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Gast LV, Platt T, Nagel AM, Gerhalter T. Recent technical developments and clinical research applications of sodium ( 23Na) MRI. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2023; 138-139:1-51. [PMID: 38065665 DOI: 10.1016/j.pnmrs.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 12/18/2023]
Abstract
Sodium is an essential ion that plays a central role in many physiological processes including the transmembrane electrochemical gradient and the maintenance of the body's homeostasis. Due to the crucial role of sodium in the human body, the sodium nucleus is a promising candidate for non-invasively assessing (patho-)physiological changes. Almost 10 years ago, Madelin et al. provided a comprehensive review of methods and applications of sodium (23Na) MRI (Madelin et al., 2014) [1]. More recent review articles have focused mainly on specific applications of 23Na MRI. For example, several articles covered 23Na MRI applications for diseases such as osteoarthritis (Zbyn et al., 2016, Zaric et al., 2020) [2,3], multiple sclerosis (Petracca et al., 2016, Huhn et al., 2019) [4,5] and brain tumors (Schepkin, 2016) [6], or for imaging certain organs such as the kidneys (Zollner et al., 2016) [7], the brain (Shah et al., 2016, Thulborn et al., 2018) [8,9], and the heart (Bottomley, 2016) [10]. Other articles have reviewed technical developments such as radiofrequency (RF) coils for 23Na MRI (Wiggins et al., 2016, Bangerter et al., 2016) [11,12], pulse sequences (Konstandin et al., 2014) [13], image reconstruction methods (Chen et al., 2021) [14], and interleaved/simultaneous imaging techniques (Lopez Kolkovsky et al., 2022) [15]. In addition, 23Na MRI topics have been covered in review articles with broader topics such as multinuclear MRI or ultra-high-field MRI (Niesporek et al., 2019, Hu et al., 2019, Ladd et al., 2018) [16-18]. During the past decade, various research groups have continued working on technical improvements to sodium MRI and have investigated its potential to serve as a diagnostic and prognostic tool. Clinical research applications of 23Na MRI have covered a broad spectrum of diseases, mainly focusing on the brain, cartilage, and skeletal muscle (see Fig. 1). In this article, we aim to provide a comprehensive summary of methodological and hardware developments, as well as a review of various clinical research applications of sodium (23Na) MRI in the last decade (i.e., published from the beginning of 2013 to the end of 2022).
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Affiliation(s)
- Lena V Gast
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Tanja Platt
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Teresa Gerhalter
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Chattopadhyay A, Tully J, Shan J, Sheikh S, Ohliger M, Gordon JW, Mauro T, Abuabara K. Sodium in the skin: a summary of the physiology and a scoping review of disease associations. Clin Exp Dermatol 2023; 48:733-743. [PMID: 36970766 DOI: 10.1093/ced/llad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/16/2023] [Indexed: 07/20/2023]
Abstract
A large and growing body of research suggests that the skin plays an important role in regulating total body sodium, challenging traditional models of sodium homeostasis that focused exclusively on blood pressure and the kidney. In addition, skin sodium may help to prevent water loss and facilitate macrophage-driven antimicrobial host defence, but may also trigger immune dysregulation via upregulation of proinflammatory markers and downregulation of anti-inflammatory processes. We performed a systematic search of PubMed for published literature on skin sodium and disease outcomes and found that skin sodium concentration is increased in patients with cardiometabolic conditions including hypertension, diabetes and end-stage renal disease; autoimmune conditions including multiple sclerosis and systemic sclerosis; and dermatological conditions including atopic dermatitis, psoriasis and lipoedema. Several patient characteristics are associated with increased skin sodium concentration including older age and male sex. Animal evidence suggests that increased salt intake results in higher skin sodium levels; however, there are conflicting results from small trials in humans. Additionally, limited data suggest that pharmaceuticals such as diuretics and sodium-glucose co-transporter-2 inhibitors approved for diabetes, as well as haemodialysis may reduce skin sodium levels. In summary, emerging research supports an important role for skin sodium in physiological processes related to osmoregulation and immunity. With the advent of new noninvasive magnetic resonance imaging measurement techniques and continued research on skin sodium, it may emerge as a marker of immune-mediated disease activity or a potential therapeutic target.
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Affiliation(s)
- Aheli Chattopadhyay
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Janell Tully
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Judy Shan
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Sidra Sheikh
- Kaiser Permanente, Department of Physical Medicine & Rehabilitation, Oakland, CA, USA
| | - Michael Ohliger
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jeremy W Gordon
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Theodora Mauro
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Dermatology Service, Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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Akbari A, McIntyre CW. Recent Advances in Sodium Magnetic Resonance Imaging and Its Future Role in Kidney Disease. J Clin Med 2023; 12:4381. [PMID: 37445416 PMCID: PMC10342976 DOI: 10.3390/jcm12134381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Sodium imbalance is a hallmark of chronic kidney disease (CKD). Excess tissue sodium in CKD is associated with hypertension, inflammation, and cardiorenal disease. Sodium magnetic resonance imaging (23Na MRI) has been increasingly utilized in CKD clinical trials especially in the past few years. These studies have demonstrated the association of excess sodium tissue accumulation with declining renal function across whole CKD spectrum (early- to end-stage), biomarkers of systemic inflammation, and cardiovascular dysfunction. In this article, we review recent advances of 23Na MRI in CKD and discuss its future role with a focus on the skin, the heart, and the kidney itself.
