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Cunningham A, Kirk M, Hong E, Yang J, Howard T, Brearley A, Sáenz-Trevizo A, Krawchuck J, Watt J, Henderson I, Dokladny K, DeAguero J, Escobar GP, Wagner B. The safety of magnetic resonance imaging contrast agents. FRONTIERS IN TOXICOLOGY 2024; 6:1376587. [PMID: 39188505 PMCID: PMC11345262 DOI: 10.3389/ftox.2024.1376587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/01/2024] [Indexed: 08/28/2024] Open
Abstract
Gadolinium-based contrast agents are increasingly used in clinical practice. While these pharmaceuticals are verified causal agents in nephrogenic systemic fibrosis, there is a growing body of literature supporting their role as causal agents in symptoms associated with gadolinium exposure after intravenous use and encephalopathy following intrathecal administration. Gadolinium-based contrast agents are multidentate organic ligands that strongly bind the metal ion to reduce the toxicity of the metal. The notion that cationic gadolinium dissociates from these chelates and causes the disease is prevalent among patients and providers. We hypothesize that non-ligand-bound (soluble) gadolinium will be exceedingly low in patients. Soluble, ionic gadolinium is not likely to be the initial step in mediating any disease. The Kidney Institute of New Mexico was the first to identify gadolinium-rich nanoparticles in skin and kidney tissues from magnetic resonance imaging contrast agents in rodents. In 2023, they found similar nanoparticles in the kidney cells of humans with normal renal function, likely from contrast agents. We suspect these nanoparticles are the mediators of chronic toxicity from magnetic resonance imaging contrast agents. This article explores associations between gadolinium contrast and adverse health outcomes supported by clinical reports and rodent models.
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Affiliation(s)
- Amy Cunningham
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM, United States
| | - Martin Kirk
- Department of Chemistry and Chemical Biology, University of New Mexico, Albuquerque, NM, United States
| | - Emily Hong
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM, United States
| | - Jing Yang
- Department of Chemistry and Chemical Biology, University of New Mexico, Albuquerque, NM, United States
| | - Tamara Howard
- Cell Biology and Physiology, University of New Mexico Health Science Center, Albuquerque, NM, United States
| | - Adrian Brearley
- Department of Earth and Planetary Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Angelica Sáenz-Trevizo
- Department of Earth and Planetary Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Jacob Krawchuck
- Sandia National Laboratory, Center for Integrated Nanotechnologies, Albuquerque, NM, United States
| | - John Watt
- Los Alamos National Laboratory, Center for Integrated Nanotechnologies, Albuquerque, NM, United States
| | | | - Karol Dokladny
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Kidney Institute of New Mexico, Albuquerque, NM, United States
| | - Joshua DeAguero
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Kidney Institute of New Mexico, Albuquerque, NM, United States
| | - G. Patricia Escobar
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Kidney Institute of New Mexico, Albuquerque, NM, United States
| | - Brent Wagner
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Kidney Institute of New Mexico, Albuquerque, NM, United States
- New Mexico VA Healthcare System, Research Service, Albuquerque, NM, United States
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DeAguero J, Howard T, Kusewitt D, Brearley A, Ali AM, Degnan JH, Jett S, Watt J, Escobar GP, Dokladny K, Wagner B. The onset of rare earth metallosis begins with renal gadolinium-rich nanoparticles from magnetic resonance imaging contrast agent exposure. Sci Rep 2023; 13:2025. [PMID: 36739294 PMCID: PMC9899216 DOI: 10.1038/s41598-023-28666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/23/2023] [Indexed: 02/06/2023] Open
Abstract
The leitmotifs of magnetic resonance imaging (MRI) contrast agent-induced complications range from acute kidney injury, symptoms associated with gadolinium exposure (SAGE)/gadolinium deposition disease, potentially fatal gadolinium encephalopathy, and irreversible systemic fibrosis. Gadolinium is the active ingredient of these contrast agents, a non-physiologic lanthanide metal. The mechanisms of MRI contrast agent-induced diseases are unknown. Mice were treated with a MRI contrast agent. Human kidney tissues from contrast-naïve and MRI contrast agent-treated patients were obtained and analyzed. Kidneys (human and mouse) were assessed with transmission electron microscopy and scanning transmission electron microscopy with X-ray energy-dispersive spectroscopy. MRI contrast agent treatment resulted in unilamellar vesicles and mitochondriopathy in renal epithelium. Electron-dense intracellular precipitates and the outer rim of lipid droplets were rich in gadolinium and phosphorus. We conclude that MRI contrast agents are not physiologically inert. The long-term safety of these synthetic metal-ligand complexes, especially with repeated use, should be studied further.
