BAT of thyrotoxic and euthyroid mice (p < 0.01). However, no significant changes in Acot expression were observed in inguinal white adipose tissue. In liver, Acot gene expression is collectively elicited by a thyrotoxic state. CONCLUSIONS These data suggest that ACOTs are targets of TH and are likely to influence 3,5,3'-triiodo-L-thyronine-orchestrated mechanisms of lipid uptake, storage and utilization to adapt the regulation of metabolic demands.
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Affiliation(s)
- Kerstin Krause
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
- *Kerstin Krause, Division of Endocrinology and Nephrology, Department of Medicine, University of Leipzig, Liebigstrasse 21, DE-04103 Leipzig (Germany), E-Mail
| | - Juliane Weiner
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
| | - Sebastian Hönes
- Department of Endocrinology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Nora Klöting
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
- IFB Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany
| | - Eddy Rijntjes
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - John T. Heiker
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
| | - Claudia Gebhardt
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
| | - Josef Köhrle
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dagmar Führer
- Department of Endocrinology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Karen Steinhoff
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
- IFB Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany
| | - Lars C. Moeller
- Department of Endocrinology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Anke Tönjes
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
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Krause K, Kranz M, Weiner J, Klöting N, Rijntjes E, Köhrle J, Zeisig V, Steinhoff K, Deuther-Conrad W, Fasshauer M, Stumvoll M, Sabri O, Blüher M, Hesse S, Brust P, Tönjes A. Influence of thyroid hormones on brown adipose tissue activity and browning of white adipose tissues in mice. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1549076] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lange C, Seese A, Schwarzenböck S, Steinhoff K, Umland-Seidler B, Krause BJ, Brenner W, Sabri O, Kurth J, Hesse S, Buchert R. CT-based attenuation correction in I-123-ioflupane SPECT. PLoS One 2014; 9:e108328. [PMID: 25268228 PMCID: PMC4182457 DOI: 10.1371/journal.pone.0108328] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Attenuation correction (AC) based on low-dose computed tomography (CT) could be more accurate in brain single-photon emission computed tomography (SPECT) than the widely used Chang method, and, therefore, has the potential to improve both semi-quantitative analysis and visual image interpretation. The present study evaluated CT-based AC for dopamine transporter SPECT with I-123-ioflupane. MATERIALS AND METHODS Sixty-two consecutive patients in whom I-123-ioflupane SPECT including low-dose CT had been performed were recruited retrospectively at 3 centres. For each patient, 3 different SPECT images were reconstructed: without AC, with Chang AC and with CT-based AC. Distribution volume ratio (DVR) images were obtained by scaling voxel intensities using the whole brain without striata as reference. For assessing the impact of AC on semi-quantitative analysis, specific-to-background ratios (SBR) in caudate and putamen were obtained by fully automated SPM8-based region of interest (ROI) analysis and tested for their diagnostic power using receiver-operator-characteristic (ROC) analysis. For assessing the impact of AC on visual image reading, screenshots of stereotactically normalized DVR images presented in randomized order were interpreted independently by two raters at each centre. RESULTS CT-based AC resulted in intermediate SBRs about half way between no AC and Chang. Maximum area under the ROC curve was achieved by the putamen SBR, with negligible impact of AC (0.924, 0.935 and 0.938 for no, CT-based and Chang AC). Diagnostic accuracy of visual interpretation also did not depend on AC. CONCLUSIONS The impact of CT-based versus Chang AC on the interpretation of I-123-ioflupane SPECT is negligible. Therefore, CT-based AC cannot be recommended for routine use in clinical patient care, not least because of the additional radiation exposure.