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Affiliation(s)
- Alireza Akbari
- Robarts Research Institute, Western University, London, ON N6A 3K7, Canada;
- Lilibeth Caberto Kidney Clinic Research Unit, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Christopher W. McIntyre
- Robarts Research Institute, Western University, London, ON N6A 3K7, Canada;
- Lilibeth Caberto Kidney Clinic Research Unit, London Health Sciences Centre, London, ON N6A 5W9, Canada
- Departments of Medicine, Pediatrics and Medical Biophysics, Western University, London, ON N6A 3K7, Canada
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Nakagawa Y, Kaseda R, Suzuki Y, Watanabe H, Otsuka T, Yamamoto S, Kaneko Y, Goto S, Terada Y, Haishi T, Sasaki S, Narita I. Sodium Magnetic Resonance Imaging Shows Impairment of the Counter-current Multiplication System in Diabetic Mice Kidney. KIDNEY360 2023; 4:582-590. [PMID: 36963113 PMCID: PMC10278814 DOI: 10.34067/kid.0000000000000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/17/2023] [Indexed: 03/26/2023]
Abstract
Key Points 23Na MRI allows us to noninvasively assess sodium distribution. We propose the utility of 23Na MRI for evaluating functional changes in diabetic kidney disease and not as a marker reflecting structural damage. 23Na MRI may be an early marker for structures beyond the glomeruli, enabling prompt intervention with novel efficacious tubule-targeting therapies. Background Sodium magnetic resonance imaging can noninvasively assess sodium distribution, specifically sodium concentration in the countercurrent multiplication system in the kidney, which forms a sodium concentration gradient from the cortex to the medulla, enabling efficient water reabsorption. This study aimed to investigate whether sodium magnetic resonance imaging can detect changes in sodium concentrations under normal conditions in mice and in disease models, such as a mouse model with diabetes mellitus. Methods We performed sodium and proton nuclear magnetic resonance imaging using a 9.4-T vertical standard-bore superconducting magnet. Results A condition of deep anesthesia, with widened breath intervals, or furosemide administration in 6-week-old C57BL/6JJcl mice showed a decrease in both tissue sodium concentrations in the medulla and sodium concentration gradients from the cortex to the medulla. Furthermore, sodium magnetic resonance imaging revealed reductions in the sodium concentration in the medulla and in the gradient from the cortex to the medulla in BKS.Cg-Leprdb+/+ Leprdb/Jcl mice at very early type 2 diabetes mellitus stages compared with corresponding control BKS.Cg-m+/m+/Jcl mice. Conclusions The kidneys of BKS.Cg-Leprdb+/+ Leprdb/Jcl mice aged 6 weeks showed impairments in the countercurrent multiplication system. We propose the utility of 23Na MRI for evaluating functional changes in diabetic kidney disease and not as a marker that reflects structural damage. Thus, 23Na MRI may be a potentially very early marker for structures beyond the glomerulus; this may prompt intervention with novel efficacious tubule-targeting therapies.
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Affiliation(s)
- Yusuke Nakagawa
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University, Niigata, Niigata, Japan
| | - Ryohei Kaseda
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University, Niigata, Niigata, Japan
| | - Yuya Suzuki
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University, Niigata, Niigata, Japan
| | - Hirofumi Watanabe
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University, Niigata, Niigata, Japan
| | - Tadashi Otsuka
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University, Niigata, Niigata, Japan
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University, Niigata, Niigata, Japan
| | - Yoshikatsu Kaneko
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University, Niigata, Niigata, Japan
| | - Shin Goto
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University, Niigata, Niigata, Japan
| | - Yasuhiko Terada
- Institute of Applied Physics, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomoyuki Haishi
- MRTechnology Inc., Tsukuba, Ibaraki, Japan
- Department of Radiological Sciences, School of Health Sciences at Narita, International University of Health and Welfare, Narita, Chiba, Japan
| | - Susumu Sasaki
- Faculty of Engineering, Niigata University, Niigata, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University, Niigata, Niigata, Japan
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Kline TL. Beyond the Protons-Sodium MR Imaging Provides New Kidney Insights. KIDNEY360 2023; 4:569-571. [PMID: 37229724 PMCID: PMC10371284 DOI: 10.34067/kid.0000000000000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Owen A, Patel JM, Parekh D, Bangash MN. Mechanisms of Post-critical Illness Cardiovascular Disease. Front Cardiovasc Med 2022; 9:854421. [PMID: 35911546 PMCID: PMC9334745 DOI: 10.3389/fcvm.2022.854421] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Prolonged critical care stays commonly follow trauma, severe burn injury, sepsis, ARDS, and complications of major surgery. Although patients leave critical care following homeostatic recovery, significant additional diseases affect these patients during and beyond the convalescent phase. New cardiovascular and renal disease is commonly seen and roughly one third of all deaths in the year following discharge from critical care may come from this cluster of diseases. During prolonged critical care stays, the immunometabolic, inflammatory and neurohumoral response to severe illness in conjunction with resuscitative treatments primes the immune system and parenchymal tissues to develop a long-lived pro-inflammatory and immunosenescent state. This state is perpetuated by persistent Toll-like receptor signaling, free radical mediated isolevuglandin protein adduct formation and presentation by antigen presenting cells, abnormal circulating HDL and LDL isoforms, redox and metabolite mediated epigenetic reprogramming of the innate immune arm (trained immunity), and the development of immunosenescence through T-cell exhaustion/anergy through epigenetic modification of the T-cell genome. Under this state, tissue remodeling in the vascular, cardiac, and renal parenchymal beds occurs through the activation of pro-fibrotic cellular signaling pathways, causing vascular dysfunction and atherosclerosis, adverse cardiac remodeling and dysfunction, and proteinuria and accelerated chronic kidney disease.
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Affiliation(s)
- Andrew Owen
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Jaimin M. Patel
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Dhruv Parekh
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Mansoor N. Bangash
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Mansoor N. Bangash
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Oppelaar JJ, Vuurboom MD, Wenstedt EFE, van Ittersum FJ, Vogt L, Olde Engberink RHG. Reconsidering the Edelman equation: impact of plasma sodium concentration, edema and body weight. Eur J Intern Med 2022; 100:94-101. [PMID: 35393237 DOI: 10.1016/j.ejim.2022.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Guidelines recommend treatment of dysnatremias to be guided by formulas based on the Edelman equation. This equation describes the relation between plasma sodium concentration and exchangeable cations. However, this formula does not take into account clinical parameters that have recently been associated with local tissue sodium accumulation, which occurs without concurrent water retention. We investigated to what extent such clinical factors affect the Edelman equation and dysnatremia treatment. METHODS We performed a post-hoc analysis with original data of the Edelman study. Linear regression was used to examine the effect of age, sex, weight, edema, total body water (TBW) and heart and kidney failure on the Edelman equation. With attenuated correction, we corrected for measurement errors of both variables. Using piecewise regression, we analyzed whether the Edelman association differs for different plasma sodium concentrations. RESULTS Data was available for 82 patients; 57 males and 25 females with a mean (SD) age of 57 (15) years. The slope of the Edelman equation was significantly affected by weight (p=0.01) and edema (p=0.03). Also, below and above plasma sodium levels of 133 mmol/L the slope of the Edelman equation was significantly different (1.25 x0025vs 0.58x0025, p<0.01). CONCLUSION Edelman's equation's coefficients are significantly affected by weight, edema and plasma sodium, possibly reflecting differences in tissue sodium accumulation capacity. The performance of Edelman-based formulas in clinical settings may be improved by taking these clinical characteristics into account.
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Affiliation(s)
- Jetta J Oppelaar
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Mart D Vuurboom
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Eliane F E Wenstedt
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Frans J van Ittersum
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine, Section of Nephrology, Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam, The Netherlands
| | - L Vogt
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Rik H G Olde Engberink
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands.