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Affiliation(s)
- Joshua DeAguero
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque, NM, USA.
- University of New Mexico Health Science Center, Albuquerque, NM, USA.
- New Mexico Veterans Administration Health Care System, Albuquerque, NM, USA.
| | - Tamara Howard
- University of New Mexico Health Science Center, Albuquerque, NM, USA
| | - Donna Kusewitt
- University of New Mexico Health Science Center, Albuquerque, NM, USA
| | - Adrian Brearley
- Department of Earth and Planetary Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Abdul-Mehdi Ali
- Department of Earth and Planetary Sciences, University of New Mexico, Albuquerque, NM, USA
| | - James H Degnan
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | - Stephen Jett
- Chan Zuckerberg Initiative, Redwood City, CA, USA
| | - John Watt
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - G Patricia Escobar
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque, NM, USA
- University of New Mexico Health Science Center, Albuquerque, NM, USA
- New Mexico Veterans Administration Health Care System, Albuquerque, NM, USA
| | - Karol Dokladny
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque, NM, USA
- University of New Mexico Health Science Center, Albuquerque, NM, USA
- New Mexico Veterans Administration Health Care System, Albuquerque, NM, USA
| | - Brent Wagner
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque, NM, USA.
- University of New Mexico Health Science Center, Albuquerque, NM, USA.
- New Mexico Veterans Administration Health Care System, Albuquerque, NM, USA.
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Jackson DB, MacIntyre T, Duarte-Miramontes V, DeAguero J, Escobar GP, Wagner B. Gadolinium Deposition Disease: A Case Report and the Prevalence of Enhanced MRI Procedures Within the Veterans Health Administration. Fed Pract 2022; 39:218-225. [PMID: 35935925 PMCID: PMC9351733 DOI: 10.12788/fp.0258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Gadolinium (Gd) usage in the Veterans Health Administration is increasing and patients with renal disease are frequently exposed. Gd is not entirely eliminated within 24 hours after administration, which may pose long-term adverse effects. Case Presentation A Vietnam-era veteran aged > 70 years presented for evaluation of Gd-based contrast agent-induced chronic multisymptom illness. In the course of his routine clinical care, he was exposed to repeated Gd-enhanced magnetic resonance imaging studies. After his second Gd-based contrast agent exposure, he noted rash, pain, headaches, and hoarseness. Years after the exposure to the contrast agents, he continued to have detectable Gd in urine and serum. Conclusions Practitioners should be aware of long-term intracellular Gd retention (including the brain) as patients increasingly turn to consultants with concerns about Gd deposition disease. Data from patient advocates demonstrate that Gd is eliminated in intermediate and long phases, which may represent a multicompartment model. The commercialization of Gd use in imaging studies is outpacing the science addressing the long-term consequences of harboring this alien, toxic, nonphysiologic rare earth metal.
