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Zhang Y, Liang C, Xu H, Li Y, Xia K, Wang L, Huang X, Chen J, Shu J, Cheng F, Shi K, Wang J, Tao Y, Wang S, Zhang Y, Li H, Feng S, Li F, Zhou X, Chen Q. Dedifferentiation-like reprogramming of degenerative nucleus pulposus cells into notochordal-like cells by defined factors. Mol Ther 2024; 32:2563-2583. [PMID: 38879755 PMCID: PMC11405157 DOI: 10.1016/j.ymthe.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/09/2024] [Accepted: 06/14/2024] [Indexed: 07/14/2024] Open
Abstract
The extensive degeneration of functional somatic cells and the depletion of endogenous stem/progenitor populations present significant challenges to tissue regeneration in degenerative diseases. Currently, a cellular reprogramming approach enabling directly generating corresponding progenitor populations from degenerative somatic cells remains elusive. The present study focused on intervertebral disc degeneration (IVDD) and identified a three-factor combination (OCT4, FOXA2, TBXT [OFT]) that could induce the dedifferentiation-like reprogramming of degenerative nucleus pulposus cells (dNPCs) toward induced notochordal-like cells (iNCs). Single-cell transcriptomics dissected the transitions of cell identity during reprogramming. Further, OCT4 was found to directly interact with bromodomain PHD-finger transcription factor to remodel the chromatin during the early phases, which was crucial for initiating this dedifferentiation-like reprogramming. In rat models, intradiscal injection of adeno-associated virus carrying OFT generated iNCs from in situ dNPCs and reversed IVDD. These results collectively present a proof-of-concept for dedifferentiation-like reprogramming of degenerated somatic cells into corresponding progenitors through the development of a factor-based strategy, providing a promising approach for regeneration in degenerative disc diseases.
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Affiliation(s)
- Yuang Zhang
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Chengzhen Liang
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province; Hangzhou City, Zhejiang Province 310009, China
| | - Haibin Xu
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Yi Li
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Kaishun Xia
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Liyin Wang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University; Shanghai 200031, China
| | - Xianpeng Huang
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Jiangjie Chen
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Jiawei Shu
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Feng Cheng
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Kesi Shi
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Jingkai Wang
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province; Hangzhou City, Zhejiang Province 310009, China
| | - Yiqing Tao
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province; Hangzhou City, Zhejiang Province 310009, China
| | - Shaoke Wang
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Yongxiang Zhang
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Hao Li
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Shoumin Feng
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China
| | - Fangcai Li
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province; Hangzhou City, Zhejiang Province 310009, China.
| | - Xiaopeng Zhou
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province; Hangzhou City, Zhejiang Province 310009, China.
| | - Qixin Chen
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou City, Zhejiang Province 310009, China; Orthopedics Research Institute of Zhejiang University; Hangzhou City, Zhejiang Province 310009, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province; Hangzhou City, Zhejiang Province 310009, China.
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Daowtak K, Pilapong C, Tochaikul G, Moonkum N. Effect of iodinated contrast media on peripheral blood mononuclear cells in terms of cell viability, cell cycle and oxidative stress in an in vitro system. Toxicol Mech Methods 2023; 33:667-674. [PMID: 37403420 DOI: 10.1080/15376516.2023.2230486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023]
Abstract
Iodine contrast agents are essential for diagnostic purposes in radiology and have significant medical benefits. However, they pose a risk of causing allergic reactions or adverse cellular effects. In this study, we examine the in vitro effects of iodine contrast agents (Iopamiro 370, Ultravist 370, Visipaque 320, and Optiray 350) on cellular functions of human peripheral blood mononuclear. The findings reveal that a concentration of 50 mgI/ml of iodine contrast agents causes a 50% reduction in cell viability, but lower concentrations of 2.5, 5.0, and 10.0 mgI/ml do not affect the cell cycle. Furthermore, the contrast agents decrease oxidative stress levels in cells. In conclusion, this study demonstrates that iodine contrast agents can be used safely in appropriate concentrations for diagnostic purposes without affecting the cell cycle and preventing oxidative stress on normal cells. The insights gained from this study could aid in the development of diagnostic contrast agents in the future of medicine.