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Chen Q, Shah NJ, Worthoff WA. Compressed Sensing in Sodium Magnetic Resonance Imaging: Techniques, Applications, and Future Prospects. J Magn Reson Imaging 2021; 55:1340-1356. [PMID: 34918429 DOI: 10.1002/jmri.28029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/06/2022] Open
Abstract
Sodium (23 Na) yields the second strongest nuclear magnetic resonance (NMR) signal in biological tissues and plays a vital role in cell physiology. Sodium magnetic resonance imaging (MRI) can provide insights into cell integrity and tissue viability relative to pathologies without significant anatomical alternations, and thus it is considered to be a potential surrogate biomarker that provides complementary information for standard hydrogen (1 H) MRI in a noninvasive and quantitative manner. However, sodium MRI suffers from a relatively low signal-to-noise ratio and long acquisition times due to its relatively low NMR sensitivity. Compressed sensing-based (CS-based) methods have been shown to accelerate sodium imaging and/or improve sodium image quality significantly. In this manuscript, the basic concepts of CS and how CS might be applied to improve sodium MRI are described, and the historical milestones of CS-based sodium MRI are briefly presented. Representative advanced techniques and evaluation methods are discussed in detail, followed by an expose of clinical applications in multiple anatomical regions and diseases as well as thoughts and suggestions on potential future research prospects of CS in sodium MRI. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Qingping Chen
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, Jülich, Germany.,Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,Department of Biomedical Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - N Jon Shah
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, Jülich, Germany.,Institute of Neuroscience and Medicine 11, INM-11, JARA, Forschungszentrum Jülich GmbH, Jülich, Germany.,JARA-BRAIN-Translational Medicine, Aachen, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - Wieland A Worthoff
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, Jülich, Germany
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Ma Z, Hummel SL, Sun N, Chen Y. From salt to hypertension, what is missed? J Clin Hypertens (Greenwich) 2021; 23:2033-2041. [PMID: 34846798 PMCID: PMC8696232 DOI: 10.1111/jch.14402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 01/18/2023]
Abstract
Excess salt intake is viewed as a major contributor to hypertension and cardiovascular disease, and dietary salt restriction is broadly recommended by public health guidelines. However, individuals can have widely varying physiological responses to salt intake, and a tailored approach to evaluation and intervention may be needed. The traditional sodium related concepts are challenging to assess clinically for two reasons: (1) spot and 24-hour urine sodium are frequently used to evaluate salt intake, but are more suitable for population study, and (2) some adverse effects of salt may be blood pressure-independent. In recent years, previously unknown mechanisms of sodium absorption and storage have been discovered. This review will outline the limitations of current methods to assess sodium balance and discuss new potential evaluation methods and treatment targets.
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Affiliation(s)
- Zhiyi Ma
- Cardiology DepartmentBeijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijingChina
| | - Scott L. Hummel
- Ann Arbor Veterans Affairs Health SystemUniversity of Michigan Frankel Cardiovascular CenterAnn ArborMichiganUSA
| | - Ningling Sun
- Cardiology DepartmentHeart CenterPeking University People's HospitalBeijingChina
| | - Yuanyuan Chen
- Cardiology DepartmentHeart CenterPeking University People's HospitalBeijingChina
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Kannenkeril D, Jung S, Harazny J, Striepe K, Ott C, Dahlmann A, Kopp C, Schiffer M, Linz P, Nagel AM, Uder M, Schmieder RE. Tissue sodium content correlates with hypertrophic vascular remodeling in type 2 diabetes. J Diabetes Complications 2021; 35:108055. [PMID: 34620556 DOI: 10.1016/j.jdiacomp.2021.108055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/16/2021] [Accepted: 09/25/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Prospective studies describe a linkage between increased sodium intake and higher incidence of cardiovascular organ damage and end points. We analyzed whether tissue sodium content in the skin and muscles correlate with vascular hypertrophic remodeling, a risk factor for cardiovascular disease. METHODS In patients with type 2 diabetes we assessed tissue sodium content and vascular structural parameters of the retinal arterioles. The structural parameters of retinal arterioles assessed by Scanning Laser Doppler Flowmetry were vessel (VD) and lumen diameter (LD), wall thickness (WT), wall-to-lumen ratio (WLR) and wall cross sectional area (WCSA). Tissue sodium content was measured with a 3.0 T clinical 23Sodium-Magnetic Resonance Imaging (23Na-MRI) system. RESULTS In patients with type 2 diabetes (N = 52) we observed a significant correlation between muscle sodium content and VD (p = 0.005), WT (p = 0.003), WCSA (p = 0.002) and WLR (p = 0.013). With respect to skin sodium content a significant correlation has been found with VD (p = 0.042), WT (p = 0.023) and WCSA (p = 0.019). Further analysis demonstrated that tissue sodium content of skin and muscle is a significant determinant of hypertrophic vascular remodeling independent of age, gender, diuretic use and 24-hour ambulatory BP. CONCLUSION With the 23Na-MRI technology we could demonstrate that high tissue sodium content is independently linked to hypertrophic vascular remodeling in type 2 diabetes. TRIAL REGISTRATION Trial registration number: NCT02383238 Date of registration: March 9, 2015.
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Affiliation(s)
- Dennis Kannenkeril
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Susanne Jung
- Department of Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Joanna Harazny
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany; Department of Human Physiology and Pathophysiology, University of Warmia and Mazury, Olsztyn, Poland
| | - Kristina Striepe
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Anke Dahlmann
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Christoph Kopp
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany; Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany.