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Affiliation(s)
- D. Bradley Jackson
- New Mexico Veterans Administration Health Care System, Albuquerque,University of New Mexico Health Sciences Center, Albuquerque
| | | | | | - Joshua DeAguero
- New Mexico Veterans Administration Health Care System, Albuquerque,University of New Mexico Health Sciences Center, Albuquerque,Kidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque
| | - G. Patricia Escobar
- New Mexico Veterans Administration Health Care System, Albuquerque,University of New Mexico Health Sciences Center, Albuquerque,Kidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque
| | - Brent Wagner
- New Mexico Veterans Administration Health Care System, Albuquerque,University of New Mexico Health Sciences Center, Albuquerque,Kidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque
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Bruno F, DeAguero J, Do C, Lee DY, Tan C, Escobar GP, Wagner B. Overlapping roles of NADPH oxidase 4 for diabetic and gadolinium-based contrast agent-induced systemic fibrosis. Am J Physiol Renal Physiol 2021; 320:F617-F627. [PMID: 33615889 DOI: 10.1152/ajprenal.00456.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dozens of millions of people are exposed to gadolinium-based contrast agents annually for enhanced magnetic resonance imaging. Gadolinium-based contrast agents are known nephrotoxins and can trigger the potentially fatal condition of systemic fibrosis. Risk factors are practically entirely undefined. We examined the role of NADPH oxidase 4 (Nox4) in gadolinium-induced systemic disease. Age- and weight-matched mice were randomized to experimental diabetes (streptozotocin) and control groups followed by systemic gadolinium-based contrast agent treatment. Nox4-deficient mice were randomized to experimental diabetes and gadolinium-based contrast agent treatment. Skin fibrosis and cellular infiltration were apparent in both gadolinium-based contrast agent-treated and experimental diabetes groups. Similarly, both groups demonstrated renal pathologies with evidence of reactive oxygen species generation. Deletion of Nox4 abrogated both skin and renal pathology, whether from diabetes or gadolinium-based contrast agent treatment. These discoveries demonstrate the importance of Nox4 in gadolinium-based contrast agent- and diabetes-induced fibrosis.NEW & NOTEWORTHY A mouse model of gadolinium-based contrast agent- and diabetes-induced fibrosis was used to demonstrate the role of NADPH oxidase 4 (Nox4) in gadolinium-induced systemic disease. Using these models, we established the role of Nox4 as a mediator of reactive oxygen species generation and subsequent skin and kidney fibrosis. These novel findings have defined Nox-4-mediated mechanisms by which gadolinium-based contrast agents induce systemic diseases.
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Affiliation(s)
- Francesca Bruno
- Eboli Hospital "Maria SS Addolorata," UOC of Nephrology and Dialysis, Eboli, Italy
| | - Joshua DeAguero
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque, New Mexico
| | - Catherine Do
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque, New Mexico.,New Mexico Veterans Administration Health Care System, Albuquerque, New Mexico
| | - Doug Yoon Lee
- University of Texas Health System, San Antonio, Texas
| | - Chunyan Tan
- University of Texas Health System, San Antonio, Texas
| | - G Patricia Escobar
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque, New Mexico.,New Mexico Veterans Administration Health Care System, Albuquerque, New Mexico
| | - Brent Wagner
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque, New Mexico.,New Mexico Veterans Administration Health Care System, Albuquerque, New Mexico
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Do C, DeAguero J, Brearley A, Trejo X, Howard T, Escobar GP, Wagner B. Gadolinium-Based Contrast Agent Use, Their Safety, and Practice Evolution. ACTA ACUST UNITED AC 2020; 1:561-568. [PMID: 34423308 DOI: 10.34067/kid.0000272019] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gadolinium-based contrast agents (GBCAs) have provided much needed image enhancement in magnetic resonance imaging (MRI) important in the advancement of disease diagnosis and treatment. The paramagnetic properties of ionized gadolinium have facilitated these advancements, but ionized gadolinium carries toxicity risk. GBCAs were formulated with organic chelates designed to reduce these toxicity risks from unbound gadolinium ions. They were preferred over iodinated contrast used in computed tomography and considered safe for use. As their use expanded, the development of new diseases associated with their use (including nephrogenic systemic fibrosis) has drawn more attention and ultimately caution with their clinical administration in those with impaired renal function. Use of GBCAs in those with preserved renal function was considered to be safe. However, in this new era with emerging clinical and experimental evidence of brain gadolinium deposition in those with repeated exposure, these safety assumptions are once again brought into question. This review article aims to add new perspectives in thinking about the role of GBCA in current clinical use. The new information begs for further discussion and consideration of the risk-benefit ratio of use of GBCAs.