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Affiliation(s)
- Krai Daowtak
- Department of Medical Technology, Naresuan University, Phitsanulok, Thailand
| | - Chalermchai Pilapong
- Department of Radiologic Technology, Chiang Mai University, Chiang Mai, Thailand
| | | | - Nutthapong Moonkum
- Faculty of Radiological Technology, Rangsit University, Patumthani, Thailand
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Peng YJ, Chen CM, Li YF, Guo YT, Chen YT, Chao KH, Yang JJ. Patent blue versus methylene blue and indigo carmine as a better dye for chromodiscography: in vitro staining efficacy and cytotoxicity study using bovine coccygeal intervertebral discs. Spine J 2023; 23:1079-1087. [PMID: 36804435 DOI: 10.1016/j.spinee.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND CONTEXT Chromodiscography is an integral part of full-endoscopic discectomy (FED), comprising ordinary discography with radiopacity produced by contrast medium and intradiscal stain for visualizing annular defects in the endoscopic field. Nevertheless, concerns remain about the cytotoxicity of the stains used. The study of their staining efficacy is also lacking. PURPOSE To evaluate the feasibility of methylene blue, patent blue, and indigo carmine for intradiscal injection, investigate the effectiveness of each dye, and define critical concentration with adequate staining efficacy and tolerable cytotoxicity for use in chromodiscography during FED. STUDY DESIGN An experimental in vitro study. METHODS Dye stock solutions were prepared from powder. The stock was diluted with culture medium or balanced saline and used for cytotoxicity or intervertebral disc staining assays, respectively. Bovine tails were obtained from the local slaughterhouse and functional spine units of intervertebral discs were acquired by transverse incision at the disc level. Each disc was punctured over the posterolateral aspect using a surgical knife to simulate an annular defect. The intradiscal injection was performed with each dye at different concentrations using a 22G needle from the contralateral aspect of the punctured site. Staining efficacy was quantified using ImageJ software. Primary cells of bovine tails were cultivated in each dye at different concentrations. Cytotoxicity was assessed 24 hours after stain exposure using the CCK-8 toxicity assay. RESULTS Staining efficacy and cytotoxicity were proportional to the concentration of tested dyes. Lower limits of concentration producing significant staining efficacy of indigo carmine, methylene blue, and patent blue were 0.25 mg/mL, 0.25 mg/mL, and 0.05 mg/mL, respectively. Compared with controls, concentrations showing significant toxicity for indigo carmine, methylene blue, and patient blue were 1 mg/mL, 0.5 mg/mL, and 2.5 mg/mL, respectively. CONCLUSIONS Patent blue can serve as a more suitable tissue stain than either indigo carmine or methylene blue due to the widest range of tradeoff concentration within 0.05 to 2.5 mg/mL. CLINICAL SIGNIFICANCE Patent blue with the characteristic of good staining efficacy and lower cytotoxicity may be a promising option for chromodiscography during FED.
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Affiliation(s)
- Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Cheng-Gong Road Section 2, Taipei 114, Taipei, 114, Taiwan, R.O.C
| | - Chiu-Ming Chen
- Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Cheng-Gong Road Section 2, Taipei 114, Taipei, 114, Taiwan, R.O.C
| | - Yao-Feng Li
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Cheng-Gong Road Section 2, Taipei 114, Taipei, 114, Taiwan, R.O.C
| | - Yi-Tzu Guo
- Institute of Pathology and Parasitology, National Defense Medical Center, No. 325, Sec. 2, Cheng-Gong Rd., Neihu Dist., Taipei 114, Taiwan, R.O.C
| | - Yi-Ting Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 325, Sec. 2, Cheng-Gong Rd., Neihu Dist., Taipei 114, Taiwan, R.O.C
| | - Kuo-Hua Chao
- Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Cheng-Gong Road Section 2, Taipei 114, Taipei, 114, Taiwan, R.O.C
| | - Jui-Jung Yang
- Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Cheng-Gong Road Section 2, Taipei 114, Taipei, 114, Taiwan, R.O.C..