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Reduction of Tissue Na + Accumulation After Renal Transplantation. Kidney Int Rep 2021; 6:2338-2347. [PMID: 34514195 PMCID: PMC8418983 DOI: 10.1016/j.ekir.2021.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Chronic kidney disease (CKD) engenders salt-sensitive hypertension. Whether or not tissue Na+ accumulation is increased in CKD patients remains uncertain. How tissue Na+ is affected after renal transplantation has not been assessed. Methods We measured tissue Na+ amount in 31 CKD patients (stage 5) and prospectively evaluated tissue Na+ content at 3 and 6 months, following living-donor kidney transplantation. Additionally, pre- and post-transplantation data were compared to 31 age- and sex-matched control subjects. 23Na-magnetic resonance imaging (23Na-MRI) was used to quantify muscle and skin Na+ of the lower leg and water distribution was assessed by bioimpedance spectroscopy. Results Compared to control subjects, CKD patients showed increased muscle (20.7 ± 5.0 vs. 15.5 ± 1.8 arbitrary units [a.u.], P < 0.001) and skin Na+ content (21.4 ± 7.7 vs. 15.0 ± 2.3 a.u., P < 0.001), whereas plasma Na+ concentration did not differ between groups. Restoration of kidney function by successful renal transplantation was accompanied by mobilization of tissue Na+ from muscle (20.7 ± 5.0 vs. 16.8 ± 2.8 a.u., P < 0.001) and skin tissue (21.4 ± 7.7 vs. 16.8 ± 5.2 a.u., P < 0.001). The reduction of tissue Na+ after transplantation was associated with improved renal function, normalization of blood pressure as well as an increase in lymphatic growth-factor concentration (vascular endothelial growth factor C [VEGF-C] 4.5 ± 1.8 vs. 6.7 ± 2.7 ng/ml, P < 0.01). Conclusions Tissue Na+ accumulation in predialysis patients with CKD was almost completely reversed to the level of healthy controls after successful kidney transplantation.
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12
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Puder L, Roth S, Krabusch P, Wiegand S, Opitz R, Bald M, Flück C, Schulz E, Voss E, Markó L, Linz P, Berger F, Müller DN, Kuehne T, Litt MJ, Cone RD, Kühnen P, Kelm M. Cardiac Phenotype and Tissue Sodium Content in Adolescents With Defects in the Melanocortin System. J Clin Endocrinol Metab 2021; 106:2606-2616. [PMID: 34036349 PMCID: PMC8372645 DOI: 10.1210/clinem/dgab368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Pro-opiomelanocortin (POMC) and the melanocortin-4 receptor (MC4R) play a pivotal role in the leptin-melanocortin pathway. Mutations in these genes lead to monogenic types of obesity due to severe hyperphagia. In addition to dietary-induced obesity, a cardiac phenotype without hypertrophy has been identified in MC4R knockout mice. OBJECTIVE We aimed to characterize cardiac morphology and function as well as tissue Na+ content in humans with mutations in POMC and MC4R genes. METHODS A cohort of 42 patients (5 patients with bi-allelic POMC mutations, 6 heterozygous MC4R mutation carriers, 19 obese controls without known monogenic cause, and 12 normal weight controls) underwent cardiac magnetic resonance (CMR) imaging and 23Na-MRI. RESULTS Monogenic obese patients with POMC or MC4R mutation respectively had a significantly lower left ventricular mass/body surface area (BSA) than nonmonogenic obese patients. Left ventricular end-diastolic volume/BSA was significantly lower in POMC- and MC4R-deficient patients than in nonmonogenic obese patients. Subcutaneous fat and skin Na+ content was significantly higher in POMC- and MC4R-deficient patients than in nonmonogenic obese patients. In these compartments, the water content was significantly higher in patients with POMC and MC4R mutation than in control groups. CONCLUSION Patients with POMC or MC4R mutations carriers had a lack of transition to hypertrophy, significantly lower cardiac muscle mass/BSA, and stored more Na+ within the subcutaneous fat tissue than nonmonogenic obese patients. The results point towards the role of the melanocortin pathway for cardiac function and tissue Na+ storage and the importance of including cardiologic assessments into the diagnostic work-up of these patients.
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Affiliation(s)
- Lia Puder
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
- Department for Pediatric Endocrinology and Diabetology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin 13353, Germany
| | - Sophie Roth
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 13353, Germany
| | - Philipp Krabusch
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
- Department for Pediatric Endocrinology and Diabetology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin 13353, Germany
| | - Susanna Wiegand
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Berlin 13353, Germany
| | - Robert Opitz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
| | - Martin Bald
- Pediatric Endocrinology, Olgahospital, Klinikum Stuttgart, Stuttgart 70174, Germany
| | - Christa Flück
- Department of Paediatrics and Department of BioMedical Research, Pediatric Endocrinology, Diabetology and Metabolism, Bern University Hospital Inselspital and University of Bern, Bern 3010, Switzerland
| | - Esther Schulz
- Pediatric Endocrinology, AKK Altonaer Kinderkrankenhaus GmbH, Hamburg 22763, Germany
| | - Egbert Voss
- Cnopfsche Kinderklinik, Nürnberg 90419, Germany
| | - Lajos Markó
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
- Experimental and Clinical Research Center, a cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin 13125, Germany
- Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany
- Berlin Institute of Health (BIH), Berlin 10178, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen 91054, Germany
| | - Felix Berger
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
| | - Dominik N Müller
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
- Experimental and Clinical Research Center, a cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin 13125, Germany
- Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany
- Berlin Institute of Health (BIH), Berlin 10178, Germany
| | - Titus Kuehne
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 13353, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
| | - Michael J Litt
- Brigham and Women’s Hospital, Harvard University, Boston, MA 02115, USA
| | - Roger D Cone
- Life Sciences Institute, and Department of Molecular and Integrative Physiology, School of Medicine, University of Michigan, Ann Arbor, MI 48109-5624, USA
| | - Peter Kühnen
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
- Correspondence: Peter Kühnen, MD, Institute for Experimental Pediatric Endocrinology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Marcus Kelm
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 13353, Germany
- Berlin Institute of Health (BIH), Berlin 10178, Germany
- Marcus Kelm, MD, Department of Congenital Heart Disease, German Heart Centre Berlin, Augustenburger Platz 1, 13353 Berlin, Germany,
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13
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Huhn K, Linz P, Pemsel F, Michalke B, Seyferth S, Kopp C, Chaudri MA, Rothhammer V, Dörfler A, Uder M, Nagel AM, Müller DN, Waschbisch A, Lee DH, Bäuerle T, Linker RA, Haase S. Skin sodium is increased in male patients with multiple sclerosis and related animal models. Proc Natl Acad Sci U S A 2021; 118:e2102549118. [PMID: 34260395 PMCID: PMC8285971 DOI: 10.1073/pnas.2102549118] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Novel MRI techniques allow a noninvasive quantification of tissue sodium and reveal the skin as a prominent compartment of sodium storage in health and disease. Since multiple sclerosis (MS) immunopathology is initiated in the periphery and increased sodium concentrations induce proinflammatory immune cells, the skin represents a promising compartment linking high sodium concentrations and MS immunopathology. We used a 7-T sodium MRI (23Na-MRI) and inductively coupled plasma mass spectrometry to investigate the skin sodium content in two mouse models of MS. We additionally performed 3-T 23Na-MRI of calf skin and muscles in 29 male relapsing-remitting MS (RRMS) patients and 29 matched healthy controls. Demographic and clinical information was collected from interviews, and disease activity was assessed by expanded disability status scale scoring. 23Na-MRI and chemical analysis demonstrated a significantly increased sodium content in the skin during experimental autoimmune encephalomyelitis independent of active immunization. In male patients with RRMS, 23Na-MRI demonstrated a higher sodium signal in the area of the skin compared to age- and biological sex-matched healthy controls with higher sodium, predicting future disease activity in cranial MRI. In both studies, the sodium enrichment was specific to the skin, as we found no alterations of sodium signals in the muscle or other tissues. Our data add to the recently identified importance of the skin as a storage compartment of sodium and may further represent an important organ for future investigations on salt as a proinflammatory agent driving autoimmune neuroinflammation such as that in MS.