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Affiliation(s)
- Catherine Do
- Kidney Institute of New Mexico, Albuquerque, New Mexico.,Renal Section, Medicine Service, New Mexico Veterans Administration Health Care System, Albuquerque, New Mexico.,Department of Medicine, University of New Mexico Health Care System, Albuquerque, New Mexico
| | - Joshua DeAguero
- Kidney Institute of New Mexico, Albuquerque, New Mexico.,University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Adrian Brearley
- Department of Earth and Planetary Science, University of New Mexico, Albuquerque, New Mexico
| | | | - Tamara Howard
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - G Patricia Escobar
- Kidney Institute of New Mexico, Albuquerque, New Mexico.,Renal Section, Medicine Service, New Mexico Veterans Administration Health Care System, Albuquerque, New Mexico.,University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Brent Wagner
- Kidney Institute of New Mexico, Albuquerque, New Mexico.,Renal Section, Medicine Service, New Mexico Veterans Administration Health Care System, Albuquerque, New Mexico.,Department of Medicine, University of New Mexico Health Care System, Albuquerque, New Mexico.,University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Abstract
PURPOSE OF REVIEW The hegemony of gadolinium-based contrast agent-induced adverse events stretches beyond those who have renal impairment. 'Nephrogenic' systemic fibrosis is a misnomer: gadolinium-based contrast agents are the known trigger for the disease; kidney impairment is a risk factor. Impaired (true) glomerular filtration may be one catalyst for gadolinium-based contrast agent-induced adverse events, but it is increasingly evident that the same cluster of symptoms occurs in patients with normal renal function. RECENT FINDINGS It has been known for nearly 30 years that gadolinium-based contrast agents distribute and are cleared according to a three compartment model. Single doses of gadolinium-based contrast agents can trigger 'nephrogenic' systemic fibrosis in nondialysis dependent patients. Manifestations have occurred years after exposure. Renal insufficiency alone is not an adequate explanation for 'nephrogenic' systemic fibrosis, and the continuum of its symptoms with the adverse events reported by patients with normal renal function clearly indicate that the physiologic reactions are largely undefined. SUMMARY Gadolinium-based contrast agents should be used with extreme caution.
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Does Age Interfere With Gadolinium Toxicity and Presence in Brain and Bone Tissues?: A Comparative Gadoterate Versus Gadodiamide Study in Juvenile and Adult Rats. Invest Radiol 2019; 54:61-71. [PMID: 30394964 PMCID: PMC6310471 DOI: 10.1097/rli.0000000000000517] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The main objective of the study was to assess the effect of age on target tissue total gadolinium (Gd) retention after repeated administration of gadodiamide (linear) or gadoterate (macrocyclic) Gd-based contrast agent (GBCA) in rats. The secondary objective was to assess the potential developmental and long-term consequences of GBCA administration during neonatal and juvenile periods. MATERIALS AND METHODS A total of 20 equivalent human clinical doses (cumulated dose, 12 mmol Gd/kg) of either gadoterate or gadodiamide were administered concurrently by the intravenous route to healthy adult and juvenile rats. Saline was administered to juvenile rats forming the control group. In juvenile rats, the doses were administered from postnatal day 12, that is, once the blood-brain barrier is functional as in humans after birth. The tests were conducted on 5 juvenile rats per sex and per group and on 3 adult animals per sex and per group. T1-weighted magnetic resonance imaging of the cerebellum was performed at 4.7 T during both the treatment and treatment-free periods. Behavioral tests were performed in juvenile rats. Rats were euthanatized at 11 to 12 weeks (ie, approximately 3 months) after the last administration. Total Gd concentrations were measured in plasma, skin, bone, and brain by inductively coupled plasma mass spectrometry. Cerebellum samples from the juvenile rats were characterized by histopathological examination (including immunohistochemistry for glial fibrillary