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Daniele G, Lafay F, Arnaudguilhem C, Mounicou S, Geffard A, Bonnard I, Dedourge-Geffard O, Bonnefoy C, Vulliet E. Evaluation of the accumulation of the iodinated contrast agents diatrizoic acid and iohexol in Dreissena polymorpha mollusks. CHEMOSPHERE 2023; 312:137153. [PMID: 36370762 DOI: 10.1016/j.chemosphere.2022.137153] [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: 07/28/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Mollusks are very sensitive to aquatic environmental alterations and then, are important bio-indicators for monitoring the contamination of water bodies. Iodinated X-ray contrast media (ICMs) are ubiquitously present in the aquatic environment, primarily due to their high consumption for diagnosis purposes, high injection levels, low biodegradability, and low removal rates by wastewater treatment plants. Although these compounds are assumed to be of low toxicity, aquatic organisms are continuously exposed to these agents, which may result in adverse effects as ICMs can act as iodine source and disrupt the endocrine system. Thus, the evaluation of their environmental risk, especially on aquatic fauna is of great interest. To this end, we first compared the accumulation behavior, based on iodine analysis, of two ICM exhibiting different osmolality, diatrizoic acid and iohexol in Dreissena polymorpha bivalves exposed under laboratory conditions at concentrations of 0, 100, and 1000 μg/L during 4 and 7 days. This study was the first to provide information on iodine concentration in whole soft tissues and several organs in control zebra mussels. Moreover, it showed, after exposure, an increase of iodine content mainly in the digestive glands, followed by gills and gonads, highlighting that ICMs actually enter the organisms. Thus, bioaccumulation of ICMs studies were then performed, by liquid chromatography coupled to tandem mass spectrometry, on entire mollusks and digestive glands of organisms exposed at 0, 10, 100, and 1000 μg/L of both ICMs during 21 days, followed by 4 days of depuration. These first data on ICMs concentrations in zebra mussels, showed a clear accumulation of ICMs in mussels as a function of relative exposure level, as well as a rapid depuration. Osmolality did not seem to have a significant impact on the accumulation level, but a slight difference was observed on the accumulation pattern between both ICMs.
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Affiliation(s)
- Gaëlle Daniele
- Univ Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR 5280, 5 Rue de la Doua, F-69100, Villeurbanne, France.
| | - Florent Lafay
- Univ Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR 5280, 5 Rue de la Doua, F-69100, Villeurbanne, France
| | | | - Sandra Mounicou
- Université de Pau et des Pays de l'Adour, E2S UPPA, CNRS, IPREM, Pau, France
| | - Alain Geffard
- UMR-I 02 SEBIO (Stress Environnementaux et BIOsurveillance des Milieux Aquatiques), Université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Campus Moulin de Housse, BP 1039, 51687, Reims, Cedex 2, France
| | - Isabelle Bonnard
- UMR-I 02 SEBIO (Stress Environnementaux et BIOsurveillance des Milieux Aquatiques), Université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Campus Moulin de Housse, BP 1039, 51687, Reims, Cedex 2, France
| | - Odile Dedourge-Geffard
- UMR-I 02 SEBIO (Stress Environnementaux et BIOsurveillance des Milieux Aquatiques), Université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Campus Moulin de Housse, BP 1039, 51687, Reims, Cedex 2, France
| | - Christelle Bonnefoy
- Univ Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR 5280, 5 Rue de la Doua, F-69100, Villeurbanne, France
| | - Emmanuelle Vulliet
- Univ Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR 5280, 5 Rue de la Doua, F-69100, Villeurbanne, France
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Zhang A, Chang Chien GC. Effects of Local Anesthetics and Contrast Agents on Regenerative Medicine Procedures. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Zhang A, Wang D, Diwan S, Lin CP, Calodney A, Rosenthal R, Chang Chien GC. Effects of local anesthetics and contrast agents on musculoskeletal regenerative medicine procedures. Regen Med 2022; 17:845-853. [PMID: 36069006 DOI: 10.2217/rme-2021-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In regenerative medicine, cells, tissues and organs are often replaced, engineered or regrown in order to restore their function after they have been damaged or lost. Local anesthetics, corticosteroids and contrast agents are commonly employed for both diagnostic and therapeutic objectives in interventional pain and musculoskeletal treatments for regenerative medicine. There is growing evidence that routine injectables promote catabolism and disease processes. Thus, understanding the effects of these compounds on regenerative medicine injectates and target tissues such as tenocytes, chondrocytes, nucleus pulposus and ligamentous tissue is critical. This review includes the current research on the effects of local anesthetics and contrast agents, as well as their use and recommendations in regenerative medicine operations.