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Affiliation(s)
- Konstantin Huhn
- Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Peter Linz
- Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Franziska Pemsel
- Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
- Department of Radiation Therapy, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Bernhard Michalke
- Research Unit Analytical BioGeoChemistry, Helmholtz Zentrum München German Research Center for Environmental Health, 85764 Munich, Germany
| | - Stefan Seyferth
- Division of Pharmaceutics, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Christoph Kopp
- Department of Nephrology and Hypertension, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Mohammad Anwar Chaudri
- Institute of Corrosion and Surface Science, Department of Material Science, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Veit Rothhammer
- Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Michael Uder
- Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Armin M Nagel
- Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
- Division of Medical Physics in Radiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Dominik N Müller
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin, 13125 Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- Berlin Institute of Health, 13125 Berlin, Germany
| | - Anne Waschbisch
- Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - De-Hyung Lee
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Tobias Bäuerle
- Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Ralf A Linker
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Stefanie Haase
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
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14
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Hanson P, Philp CJ, Randeva HS, James S, O’Hare JP, Meersmann T, Pavlovskaya GE, Barber TM. Sodium in the dermis colocates to glycosaminoglycan scaffold, with diminishment in type 2 diabetes mellitus. JCI Insight 2021; 6:145470. [PMID: 34003801 PMCID: PMC8262470 DOI: 10.1172/jci.insight.145470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/13/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Dietary sodium intake mismatches urinary sodium excretion over prolonged periods. Our aims were to localize and quantify electrostatically bound sodium within human skin using triple-quantum-filtered (TQF) protocols for MRI and magnetic resonance spectroscopy (MRS) and to explore dermal sodium in type 2 diabetes mellitus (T2D). METHODS We recruited adult participants with T2D (n = 9) and euglycemic participants with no history of diabetes mellitus (n = 8). All had undergone lower limb amputations or abdominal skin reduction surgery for clinical purposes. We used 20 μm in-plane resolution 1H MRI to visualize anatomical skin regions ex vivo from skin biopsies taken intraoperatively, 23Na TQF MRI/MRS to explore distribution and quantification of freely dissolved and bound sodium, and inductively coupled plasma mass spectrometry to quantify sodium in selected skin samples. RESULTS Human dermis has a preponderance (>90%) of bound sodium that colocalizes with the glycosaminoglycan (GAG) scaffold. Bound and free sodium have similar anatomical locations. T2D associates with a severely reduced dermal bound sodium capacity. CONCLUSION We provide the first evidence to our knowledge for high levels of bound sodium within human dermis, colocating to the GAG scaffold, consistent with a dermal "third space repository" for sodium. T2D associates with diminished dermal electrostatic binding capacity for sodium.
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Affiliation(s)
- Petra Hanson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | | | - Harpal S. Randeva
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | - Sean James
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | - J. Paul O’Hare
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
| | - Thomas Meersmann
- Sir Peter Mansfield Imaging Centre (SPMIC), School of Medicine, and
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Galina E. Pavlovskaya
- Sir Peter Mansfield Imaging Centre (SPMIC), School of Medicine, and
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Thomas M. Barber
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire (UHCW), Clifford Bridge Road, Coventry, United Kingdom
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15
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Fantasia M, Galante A, Maggiorelli F, Retico A, Fontana N, Monorchio A, Alecci M. Numerical and Workbench Design of 2.35 T Double-Tuned (¹H/²³Na) Nested RF Birdcage Coils Suitable for Animal Size MRI. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:3175-3186. [PMID: 32310762 DOI: 10.1109/tmi.2020.2988599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The birdcage Radio Frequency (RF) coil is one of the most used configurations in Magnetic Resonance Imaging (MRI) scanners for the detection of the proton (1H) signal over a large homogeneous volume. More recently, birdcage RF coils have been successfully used also in the field of X-nuclei MRI, where the signal of a second nucleus (e.g. 13C, 23Na, 31P, and many others) needs to be detected with high sensitivity and spatial homogeneity. To this purpose several technical solutions have been adopted to design Double Tuned (DT) volume RF coils, including the recent configuration of the nested birdcage RF coils. One of the main problems in the design of DT RF coils is the decoupling between the 1H and X channels, and a number of solutions have been adopted over the years. In this work, based on numerical and workbench methods, we report the decoupling optimization of DT (1H/23Na) nested RF birdcage coils suitable for 2.35 T MRI scanners encompassing an inner Low-Pass (LP) birdcage used for X-nuclei, an outer High-Pass (HP) birdcage for 1H and an external cylindrical RF shield. We show that a suitable geometrical selection of the two coaxial RF birdcage coils (relative angular orientation, diameters and lengths) and RF shield (diameter, length) allows a significant decoupling optimization. We also provide valuable information about the RF B1+ field homogeneity and efficiency. Our approach was validated both with numerical simulations and workbench testing using DT nested RF coil prototypes.
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16
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Agócs R, Sugár D, Szabó AJ. Is too much salt harmful? Yes. Pediatr Nephrol 2020; 35:1777-1785. [PMID: 31781959 PMCID: PMC7384997 DOI: 10.1007/s00467-019-04387-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/18/2019] [Accepted: 09/27/2019] [Indexed: 01/11/2023]
Abstract
The contribution of high sodium intake to hypertension and to the severity of immune-mediated diseases is still being heatedly debated in medical literature and in the lay media. This review aims to demonstrate two conflicting views on the topic, with the first part citing the detrimental effects of excessive salt consumption. Sodium plays a central role in volume and blood pressure homeostasis, and the positive correlation between sodium intake and blood pressure has been extensively researched. Despite the fact that the average of global daily salt consumption exceeds recommendations of international associations, health damage from excessive salt intake is still controversial. Individual differences in salt sensitivity are in great part attributed to this contradiction. Patients suffering from certain diseases as well as other vulnerable groups-either minors or individuals of full age-exhibit more pronounced blood pressure reduction when consuming a low-sodium diet. Furthermore, findings from the last two decades give insight into the concept of extrarenal sodium storage; however, the long-term consequences of this phenomenon are lesser known. Evidence of the relationship between sodium and autoimmune diseases are cited in the review, too. Nevertheless, further clinical trials are needed to clarify their interplay. In conclusion, for salt-sensitive risk groups in the population, even stricter limits of sodium consumption should be set than for young, healthy individuals. Therefore, the question raised in the title should be rephrased as follows: "how much salt is harmful" and "for whom is elevated salt intake harmful?"