acidic protein or GFAP, and CD68). Lipofuscin pigments were also studied by fluorescence microscopy. All tests were performed blindly on randomized animals. RESULTS Transient skin lesions were observed in juvenile rats (5/5 females and 2/4 males) and not in adult rats having received gadodiamide. Persisting (up to completion of the study) T1 hyperintensity in the deep cerebellar nuclei (DCNs) was observed only in gadodiamide-treated rats. Quantitatively, a slightly higher progressive increase in the DCN/brain stem ratio was observed in adult rats compared with juvenile rats, whereas no difference was noted visually. In all tissues, total Gd concentrations were higher (10- to 30-fold higher) in the gadodiamide-treated groups than in the gadoterate groups. No age-related differences were observed except in bone marrow where total Gd concentrations in gadodiamide-treated juvenile rats were higher than those measured in adults and similar to those measured in cortical bone tissue. No significant treatment-related effects were observed in histopathological findings or in development, behavior, and biochemistry parameters. However, in the elevated plus maze test, a trend toward an anxiogenic effect was observed in the gadodiamide group compared with other groups (nonsignificant). Moreover, in the balance beam test, a high number of trials were excluded in the gadodiamide group because rats (mainly males) did not completely cross the beam, which may also reflect an anxiogenic effect. CONCLUSIONS No T1 hyperintensity was observed in the DCN after administration of the macrocyclic GBCA gadoterate regardless of age as opposed to administration of the linear GBCA gadodiamide. Repeated administration of gadodiamide in neonatal and juvenile rats resulted in similar total Gd retention in the skin, brain, and bone to that in adult rats with sex having no effect, whereas Gd distribution in bone marrow was influenced by age. Further studies are required to assess the form of the retained Gd and to investigate the potential risks associated with Gd retention in bone marrow in juvenile animals treated with gadodiamide. Regardless of age, total Gd concentration in the brain and bone was 10- to 30-fold higher after administration of gadodiamide compared with gadoterate.
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Gadolinium-based contrast agents: Stimulators of myeloid-induced renal fibrosis and major metabolic disruptors. Toxicol Appl Pharmacol 2019; 375:32-45. [PMID: 31082427 DOI: 10.1016/j.taap.2019.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 12/18/2022]
Abstract
Evidence for gadolinium-based contrast agent- (GBCA-) induced disease continues to mount. Risk factors for gadolinium-induced systemic fibrosis are entirely unexplored. Obesity-related renal injury is characterized by activation of glomerular mesangial cells and podocyte damage with alteration of lipid metabolism/lipid accumulation in both cell types resulting in matrix accumulation and eventual progression to glomerulosclerosis. We examined the consequences of GBCA treatment in the kidneys from mice with normal kidney function and the potential interplay between obesity and gadolinium exposure. We found that administration of GBCA (4 weeks) causes significant renal fibrosis and podocyte injury that are associated with metabolic disorders as evidenced by dyslipidemia. Metabolomic analysis demonstrated that renal lipid metabolism and metabolic markers of collagen turnover are significantly altered by gadolinium. GBCA stimulates myeloid-derived fibrocytes to the kidney. Obesity was induced by feeding a group of mice a high fat diet (HFD) for 22 weeks. Groups were sub-randomized to GBCA treatment versus none for 4 weeks before sacrifice. HFD-induced fibrosis and podocyte injury were worsened by GBCA. Similarly, HFD-mediated hyperlipidemia and lipid metabolites were exacerbated by gadolinium. This is the first evidence that GBCA causes significant metabolic disorders and kidney injury in mice without renal insufficiency and that the injurious actions of GBCA are amplified by obesity. The understanding of the functional interplay between gadolinium and obesity will allow the development of therapeutic interventions or the establishment of effective preventive measures to reduce gadolinium- and obesity-mediated renal pathologies.