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Affiliation(s)
- Catharina Lange
- Department of Nuclear Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Anita Seese
- Department of Nuclear Medicine, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Sarah Schwarzenböck
- Department of Nuclear Medicine, Universitätsmedizin Rostock, Rostock, Germany
| | - Karen Steinhoff
- Department of Nuclear Medicine, Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Bernd J. Krause
- Department of Nuclear Medicine, Universitätsmedizin Rostock, Rostock, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Jens Kurth
- Department of Nuclear Medicine, Universitätsmedizin Rostock, Rostock, Germany
| | - Swen Hesse
- Department of Nuclear Medicine, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ralph Buchert
- Department of Nuclear Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Krause K, Kranz M, Zeisig V, Klöting N, Steinhoff K, Deuther-Conrad W, Fasshauer M, Stumvoll M, Sabri O, Hesse S, Brust P, Tönjes A. The influence of thyroid dysfunction on the activity of brown adipose tissue in mice detected by [18F]FDG PET/MR. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374879] [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: 10/25/2022]
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Steinhoff K, Pierer M, Siegert J, Pigla U, Laub R, Hesse S, Seidel W, Sorger D, Seese A, Kuenstler JU, Pietzsch HJ, Lincke T, Rullmann M, Emmrich F, Sabri O. Visualizing inflammation activity in rheumatoid arthritis with Tc-99 m anti-CD4-mAb fragment scintigraphy. Nucl Med Biol 2014; 41:350-4. [PMID: 24503329 DOI: 10.1016/j.nucmedbio.2013.12.018] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 11/27/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE T-cell-located CD4 antigen represents one of the therapeutic targets in rheumatoid arthritis (RA). However, up to now there is no established imaging tool to visualize this target in vivo. The aim of our study was to assess the safety and tolerability of a technetium-99m labelled murine anti-human CD4 IgG1-Fab fragment ([(99m)Tc]-anti-CD4-Fab, [(99m)Tc]-EP1645) in patients with active synovitis due to RA, and to evaluate its potential as a marker of disease activity. METHODS In the present phase I proof of principle study five patients with RA were examined. Planar scans of the whole body, hands, and feet were taken 30 min up to 24h after application of 550 ± 150 MBq [(99m)Tc]-anti-CD4-Fab, followed by visual analyses, comparison with clinical data in 68 joints per patient and semiquantitative analysis of hand and wrist joints. RESULTS Neither infusion related adverse events nor adverse events during follow up were observed. No increase in human anti-murine antibody titres was seen. All patients had positive scans in almost 70% of clinically affected joints. Positive scans were also found in 8% of joints without evidence of swelling or tenderness. CONCLUSION Scintigraphy with [(99m)Tc]-anti-CD4-Fab is a promising technique for evaluation of inflammatory activity in patients with RA, pre-therapeutical evaluation of CD4 status and therapy control. Tracer uptake in clinically inconspicuous joints strongly indicates diagnostic potential of [(99m)Tc]-anti-CD4-Fab. Whether this technique is eligible as a prognostic factor in RA needs to be analysed in further studies as well as the pathophysiological background of clinically affected joints lacking tracer uptake.
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Affiliation(s)
- K Steinhoff
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany.
| | - M Pierer
- Department of Rheumatology, Medical Department II, University of Leipzig, Germany
| | - J Siegert
- Institute of Clinical Pharmacology, Medical Faculty, Technical University Dresden, Germany
| | - U Pigla
- Biotectid GmbH, Leipzig, Germany
| | - R Laub
- Biotectid GmbH, Leipzig, Germany
| | - S Hesse
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany
| | - W Seidel
- St. Georg Hospital, Department of Rheumatology, Leipzig, Germany
| | - D Sorger
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany
| | - A Seese
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany
| | - J U Kuenstler
- Biotectid GmbH, Leipzig, Germany; Institute of Radiopharmacy, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - H J Pietzsch
- Institute of Radiopharmacy, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - T Lincke
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany
| | - M Rullmann
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Germany
| | - F Emmrich
- Institute for Clinical Immunology and Transfusion Medicine, University of Leipzig, Leipzig, Germany; Translational Centre for Regenerative Medicine, Leipzig, Germany
| | - O Sabri
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany
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Babalis K, Harnett E, Steinhoff K. Implementation of the process of ethical review of improvement activities at the Children's Hospital at Westmead. BMJ Qual Saf 2011; 20:366-71. [PMID: 21228433 DOI: 10.1136/bmjqs.2010.043869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Research in healthcare has long been very well regulated, but this is rarely the case for improvement activities. Improvement activities are activities which use data to assess the current situation to identify areas for improvement. Solutions are then developed and implemented, and later evaluated to measure their success and sustainability. There has been much discussion in the literature as to whether, like research activities, improvement activities should undergo independent ethical review. In fact, most healthcare organisations in Australia struggle with how best to manage improvement activities, despite the 2003 publication of the National Health and Medical Research Council guidelines on this subject. DISCUSSION At The Children's Hospital at Westmead, the authors take the view supported by others that ethical review is necessary and so have developed a process which utilises the unique skills available in the Clinical Governance Unit to ensure improvement activities are reviewed for ethical considerations in an effective and efficient manner and implemented a database to approve, monitor and report on improvement activities. This has resulted in staff being increasingly satisfied with the turnaround time for approval of improvement activities they are undertaking as well as for the methodological support provided. The authors have experienced a dramatic increase in the number of improvement activities being recorded and ethically reviewed.