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Affiliation(s)
- Róbert Agócs
- 1st Department of Paediatrics, Semmelweis University, Bókay János u. 53-54, Budapest, H-1083, Hungary
| | - Dániel Sugár
- 1st Department of Paediatrics, Semmelweis University, Bókay János u. 53-54, Budapest, H-1083, Hungary
| | - Attila J Szabó
- 1st Department of Paediatrics, Semmelweis University, Bókay János u. 53-54, Budapest, H-1083, Hungary.
- MTA-SE Paediatrics and Nephrology Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.
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17
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Gast LV, Völker S, Utzschneider M, Linz P, Wilferth T, Müller M, Kopp C, Hensel B, Uder M, Nagel AM. Combined imaging of potassium and sodium in human skeletal muscle tissue at 7 T. Magn Reson Med 2020; 85:239-253. [PMID: 32869364 DOI: 10.1002/mrm.28428] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/02/2020] [Accepted: 06/23/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To validate the feasibility of quantitative combined potassium (39 K) and sodium (23 Na) MRI in human calf muscle tissue, as well as to evaluate the reproducibility of the apparent tissue potassium concentration (aTPC) and apparent tissue sodium concentration (aTSC) determination in healthy muscle tissue. METHODS Quantitative 23 Na and 39 K MRI acquisition protocols were implemented on a 7 T MR system. A double-resonant 23 Na/39 K birdcage RF coil was used. Measurements of human lower leg were performed in a total acquisition time of TANa = 10:54 min/TAK = 8:06 min and using a nominal spatial resolution of 2.5 × 2.5 × 15 mm3 /7.5 × 7.5 × 30 mm3 for 23 Na/39 K MRI. Two aTSC and aTPC examinations in muscle tissue were performed during the same day on 10 healthy subjects. RESULTS The proposed acquisition and postprocessing workflow for 23 Na and 39 K MRI data sets provided reproducible aTSC and aTPC measurements. In human calf muscle tissue, the coefficient of variation between scan and re-scan was 5.7% for both aTSC and aTPC determination. Overall, mean values of aTSC = (17 ± 1) mM and aTPC = (85 ± 5) mM were measured. Moreover, for 39 K in calf muscle tissue, T 2 ∗ components of T 2 f ∗ = (1.2 ± 0.2) ms and T 2 s ∗ = (7.9 ± 0.9) ms, as well as a residual quadrupolar interaction of ω q ¯ = (143 ± 17) Hz, were determined. The fraction of the fast component was f = (58 ± 4)%. CONCLUSION Using the presented measurement and postprocessing approach, a reproducible aTSC and aTPC determination using 23 Na and 39 K MRI at 7 T in human skeletal muscle tissue is feasible in clinically acceptable acquisition durations.
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Affiliation(s)
- Lena V Gast
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefanie Völker
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias Utzschneider
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Tobias Wilferth
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Max Müller
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christoph Kopp
- Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany
| | - Bernhard Hensel
- Center for Medical Physics and Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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18
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Tissue sodium content in hypertension and related organ damage. J Hypertens 2020; 38:2363-2368. [PMID: 32740402 DOI: 10.1097/hjh.0000000000002580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
: Most textbooks state that sodium (Na) accumulation goes hand in hand with fluid retention to maintain the environmental isotonicity. In the last century, several studies found, however, that Na is stored in the extravascular space leading to an activation of the monocyte phagocytic system cells that work as a regulator of the interstitial electrolyte homeostasis. Na-MRI was developed to quantify noninvasively, accurately and reliably tissue Na content. In this review, we give an up-to-date overview of clinical studies utilizing this Na-MRI technique to elucidate the importance of tissue Na content in patients with cardiovascular risk factors leading to microvascular and macrovascular complications. Na storage leads ultimately to organ damage such as left ventricular hypertrophy or hypertrophic vascular remodeling of resistance vessels. Elevated Na content in muscle and skin has been detected in patients with treatment resistant hypertension, type 2 diabetes mellitus, acute and chronic heart failure, chronic kidney disease and end-stage renal failure. Pharmacological interventions have shown that a mobilization of extracellular accumulated Na is possible and may emerge as a new therapeutic approach in some diseases.
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19
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Olde Engberink RHG, Selvarajah V, Vogt L. Clinical impact of tissue sodium storage. Pediatr Nephrol 2020; 35:1373-1380. [PMID: 31363839 PMCID: PMC7316850 DOI: 10.1007/s00467-019-04305-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/18/2019] [Accepted: 04/18/2019] [Indexed: 12/20/2022]
Abstract
In recent times, the traditional nephrocentric, two-compartment model of body sodium has been challenged by long-term sodium balance studies and experimental work on the dermal interstitium and endothelial surface layer. In the new paradigm, sodium can be stored without commensurate water retention in the interstitium and endothelial surface layer, forming a dynamic third compartment for sodium. This has important implications for sodium homeostasis, osmoregulation and the hemodynamic response to salt intake. Sodium storage in the skin and endothelial surface layer may function as a buffer during periods of dietary depletion and excess, representing an extra-renal mechanism regulating body sodium and water. Interstitial sodium storage may also serve as a biomarker for sodium sensitivity and cardiovascular risk, as well as a target for hypertension treatment. Furthermore, sodium storage may explain the limitations of traditional techniques used to quantify sodium intake and determine infusion strategies for dysnatraemias. This review is aimed at outlining these new insights into sodium homeostasis, exploring their implications for clinical practice and potential areas for further research for paediatric and adult populations.