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Do C, Drel V, Tan C, Lee D, Wagner B. Nephrogenic Systemic Fibrosis Is Mediated by Myeloid C-C Chemokine Receptor 2. J Invest Dermatol 2019; 139:2134-2143.e2. [PMID: 30978353 DOI: 10.1016/j.jid.2019.03.1145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/12/2019] [Accepted: 03/25/2019] [Indexed: 12/19/2022]
Abstract
Gadolinium-based contrast agents are implicated in several pathologic abnormalities (long-term retention in vital organs such as the skin and the brain) and are the cause of a sometimes fatal condition in patients, nephrogenic systemic fibrosis. Bone marrow-derived fibrocytes and the monocyte chemoattractant protein-1 inflammatory pathway have been implicated as mediators of the adverse effects induced by gadolinium-based contrast agents. Mechanistic studies are scant; therefore, a mouse model of nephrogenic systemic fibrosis was established. Dermal cellularity was increased in contrast-treated green fluorescent protein (GFP) chimeric mice. GFP in the skin and fibrosis were increased in the contrast-treated chimeric animals. Monocyte chemoattractant protein-1 and C-C chemokine receptor 2 were increased in the tissues from contrast-treated mice. C-C chemokine receptor 2-deficient recipients of GFP-expressing marrow had an abrogation of gadolinium-induced pathology and displayed less GFP-positive cells in the skin. Wild-type animals that received C-C chemokine receptor 2-deficient bone marrow had a complete abrogation of dermal pathology. That GFP levels and expression increase in the skin, in tandem with a fibrocyte marker, supports the blood-borne circulating fibrocyte hypothesis of the disease. As of now, fibrocyte trafficking has yet to be demonstrated. Importantly, our data demonstrate that the monocyte chemoattractant protein-1/C-C chemokine receptor 2 axis plays a critical role in the pathogenesis of nephrogenic systemic fibrosis.
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Affiliation(s)
- Catherine Do
- South Texas Veterans Health Care System, San Antonio, Texas, USA; University of Texas Health Science Center, San Antonio, Texas, USA
| | - Viktor Drel
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Chunyan Tan
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Doug Lee
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Brent Wagner
- Kidney Institute of New Mexico, Albuquerque, New Mexico, USA; University of New Mexico Health Science Center, Albuquerque, New Mexico, USA; New Mexico Veterans Administration Health Care System, Albuquerque, New Mexico, USA.
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Mack M. Inflammation and fibrosis. Matrix Biol 2018; 68-69:106-121. [DOI: 10.1016/j.matbio.2017.11.010] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/24/2017] [Accepted: 11/25/2017] [Indexed: 02/07/2023]
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Yee J. Prophylactic Hemodialysis for Protection Against Gadolinium-Induced Nephrogenic Systemic Fibrosis: A Doll's House. Adv Chronic Kidney Dis 2017; 24:133-135. [PMID: 28501073 DOI: 10.1053/j.ackd.2017.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rasschaert M, Idée JM, Robert P, Fretellier N, Vives V, Violas X, Ballet S, Corot C. Moderate Renal Failure Accentuates T1 Signal Enhancement in the Deep Cerebellar Nuclei of Gadodiamide-Treated Rats. Invest Radiol 2017; 52:255-264. [PMID: 28067754 PMCID: PMC5383202 DOI: 10.1097/rli.0000000000000339] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/06/2016] [Indexed: 12/02/2022]
Abstract
OBJECTIVES The purpose of this preclinical study was to investigate whether moderate chronic kidney disease is a factor in potentiating gadolinium (Gd) uptake in the brain. MATERIALS AND METHODS A comparative study was performed on renally impaired (subtotal nephrectomy) rats versus rats with normal renal function. The animals received 4 daily injections of 0.6 mmol Gd/kg a week for 5 weeks (cumulative dose of 12 mmol Gd/kg) of gadodiamide or saline solution. The MR signal enhancement in the deep cerebellar nuclei was monitored by weekly magnetic resonance imaging examinations. One week after the final injection, the total Gd concentration was determined by inductively coupled plasma mass spectrometry in different regions of the brain including the cerebellum, plasma, cerebrospinal fluid, parietal bone, and femur. RESULTS After the administration of gadodiamide, the subtotal nephrectomy group presented a significantly higher T1 signal enhancement in the deep cerebellar nuclei and a major increase in the total Gd concentration in all the studied structures, compared with the normal renal function group receiving the same linear Gd-based contrast agent. Those potentiated animals also showed a pronounced hypersignal in the choroid plexus, still persistent 6 days after the last injection, whereas low concentration of Gd was found in the cerebrospinal fluid (<0.05 μmol/L) at this time point. Plasma Gd concentration was then around 1 μmol/L. Interestingly, plasma Gd was predominantly in a dissociated and soluble form (around 90% of total Gd). Total Gd concentrations in the brain, cerebellum, plasma, and bones correlated with creatinine clearance in both the gadodiamide-treated groups. CONCLUSIONS Renal insufficiency in rats potentiates Gd uptake in the cerebellum, brain, and bones.