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Affiliation(s)
- Allan Zhang
- Department of Radiology, University of Connecticut Health Center, Farmington, CT, USA
| | - Daniel Wang
- Kansas City University, Kansas City, MO 64106, USA
| | | | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei, 10048, Taiwan
| | | | | | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA 93003, USA.,GCC Institute Regenerative Medicine, Newport Beach, CA 92606, USA
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Yang J, Sun Q, Huang C, Qin S, Han S, Huo Z, Li Y, Sun X, Chen J. 3-Aminophenylboronic acid-mediated aggregation of gold nanoparticles for colorimetric sensing of iohexol in environmental and biological samples. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2021; 261:120004. [PMID: 34098478 DOI: 10.1016/j.saa.2021.120004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 06/12/2023]
Abstract
Iohexol (IHO), as one of iodinated X-ray contrast, is often used as not only a chemical marker for tracking wastewater contamination in aquatic environment, but also an ideal glomerular filtration rate marker for explorating kidney disease. To these aims, it is important to establish reliable, fast, and cheap methods to detect IHO in environmental and biological samples. This work describes for the first time the development of a selective, sensitive and reliable colorimetric sensing assay for the fast determination of IHO in environmental and biological samples based on 3-aminophenylboronic acid (3-APBA) mediated aggregation of gold nanoparticles (AuNPs). In this approach, 3-APBA can assemble on the AuNPs surface through electrostatic interaction between its amino groups with the negatively charged citrate stabilizer of AuNPs to form AuNP@3-APBA. Subsequently, the aggregation and visual color change of the assembled AuNP@3-APBA are induced by the covalent reaction between boronic acid ligands of 3-APBA and cis-diols of IHO. The developed assay presented a very simple operating procedure and a rapid analysis time of around 10 min. The developed assay also exhibited good selectivity and a low limit of detection (LOD) of 0.005 mM for detecting IHO. Moreover, the developed assay showed comparable accuracy and precision to the high-performance liquid chromatography-diode array detector (HPLC-DAD) method when used for the rapid determination of IHO in river water and human urine samples. The recoveries of IHO at three spiking levels were in the range of 91.5-106.3% with relative standard deviation (RSD) values below 6.39%.
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Affiliation(s)
- Jiajia Yang
- College of Materials Science and Engineering, Hebei University of Engineering, 19 Taiji Road, Handan 056038, China
| | - Qingye Sun
- College of Materials Science and Engineering, Hebei University of Engineering, 19 Taiji Road, Handan 056038, China
| | - Chaonan Huang
- School of Environmental and Municipal Engineering, Qingdao University of Technology, 11 Fushun Road, Qingdao 266033, China
| | - Shenjun Qin
- College of Materials Science and Engineering, Hebei University of Engineering, 19 Taiji Road, Handan 056038, China
| | - Shuai Han
- College of Materials Science and Engineering, Hebei University of Engineering, 19 Taiji Road, Handan 056038, China
| | - Zhongchao Huo
- Second Department of Oncology, Affiliated Hospital of Hebei University of Engineering, 81 Congtai Road, Handan 056002, China
| | - Yun Li
- CAS Key Laboratory of Separation Sciences for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian 116023, China.
| | - Xiaoli Sun
- Department of Chemistry, Lishui University, 1 Xueyuan Road, Lishui 323000, China
| | - Jiping Chen
- CAS Key Laboratory of Separation Sciences for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Dalian 116023, China
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Sengar A, Vijayanandan A. Comprehensive review on iodinated X-ray contrast media: Complete fate, occurrence, and formation of disinfection byproducts. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 769:144846. [PMID: 33736235 DOI: 10.1016/j.scitotenv.2020.144846] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 05/22/2023]
Abstract
Iodinated contrast media (ICM) are drugs which are used in medical examinations for organ imaging purposes. Wastewater treatment plants (WWTPs) have shown incapability to remove ICM, and as a consequence, ICM and their transformation products (TPs) have been detected in environmental waters. ICM show limited biotransformation and low sorption potential. ICM can act as iodine source and can react with commonly used disinfectants such as chlorine in presence of organic matter to yield iodinated disinfection byproducts (IDBPs) which are more cytotoxic and genotoxic than conventionally known disinfection byproducts (DBPs). Even highly efficient advanced treatment systems have failed to completely mineralize ICM, and TPs that are more toxic than parent ICM are produced. This raises issues regarding the efficacy of existing treatment technologies and serious concern over disinfection of ICM containing waters. Realizing this, the current review aims to capture the attention of scientific community on areas of less focus. The review features in depth knowledge regarding complete environmental fate of ICM along with their existing treatment options.
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Affiliation(s)
- Ashish Sengar
- Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Arya Vijayanandan
- Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India.