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Affiliation(s)
- Rik H. G. Olde Engberink
- grid.7177.60000000084992262Location AMC, Department of Internal Medicine, Section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Viknesh Selvarajah
- grid.5335.00000000121885934Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Liffert Vogt
- grid.7177.60000000084992262Location AMC, Department of Internal Medicine, Section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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20
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Roth S, Markó L, Birukov A, Hennemuth A, Kühnen P, Jones A, Ghorbani N, Linz P, Müller DN, Wiegand S, Berger F, Kuehne T, Kelm M. Tissue Sodium Content and Arterial Hypertension in Obese Adolescents. J Clin Med 2019; 8:jcm8122036. [PMID: 31766426 PMCID: PMC6947559 DOI: 10.3390/jcm8122036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/08/2019] [Accepted: 11/15/2019] [Indexed: 12/20/2022] Open
Abstract
Early-onset obesity is known to culminate in type 2 diabetes, arterial hypertension and subsequent cardiovascular disease. The role of sodium (Na+) homeostasis in this process is incompletely understood, yet correlations between Na+ accumulation and hypertension have been observed in adults. We aimed to investigate these associations in adolescents. A cohort of 32 adolescents (13–17 years), comprising 20 obese patients, of whom 11 were hypertensive, as well as 12 age-matched controls, underwent 23Na-MRI of the left lower leg with a standard clinical 3T scanner. Median triceps surae muscle Na+ content in hypertensive obese (11.95 mmol/L [interquartile range 11.62–13.66]) was significantly lower than in normotensive obese (13.63 mmol/L [12.97–17.64]; p = 0.043) or controls (15.37 mmol/L [14.12–16.08]; p = 0.012). No significant differences were found between normotensive obese and controls. Skin Na+ content in hypertensive obese (13.33 mmol/L [11.53–14.22] did not differ to normotensive obese (14.12 mmol/L [13.15–15.83]) or controls (11.48 mmol/L [10.48–12.80]), whereas normotensive obese had higher values compared to controls (p = 0.004). Arterial hypertension in obese adolescents is associated with low muscle Na+ content. These findings suggest an early dysregulation of Na+ homeostasis in cardiometabolic disease. Further research is needed to determine whether this association is causal and how it evolves in the transition to adulthood.
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Affiliation(s)
- Sophie Roth
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité–Universitätsmedizin 13353 Berlin, Germany; (S.R.); (A.H.); (N.G.); (T.K.)
- Deutsches Herzzentrum Berlin, Department of Congenital Heart Disease, 13353 Berlin, Germany;
| | - Lajos Markó
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, 10785 Berlin, Germany; (L.M.); (A.B.); (D.N.M.)
- Max Delbruck Center for Molecular Medicine, 13092 Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbruck Center for Molecular Medicine, 13125 Berlin, Germany
| | - Anna Birukov
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, 10785 Berlin, Germany; (L.M.); (A.B.); (D.N.M.)
- Max Delbruck Center for Molecular Medicine, 13092 Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbruck Center for Molecular Medicine, 13125 Berlin, Germany
| | - Anja Hennemuth
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité–Universitätsmedizin 13353 Berlin, Germany; (S.R.); (A.H.); (N.G.); (T.K.)
| | - Peter Kühnen
- Department of Paediatrics, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (P.K.); (S.W.)
| | - Alexander Jones
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK;
| | - Niky Ghorbani
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité–Universitätsmedizin 13353 Berlin, Germany; (S.R.); (A.H.); (N.G.); (T.K.)
| | - Peter Linz
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Dominik N Müller
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, 10785 Berlin, Germany; (L.M.); (A.B.); (D.N.M.)
- Max Delbruck Center for Molecular Medicine, 13092 Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbruck Center for Molecular Medicine, 13125 Berlin, Germany
| | - Susanna Wiegand
- Department of Paediatrics, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (P.K.); (S.W.)
| | - Felix Berger
- Deutsches Herzzentrum Berlin, Department of Congenital Heart Disease, 13353 Berlin, Germany;
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, 10785 Berlin, Germany; (L.M.); (A.B.); (D.N.M.)
| | - Titus Kuehne
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité–Universitätsmedizin 13353 Berlin, Germany; (S.R.); (A.H.); (N.G.); (T.K.)
- Deutsches Herzzentrum Berlin, Department of Congenital Heart Disease, 13353 Berlin, Germany;
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, 10785 Berlin, Germany; (L.M.); (A.B.); (D.N.M.)
| | - Marcus Kelm
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité–Universitätsmedizin 13353 Berlin, Germany; (S.R.); (A.H.); (N.G.); (T.K.)
- Deutsches Herzzentrum Berlin, Department of Congenital Heart Disease, 13353 Berlin, Germany;
- Correspondence: ; Tel.: +49-(0)30-4593-2864; Fax: +49-(0)30-4505-76983
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21
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Kannenkeril D, Karg MV, Bosch A, Ott C, Linz P, Nagel AM, Uder M, Schmieder RE. Tissue sodium content in patients with type 2 diabetes mellitus. J Diabetes Complications 2019; 33:485-489. [PMID: 31101486 DOI: 10.1016/j.jdiacomp.2019.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/15/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tissue sodium content by 23Na magnetic resonance imaging (MRI) has been found to be increased in arterial hypertension. We analyzed whether tissue sodium content is increased in patients with type-2 diabetes (T2DM). METHODS Patients with T2DM were compared to those with primary hypertension. Patients with T2DM were off any antidiabetic and hypertensive patients off any antihypertensive therapy for at least 4 weeks. Skin and muscle sodium content was assessed non-invasively with a 3.0 T clinical MRI system (Magnetom Verio, Siemens Health Care, Erlangen, Germany) in each patient. RESULTS In patients with T2DM (N = 59) we observed significantly greater muscle sodium content (diabetes: 20.6 ± 3.5 vs hypertension: 16.3 ± 2.5 mmol/l, p < 0.001) and skin sodium content (diabetes: 24.5 ± 7.2 vs hypertension: 20.6 ± 5.7 mmol/l, p = 0.01) than in those with primary hypertension (N = 33). When potential confounders (age, body mass index, gender, systolic and diastolic blood pressure, estimated glomerular filtration rate) were entered in a covariance analysis, both skin sodium content (p = 0.037) and muscle sodium content (p < 0.001) were still clearly elevated. CONCLUSION Patients with T2DM have greater skin and muscle sodium content. These are the first known data to demonstrate increased tissue sodium content in patients with T2DM, measured by 23Na magnetic resonance imaging. Since tissue sodium content is related to organ damage, therapeutic intervention should aim at reducing tissue sodium content.
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Affiliation(s)
- Dennis Kannenkeril
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Marina V Karg
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Agnes Bosch
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany; Paracelsus Medical School Nürnberg, Nürnberg, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany; Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany.