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Affiliation(s)
- Marlène Rasschaert
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut Curie, Centre de Recherche, PSL Research University; and ‡Université Paris-Sud, Université Paris-Saclay, CNRS, UMR-9187, INSERM, U1196, F-91405, Orsay, France
| | - Jean-Marc Idée
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut Curie, Centre de Recherche, PSL Research University; and ‡Université Paris-Sud, Université Paris-Saclay, CNRS, UMR-9187, INSERM, U1196, F-91405, Orsay, France
| | - Philippe Robert
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut Curie, Centre de Recherche, PSL Research University; and ‡Université Paris-Sud, Université Paris-Saclay, CNRS, UMR-9187, INSERM, U1196, F-91405, Orsay, France
| | - Nathalie Fretellier
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut Curie, Centre de Recherche, PSL Research University; and ‡Université Paris-Sud, Université Paris-Saclay, CNRS, UMR-9187, INSERM, U1196, F-91405, Orsay, France
| | - Véronique Vives
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut Curie, Centre de Recherche, PSL Research University; and ‡Université Paris-Sud, Université Paris-Saclay, CNRS, UMR-9187, INSERM, U1196, F-91405, Orsay, France
| | - Xavier Violas
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut Curie, Centre de Recherche, PSL Research University; and ‡Université Paris-Sud, Université Paris-Saclay, CNRS, UMR-9187, INSERM, U1196, F-91405, Orsay, France
| | - Sébastien Ballet
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut Curie, Centre de Recherche, PSL Research University; and ‡Université Paris-Sud, Université Paris-Saclay, CNRS, UMR-9187, INSERM, U1196, F-91405, Orsay, France
| | - Claire Corot
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut Curie, Centre de Recherche, PSL Research University; and ‡Université Paris-Sud, Université Paris-Saclay, CNRS, UMR-9187, INSERM, U1196, F-91405, Orsay, France
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Swaminathan S. Gadolinium toxicity: Iron and ferroportin as central targets. Magn Reson Imaging 2016; 34:1373-1376. [PMID: 27580520 DOI: 10.1016/j.mri.2016.08.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/20/2016] [Indexed: 01/18/2023]
Abstract
Gadolinium-based magnetic resonance (MR) contrast agents (GBCM) causes a devastating systemic fibrosing illness, nephrogenic systemic fibrosis (NSF), in patients with reduced kidney function. GBCM targets iron-recycling CD163- and ferroportin-expressing macrophages to release labile iron that mediates gadolinium toxicity and NSF. GBCA might similarly target iron-rich, ferroportin-expressing structures such as globus pallidus and cerebellar dentate nucleus in the brain to result in metal accumulation and potential toxicity.
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Affiliation(s)
- Sundararaman Swaminathan
- Division of Nephrology & Center for Immunity, Inflammation and Regeneration, University of Virginia, Charlottesville, VA.
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