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Rowe ES, Rowe VD, Hunter J, Gralinski MR, Neves LA. A nephroprotective iodinated contrast agent with cardioprotective properties: A pilot study. J Neuroimaging 2021; 31:706-713. [PMID: 33979019 PMCID: PMC8359965 DOI: 10.1111/jon.12873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Evaluation and treatment of acute ischemic syndromes, in the heart and brain, require vessel visualization by iodinated X-ray contrast agents. However, these contrast agents can induce injury, in both the kidneys and target organs themselves. Sulfobutylether beta cyclodextrin (SBECD) added to iohexol (SBECD-iohexol) (Captisol Enabled-iohexol, Ligand Pharmaceuticals, Inc, San Diego, CA) is currently in clinical trials in cardiovascular procedures, to determine its relative renal safety in high-risk patients. Preclinical studies showed that SBECD-iohexol reduced contrast-induced acute kidney injury in rodent models by blocking apoptosis. The current study was undertaken to determine whether SBECD-iohexol is also cardioprotective, in the male rat ischemia-reperfusion model, compared to iohexol alone. METHODS After anesthesia, the left coronary artery was ligated for 30 min and the ligation released and reperfusion followed for 2 h prior to sacrifice. Groups 1-4 were injected in the tail vein 10 min prior to ischemia with: (1) vehicle; (2) iohexol; (3) SBECD; and (4) SBECD-iohexol. Infarct size, hemodynamics, and serum markers were measured. RESULTS An eight-fold increase in serum creatine kinase in the iohexol-alone group was observed, compared with no increase in the SBECD-iohexol group. The mean arterial pressure and rate pressure product were depressed in the iohexol-alone group, but not in the SBECD-iohexol group, or controls. No difference in infarct size or serum creatinine among the groups was observed. CONCLUSION The results of this study suggest that SBECD-iohexol is superior to iohexol alone, for both the preservation of cardiomyocyte integrity and preservation of myocardial function in myocardial ischemia.
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Affiliation(s)
| | | | - John Hunter
- Neurrow Pharmaceuticals, Inc, Shawnee, Kansas, USA
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Supawat B, Wattanapongpitak S, Tima S, Kothan S, Tungjai M. Effect of fluoroscopic X-rays combined with iodinated radiographic contrast media on human hematological parameters. TOXICOLOGY AND ENVIRONMENTAL HEALTH SCIENCES 2021. [DOI: 10.1007/s13530-021-00093-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Collateral effects of targeting the nucleus pulposus via a transpedicular or transannular surgical route: a combined X-ray, MRI, and histological long-term descriptive study in sheep. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:585-595. [PMID: 32945962 DOI: 10.1007/s00586-020-06602-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE In the context of regenerative medicine strategies, based in particular on the injection of regenerative cells, biological factors, or biomaterials into the nucleus pulposus (NP), two main routes are used: the transpedicular approach (TPA) and the transannular approach (TAA). The purpose of our study was to compare the long-term consequences of the TPA and the TAA on intervertebral disc (IVD) health through a longitudinal follow-up in an ovine model. METHODS The TPA and the TAA were performed on 12 IVDs from 3 sheep. Six discs were left untreated and used as controls. The route and injection feasibility, as well as the IVD environment integrity, were assessed by MRI (T2-weighted signal intensity), micro-CT scan, and histological analyses (Boos' scoring). The sheep were assessed at 1, 3, and 7 months. RESULTS Both the TPA and the TAA allowed access to the NP. They both induced NP degeneration, as evidenced by a decrease in the T2wsi and an increase in the Boos' scores. The TPA led to persistent end-plate defects and herniation of NP tissue (Schmorl's node-like) after 7 months as well as the presence of osseous fragments in the NP. CONCLUSIONS The TPA induced more severe lesions in IVDs and vertebrae compared to the TAA. The lesions induced by the TPA are reason to consider whether or not this route is optimal for studying IVD regenerative medicine approaches.
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Supawat B, Udomtanakunchai C, Kothan S, Tungjai M. The Effects of Iodinated Radiographic Contrast Media on Multidrug-resistant K562/Dox Cells: Mitochondria Impairment and P-glycoprotein Inhibition. Cell Biochem Biophys 2019; 77:157-163. [PMID: 30924055 DOI: 10.1007/s12013-019-00868-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/11/2019] [Indexed: 02/07/2023]
Abstract
Iodinated radiographic contrast media is used in cancer radiography for cancer diagnosis. The aim of this present study was to examine five iodinated radiographic contrast media (IRCM) (i.e., iohexol, iopamidol, iobitridol, ioxaglate, and iodixanol) in terms of their cytotoxicity, mitochondria membrane potential (ΔΨm), and P-glycoprotein function in multidrug resistant K562/Dox cancer cells and corresponding sensitive cancer cells. The cytotoxicity was determined by colorimetric resazurin reduction assay. The ΔΨm and P-glycoprotein function was measured using a noninvasive functional spectrofluorometry. Rhodamine B, fluorescence probe, was used to estimate ΔΨm. The kinetic of P-glycoprotein-mediated efflux pirarubicin was used to monitor P-glycoprotein function in multidrug resistant (MDR) cancer cells. The results showed that ioxaglate and iodixanol show similar efficacy in MDR cancer cells and for their corresponding sensitive cancer cells. Iopamidol, iohexol, and iobitridol showed higher efficacy in MDR cancer cells than for the corresponding sensitive cancer cells by approximately 2 fold. The results also showed no significant change in the |ΔΨm| values in treated K562 and K562/Dox cancer cells when compared to the non-treated K562 and K562/Dox cancer cells. However, there were notable changes detected for iobitridol and iodixanol at 50 mgI/mL. Similarly, the results showed significant differences in P-glycoprotein function of K562/Dox cancer cells after treatment with IRCM when compared to the non-treated K562/Dox cancer cells, with iohexol and iodixanol being the notable exceptions once again. In this present study, IRCM exhibited cytotoxicity on MDR cancer cells and their corresponding sensitive cancer cells. IRCM also showed potential as an anticancer agent in the future.