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Affiliation(s)
- K Babalis
- The Children's Hospital at Westmead, Australia.
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Haas RJ, Meyer-Hamme K, Fliedner TM, Barthel E, Fache I, Steinhoff K. The role of transplanted slowly proliferating bone marrow cells for regeneration of lethally x-irradiated rat bone marrow. Scand J Haematol 2009; 9:121-9. [PMID: 4556674 DOI: 10.1111/j.1600-0609.1972.tb00920.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Wilde F, Steinhoff K, Frerich B, Schulz T, Winter K, Hemprich A, Sabri O, Kluge R. Positron-emission tomography imaging in the diagnosis of bisphosphonate-related osteonecrosis of the jaw. ACTA ACUST UNITED AC 2009; 107:412-9. [DOI: 10.1016/j.tripleo.2008.09.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 09/15/2008] [Accepted: 09/24/2008] [Indexed: 11/27/2022]
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Swanson JM, Lerner M, Wigal T, Steinhoff K, Greenhill L, Posner K, Freid J, Wigal S. The use of a laboratory school protocol to evaluate concepts about efficacy and side effects of new formulations of stimulant medications. J Atten Disord 2003; 6 Suppl 1:S73-88. [PMID: 12685522 DOI: 10.1177/070674370200601s10] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recently, new long-acting formulations of racemic methylphenidate (MPH: Ritalin LA, Metadate CD and Concerta) and amphetamine (AMP: Adderall XR) were developed and are now approved by the Food and Drug Administration (FDA). In addition, dexmethylphenidate (Focalin), the pharmacologically active d-threo enantiomer of MPH, also was approved by the FDA. In the initial phases of development, prototypes of these five new formulations were evaluated using the University of California, Irvine (UCI) Laboratory School Protocol (LSP), in which surrogate measures of efficacy are collected in highly controlled settings rather than clinical measures of effectiveness in the less-controlled, natural environments of home or school. The LSP studies were followed by large effectiveness and safety studies required for gaining FDA approval. These initial efficacy and side effect studies in the LSP provided missing information about the basic pharmacokinetic (PK) and pharmacodynamic (PD) properties of MPH and AMP and produced some new discoveries (i.e., acute tolerance) that were used to help design the final products. The final once-a-day formulations used different drug delivery systems to achieve long-acting efficacy (Ritalin LA, Metadate CD, Concerta, Adderall XR). All four drug delivery systems were based on two processes: first, a bolus delivery (BD) process to achieve rapid onset of efficacy (mg), and second, a controlled delivery (CD) process to achieve rates of delivery (mg/hr) or a delayed bolus (mg) to maintain efficacy. A theoretical approach was used to compare and contrast the new once-a day formulations of MPH by selecting total daily doses (mg/d) that would equate drug delivery by the first process (mg of the initial bolus) and the second process (mg/hr over specified time period). In addition to efficacy, applications of the LSP to measure common side effects related to eating and sleeping were described and discussed.
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Affiliation(s)
- J M Swanson
- Child Development Center, University of California, Department of Pediatrics, Irvine 92697-4480, USA.
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Muratore LM, Steinhoff K, Davis TP. Self-reinforcing hydrogels comprised of hydrophobic methyl methacrylate macromers copolymerised with either N-vinyl-2-pyrrolidone or 2-hydroxyethyl acrylate. ACTA ACUST UNITED AC 1999. [DOI: 10.1039/a903071i] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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