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22
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Abstract
Sodium intake is undoubtedly indispensable for normal body functions but can be detrimental when taken in excess of dietary requirements. The consequences of excessive salt intake are becoming increasingly clear as high salt consumption persists across the globe. Salt has long been suspected to promote the development of hypertension and cardiovascular diseases and is now also recognized as a potential modulator of inflammatory and autoimmune diseases through its direct and indirect effects on immune cells. The finding that, in addition to the kidneys, other organs such as the skin regulate sodium levels in the body prompted new hypotheses, including the concept that skin-resident macrophages might participate in tissue sodium regulation through their interactions with lymphatic vessels. Moreover, immune cells such as macrophages and different T cell subsets are found in sodium-rich interstitial microenvironments, where sodium levels modulate their function. Alterations to the intestinal bacterial community induced by excess dietary salt represent another relevant axis whereby salt indirectly modulates immune cell function. Depending on the inflammatory context, sodium might either contribute to protective immunity (for example, by enhancing host responses against cutaneous pathogens) or it might contribute to immune dysregulation and promote the development of cardiovascular and autoimmune diseases.
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23
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Abstract
Kidney diseases can be caused by a wide range of genetic, hemodynamic, toxic, infectious, and autoimmune factors. The diagnosis of kidney disease usually involves the biochemical analysis of serum and blood, but these tests are often insufficiently sensitive or specific to make a definitive diagnosis. Although radiologic imaging currently has a limited role in the evaluation of most kidney diseases, several new imaging methods hold great promise for improving our ability to non-invasively detect structural, functional, and molecular changes within the kidney. New methods, such as dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and blood oxygen level-dependent (BOLD) MRI, allow functional imaging of the kidney. The use of novel contrast agents, such as microbubbles and nanoparticles, allows the detection of specific molecules in the kidney. These methods could greatly advance our ability to diagnose disease and also to safely monitor patients over time. This could improve the care of individual patients, and it could also facilitate the evaluation of new treatment strategies.
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Affiliation(s)
- Joshua Thurman
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
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24
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Karg MV, Bosch A, Kannenkeril D, Striepe K, Ott C, Schneider MP, Boemke-Zelch F, Linz P, Nagel AM, Titze J, Uder M, Schmieder RE. SGLT-2-inhibition with dapagliflozin reduces tissue sodium content: a randomised controlled trial. Cardiovasc Diabetol 2018; 17:5. [PMID: 29301520 PMCID: PMC5753452 DOI: 10.1186/s12933-017-0654-z] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/26/2017] [Indexed: 12/11/2022] Open
Abstract
Background and aims Sodium tissue content by 23Na magnetic resonance imaging (Na-MRI) has been validated in experimental and human studies. SGLT-2 inhibition blocks the reabsorption of glucose and of sodium in the proximal tubular cells in a 1:1 fashion. We hypothesized that SGLT-2 inhibition in patients with type 2 diabetes characterized by sodium retention leads to decreased tissue sodium content due to its pharmacological action. Materials and methods In a prospective double blind, placebo controlled, cross-over trial 59 patients (61 ± 7.6 years) with type 2 diabetes were randomized to either dapagliflozin 10 mg or placebo once daily for 6 weeks each. In addition to metabolic parameters and ambulatory blood pressure (BP) we analysed the sodium content in the skin and muscles of the lower leg by Na-MRI. Results Compared to baseline 6 weeks treatment with the SGLT-2 inhibitor dapagliflozin decreased fasting (132 ± 28 vs. 114 ± 19 mg/dl, p < 0.001), postprandial blood glucose (178 ± 66 mg/dl vs. 153 ± 46 mg/dl, p < 0.001), body weight (87.6 vs. 86.6 kg, p < 0.001) and systolic (129 ± 12 vs. 126 ± 11 mmHg, p = 0.010), and diastolic (77.4 ± 9 vs. 75.6 ± 8 mmHg, p = 0.024), 24-h ambulatory BP. Tissue sodium content in the skin was reduced after 6 weeks treatment with dapagliflozin compared to baseline [24.1 ± 6.6 vs. 22.7 ± 6.4 A.U.(arbitrary unit) p = 0.013]. No significant reduction of tissue sodium content was observed in the muscle (M. triceps surae: 20.5 ± 3.5 vs. 20.4 ± 3.7 A.U. p = 0.801). No clear significant difference in tissue water content of muscle and skin was observed after 6 weeks of treatment with dapagliflozin, compared to baseline. Conclusion SGLT-2 inhibition with dapagliflozin resulted in a significant decrease in tissue sodium content of the skin after 6 weeks. This observation point to a decrease of total sodium content in patients with type 2 diabetes prone to cardiovascular complications, that might be mitigated by SGLT-2 inhibition. Trial registration The study was registered at http://www.clinicaltrials.gov (NCT02383238) retrospectively registered
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Affiliation(s)
- M V Karg
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - A Bosch
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - D Kannenkeril
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - K Striepe
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - C Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - M P Schneider
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - F Boemke-Zelch
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - P Linz
- Department for Diagnostic Radiology, University Hospital Erlangen, Erlangen, Germany
| | - A M Nagel
- Department for Diagnostic Radiology, University Hospital Erlangen, Erlangen, Germany
| | - J Titze
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - M Uder
- Department for Diagnostic Radiology, University Hospital Erlangen, Erlangen, Germany
| | - R E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
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25
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Francis S, Buchanan CE, Prestwich B, Taal MW. Sodium MRI: a new frontier in imaging in nephrology. Curr Opin Nephrol Hypertens 2017; 26:435-441. [PMID: 28877041 DOI: 10.1097/mnh.0000000000000370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW This review focuses on the recent technological advances in quantitative sodium (Na) MRI to provide a noninvasive measure of tissue viability for use in clinical studies of patients with kidney disease. Na MRI is the only noninvasive imaging technique that allows for the absolute spatial quantification of tissue sodium concentration (TSC), providing assessment of the corticomedullary sodium gradient (CMSG) in the kidney, and allowing measures of TSC in the skin and muscle. RECENT FINDINGS Na MRI of the kidney has demonstrated the sensitivity to measure the CMSG, providing the normal range in healthy individuals and demonstrating a reduction in CMSG in kidney disease and transplanted kidneys. Studies using Na and H MRI have shown that in humans, skeletal muscle and skin can store sodium without water retention, and that sodium concentrations in muscle and skin increase with advancing age. Recent studies have shown that TSC can be mobilised during haemodialysis, and that skin sodium content links closely to left ventricular mass in patients with chronic kidney disease. SUMMARY Na MRI is currently a research technique, but with future advances, Na MRI has potential to become a noninvasive renal biomarker and a measure of tissue sodium storage for clinical studies.
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Affiliation(s)
- Susan Francis
- aSir Peter Mansfield Imaging Centre, School of Physics and Astronomy bCentre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, United Kingdom
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