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Affiliation(s)
- Benjamaporn Supawat
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
- Graduate School, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chatchanok Udomtanakunchai
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Suchart Kothan
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Montree Tungjai
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Karaarslan N, Yilmaz I, Ozbek H, Yasar Sirin D, Kaplan N, Caliskan T, Ozdemir C, Akyuva Y, Ates O. Are radio-contrast agents commonly used in discography toxic to the intact intervertebral disc tissue cells? Basic Clin Pharmacol Toxicol 2018; 124:181-189. [PMID: 30120906 DOI: 10.1111/bcpt.13112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/13/2018] [Indexed: 11/26/2022]
Abstract
In the literature, there have been no studies showing clear results on how radio-contrast pharmaceuticals would affect intact disc tissue cells. In this context, it was aimed to evaluate the effects of iopromide and gadoxetic acid, frequently used in the discography, on intact lumbar disc tissue in pharmaco-molecular and histopathological level. Primary cell cultures were prepared from the healthy disc tissue of the patients operated in the neurosurgery clinic. Except for the control group, the cultures were incubated with the indicated radio-contrast agents. Cell viability, toxicity and proliferation indices were tested at specific time intervals. The cell viability was quantitatively analysed. It was also visually rechecked under a fluorescence microscope with acridine orange/propidium iodide staining. Simultaneously, cell surface morphology was analysed with an inverted light microscope, while haematoxylin and eosin (H&E) staining methodology was used in the histopathological evaluations. The obtained data were evaluated statistically. Unlike the literature, iopromide or gadoxetic acid did not have any adverse effects on the cell viability, proliferation and toxicity (P < 0.05). Although this study reveals that radio-contrast pharmaceuticals used in the discography, often used in neurosurgical practice, can be safely used, it should be remembered that this study was performed in an in vitro environment.
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Affiliation(s)
- Numan Karaarslan
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, Istanbul, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag, Turkey
| | - Necati Kaplan
- Department of Neurosurgery, Corlu Reyap Hospital, Istanbul Rumeli University, Tekirdag, Turkey
| | - Tezcan Caliskan
- Department of Neurosurgery, Namik Kemal University School of Medicine, Tekirdag, Turkey
| | - Cigdem Ozdemir
- Department of Pathology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Yener Akyuva
- Department of Neurosurgery, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Esencan Hospital, Istanbul Esenyurt University, Istanbul, Turkey
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Wu T, Nie H, Dietz AB, Salek DR, Smith J, van Wijnen AJ, Qu W. Cytotoxic Effects of Nonionic Iodinated Contrast Agent on Human Adipose-Derived Mesenchymal Stem Cells. PM R 2018; 11:S1934-1482(18)30294-6. [PMID: 29860023 PMCID: PMC6358519 DOI: 10.1016/j.pmrj.2018.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/20/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transplantation of mesenchymal stem cells (MSCs) is a promising therapy for degenerative spine conditions. However, cell therapy for painful spine degeneration presently requires use of contrast agents during fluoroscopy-guided injections, and the effects of these agents on MSCs represents a gap in knowledge. OBJECTIVE To investigate the biological effects of contrast media (CM) that are coinjected with MSCs. DESIGN Prospective observational study. SETTING Academic medical center. PARTICIPANTS Patient-derived clinical-grade culture expanded MSCs. INTERVENTIONS Iohexol (Omnipaque300) was reduced to 12.5%, 25%, 50%, and 100% of the stock solution and incubated with MSCs for 30 minutes, 4 hours, and 48 hours. We also used complete media and 12.5%, 25%, 50%, 100% of phosphate-buffered saline as a control group. MAIN OUTCOME MEASURES We examined cytotoxicity of iohexol at different concentrations and exposure duration, as well as the potential for recovery over time. Cell counts, mitochondrial activity, and quantitative real time reverse-transcriptase polymerase chain reaction of related genes were analyzed immediately after exposure (day 0) and after 2 days of exposure (day 2). RESULTS Human MSCs exhibit a time- and concentration-dependent cytotoxic response to iodinated CM. A brief, 30-minute exposure did not affect MSCs function and viability. However, extended treatment with iohexol for 4 hours at 50% or higher concentration had a significant impact on both viability and gene expression in MSCs. CONCLUSIONS CM (Omnipaque300) is cytotoxic to MSCs in a time-and concentration-dependent manner. Hence, the concentration of CM that accompanies MSC injections should be carefully considered during MSC therapy for disk-degenerative diseases. LEVEL OF EVIDENCE To be determined.
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Affiliation(s)
- Tao Wu
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Rochester, MN
| | - Hai Nie
- Department of Orthopedic Surgery, Mayo Clinic Rochester, MN
| | - Allan B. Dietz
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN
| | | | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Rochester, MN
- Department of Radiology, Mayo Clinic Rochester, MN
- Department of Anatomy, Mayo Clinic Rochester, MN
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic Rochester, MN
- Department of Biochemistry and Molecular Biology, Mayo Clinic Rochester, MN
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, MN
| | - Wenchun Qu
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Rochester, MN
- Division of Pain Medicine, Mayo Clinic Rochester, MN
- Spine Center, Mayo Clinic Rochester, MN
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Cytotoxicity of radiocontrast dyes in human umbilical cord mesenchymal stem cells. Toxicol Appl Pharmacol 2018; 349:72-82. [PMID: 29705293 DOI: 10.1016/j.taap.2018.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 11/22/2022]
Abstract
Radiocontrast dyes are used for a wide range of diagnostic procedures for enhancing the image of anatomical structures, pain targets, and vascular uptake. While some of these dyes show toxicity to primary cells, their effect on stem cells, particularly mesenchymal stem cells (MSCs), is unknown. This study investigates the cytotoxic effects of two clinically used radiocontrast dyes, iohexol and iopamidol, on bone marrow and human umbilical cord MSCs. Exposure to these dyes significantly affected morphology of MSCs from both sources, as treated cells appeared transparent and no longer fibroblastoid. Cell viability decreased as determined by trypan blue and Annexin-V/PI staining, in a dose dependent manner with simultaneous loss of CD90 and CD105 concurrent with spontaneous differentiation in MSCs treated with iohexol and iopamidol. In addition, significantly higher cell death was observed in MSCs exposed to iopamidol than iohexol. At a concentration of 1:1, iohexol and iopamidol induced apoptosis in 19% and 92% (<.01) of MSCs, respectively. Global transcriptome analysis of treated MSCs revealed 139 and 384 differentially expressed genes in iohexol vs control and iopamidol vs control at p ≤ .01 and 1.5-fold, respectively. This suggested that iopamidol had more significant effect on the transcription of MSCs. Based on these results a molecular mechanism of radiocontast dye induced cell death via intrinsic apoptosis pathway mediated by p53 was proposed. Since iopamidol was significantly more toxic than iohexol in human MSCs, a more careful examination of safety of radiocontrast dyes for clinical use is warranted.
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Xu Z, Li X, Hu X, Yin D. Distribution and relevance of iodinated X-ray contrast media and iodinated trihalomethanes in an aquatic environment. CHEMOSPHERE 2017; 184:253-260. [PMID: 28601007 DOI: 10.1016/j.chemosphere.2017.05.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 06/07/2023]
Abstract
Distribution and relevance of iodinated X-ray contrast media (ICM) and iodinated disinfection byproducts (I-DBPs) in a real aquatic environment have been rarely documented. In this paper, some ICM were proven to be strongly correlated with I-DBPs through investigation of five ICM and five iodinated trihalomethanes (I-THMs) in surface water and two drinking water treatment plants (DWTPs) of the Yangtze River Delta, China. The total ICM concentrations in Taihu Lake and the Huangpu River ranged from 88.7 to 131 ng L-1 and 102-252 ng L-1, respectively. While the total I-THM concentrations ranged from 128 to 967 ng L-1 in Taihu Lake and 267-680 ng L-1 in the Huangpu River. Iohexol, the dominant ICM, showed significant positive correlation (p < 0.01) with CHClI2 in Taihu Lake. Iopamidol and iomeprol correlated positively (p < 0.01) with some I-THMs in the Huangpu River. The observed pronounced correlations between ICM and I-THMs indicated that ICM play an important role in the formation of I-THMs in a real aquatic environment. Characteristics of the I-THM species distributions indicated that I-THMs may be transformed by natural conditions. Both DWTPs showed negligible removal efficiencies for total ICM (<20%). Strikingly high concentrations of total I-THMs were observed in the finished water (2848 ng L-1 in conventional DWTP and 356 ng L-1 in advanced DWTP). Obvious transformation of ICM to I-THMs was observed during the chlorination and ozonization processes in DWTPs. We suggest that ICM is an important source for I-DBP formation in the real aquatic environment.
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Affiliation(s)
- Zhifa Xu
- Key Laboratory of Yangtze River Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, 1239 Siping Road, Shanghai, 200092, China
| | - Xia Li
- Key Laboratory of Yangtze River Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, 1239 Siping Road, Shanghai, 200092, China
| | - Xialin Hu
- Key Laboratory of Yangtze River Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, 1239 Siping Road, Shanghai, 200092, China.
| | - Daqiang Yin
- Key Laboratory of Yangtze River Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, 1239 Siping Road, Shanghai, 200092, China
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Oznam K, Sirin DY, Yilmaz I, Kaya YE, Isyar M, Gumustas SA, Ozbek H, Akkaya S, Kayhan A, Mahirogullari M. Iopromide- and gadopentetic acid-derived preparates used in MR arthrography may be harmful to chondrocytes. J Orthop Surg Res 2017; 12:98. [PMID: 28651625 PMCID: PMC5485569 DOI: 10.1186/s13018-017-0600-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/20/2017] [Indexed: 01/22/2023] Open
Abstract
Background Magnetic resonance arthrography, a procedure through which contrast agents containing gadolinium and/or iopromide are administered intra-articularly, has become a useful tool in musculoskeletal diagnosis. Nevertheless, despite being considered safe for systemic use, certain tissue toxicities have been identified for both drugs. In this study, the effects of short-term exposure of human primary chondrocyte cell cultures to gadolinium and/or iopromide contrast agents were examined by assaying for stage-specific embryonic antigen-1 (SSEA-1) protein expression (a chondrogenic differentiation marker), cell viability, toxicity, and proliferation. Methods Human articular chondrocytes were grown in monolayer culture and were exposed to iopromide and/or gadolinium diethylenetriamine-pentaacetate (Gd-DPT) for 2 and 6 h. Cell cultures with no drug exposure were used as the control group. Cell differentiation status was assessed according to SSEA-1 protein expression. Contrast agent effects on cell viability and proliferation were analyzed using MTT analysis. Further, changes in cell morphology in relation to the control group were evaluated using inverted light microscopy, environmental scanning electron microscopy (ESEM), and 3-tesla magnetic resonance imaging. The obtained data were statistically compared. Results When compared with the control group, both SSEA-1 protein expression and cell proliferation were lowest in the Gd-DPT group (P = 0.000). There was a statistically significant correlation between SSEA-1 expression and MTT results (rho = 0.351; P = 0.003). Conclusions Nevertheless, the data obtained from in vitro experiments may not directly correspond to clinical applications. However, the mere fact that a drug used solely for diagnostic purposes may repress chondrocyte cell proliferation should be carefully considered by clinicians.
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Affiliation(s)
- Kadir Oznam
- Department of Orthopaedic and Traumatology, Istanbul Medipol University School of Medicine, 34214, Istanbul, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetic, Namik Kemal University Faculty of Arts and Sciences, 59100, Tekirdag, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, 34810, Istanbul, Turkey.
| | - Yasin Emre Kaya
- Republic of Turkey, Ministry of Health, Department of Orthopaedic and Traumatology, Corlu State Hospital, 59100, Tekirdag, Turkey
| | - Mehmet Isyar
- Department of Orthopaedic and Traumatology, Acibadem Hospitals Group, 34180, Istanbul, Turkey
| | - Seyit Ali Gumustas
- Republic of Turkey, Ministry of Health, Dr. Lutfi Kirdar Research and Training Hospital, 34890, Istanbul, Turkey
| | - Hanefi Ozbek
- Department of Medical Pharmacology, Istanbul Medipol University School of Medicine, 34810, Istanbul, Turkey
| | - Semih Akkaya
- Department of Orthopaedic and Traumatology, Denizli Private Surgery Hospital, 20070, Denizli, Turkey
| | - Arda Kayhan
- Department of Radiology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, 34303, Istanbul, Turkey
| | - Mahir Mahirogullari
- Department of Orthopaedic and Traumatology, Memorial Health Group, 34384, Istanbul, Turkey
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