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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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Echenique-Errandonea E, Rojas S, Ortuño AM, Cepeda J, Ramos-Cabrer P, Vitórica-Yrezábal ÍJ, Cuerva JM, Seco JM, Rodríguez-Diéguez A. Multifunctional Amino Acid Derivative Coordination Compounds: Novel Contrast Agent and Luminescence Materials. Chemistry 2024; 30:e202304146. [PMID: 38687127 DOI: 10.1002/chem.202304146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Indexed: 05/02/2024]
Abstract
In this work a family of multidimensional (2-(1H-tetrazol-5-yl)ethyl) amino acid coordination compounds have been synthesized and thoroughly characterized. For this purpose, glycine, valine, phenylalanine and tyrosine have been selected as starting amino acids and Mn2+, Zn2+ and Cd2+ as metallic nodes. From one side, for Mn2+ based dimer magnetic resonance imaging studies have been conducted, prompted by the number and disposition of the coordinated water molecules and taking into consideration the promising future of manganese-based coordination compounds as bio-compatible substitutes to conventional Gd based contrast agents. From another side, d10 block metal-based complexes allowed exploring photoluminescence properties derived by in situ synthesized ligands. Finally, amino acid preserved structural chirality allowed us to examine chiroptical properties, particularly focusing on circularly polarized luminescence.
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Affiliation(s)
- Estitxu Echenique-Errandonea
- Department of Applied Chemistry, Faculty of Chemistry, University of Basque Country/Euskal Herriko Unibertsitatea (UPV/EHU), 20018, Donostia, Spain
| | - Sara Rojas
- Department of Inorganic Chemistry, University of Granada, C/ Severo Ochoa s/n, 18071, Granada, Spain
| | - Ana M Ortuño
- Department of Inorganic Chemistry, University of Granada, C/ Severo Ochoa s/n, 18071, Granada, Spain
| | - Javier Cepeda
- Department of Applied Chemistry, Faculty of Chemistry, University of Basque Country/Euskal Herriko Unibertsitatea (UPV/EHU), 20018, Donostia, Spain
| | - Pedro Ramos-Cabrer
- Magnetic Resonance Imaging Laboratory, CIC biomaGUNE, 20014, Donostia-San Sebastián, Spain
| | - Íñigo J Vitórica-Yrezábal
- Department of Inorganic Chemistry, University of Granada, C/ Severo Ochoa s/n, 18071, Granada, Spain
| | - Juan M Cuerva
- Department of Inorganic Chemistry, University of Granada, C/ Severo Ochoa s/n, 18071, Granada, Spain
| | - José M Seco
- Department of Applied Chemistry, Faculty of Chemistry, University of Basque Country/Euskal Herriko Unibertsitatea (UPV/EHU), 20018, Donostia, Spain
| | - Antonio Rodríguez-Diéguez
- Department of Inorganic Chemistry, University of Granada, C/ Severo Ochoa s/n, 18071, Granada, Spain
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Haase T, Ludwig A, Stach A, Mohtashamdolatshahi A, Hauptmann R, Mundhenk L, Kratz H, Metzkow S, Kader A, Freise C, Mueller S, Stolzenburg N, Radon P, Liebl M, Wiekhorst F, Hamm B, Taupitz M, Schnorr J. Repeated Injection of Very Small Superparamagnetic Iron Oxide Particles (VSOPs) in Murine Atherosclerosis: A Safety Study. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:773. [PMID: 38727367 PMCID: PMC11085881 DOI: 10.3390/nano14090773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024]
Abstract
Citrate-coated electrostatically stabilized very small superparamagnetic iron oxide particles (VSOPs) have been successfully tested as magnetic resonance angiography (MRA) contrast agents and are promising tools for molecular imaging of atherosclerosis. Their repeated use in the background of pre-existing hyperlipidemia and atherosclerosis has not yet been studied. This study aimed to investigate the effect of multiple intravenous injections of VSOPs in atherosclerotic mice. Taurine-formulated VSOPs (VSOP-T) were repeatedly intravenously injected at 100 µmol Fe/kg in apolipoprotein E-deficient (ApoE KO) mice with diet-induced atherosclerosis. Angiographic imaging was carried out by in vivo MRI. Magnetic particle spectrometry was used to detect tissue VSOP content, and tissue iron content was quantified photometrically. Pathological changes in organs, atherosclerotic plaque development, and expression of hepatic iron-related proteins were evaluated. VSOP-T enabled the angiographic imaging of heart and blood vessels with a blood half-life of one hour. Repeated intravenous injection led to VSOP deposition and iron accumulation in the liver and spleen without affecting liver and spleen pathology, expression of hepatic iron metabolism proteins, serum lipids, or atherosclerotic lesion formation. Repeated injections of VSOP-T doses sufficient for MRA analyses had no significant effects on plaque burden, steatohepatitis, and iron homeostasis in atherosclerotic mice. These findings underscore the safety of VSOP-T and support its further development as a contrast agent and molecular imaging tool.
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Affiliation(s)
- Tobias Haase
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Radiology, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Antje Ludwig
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10117 Berlin, Germany
| | - Anke Stach
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117 Berlin, Germany
| | - Azadeh Mohtashamdolatshahi
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Radiology, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Ralf Hauptmann
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Radiology, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Lars Mundhenk
- Institute of Veterinary Pathology, Freie Universität Berlin, Robert-von-Ostertag-Str. 15, 14163 Berlin, Germany;
| | - Harald Kratz
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Radiology, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Susanne Metzkow
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Radiology, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Avan Kader
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Radiology, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Christian Freise
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Radiology, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Susanne Mueller
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Experimental Neurology, Center for Stroke Research Berlin (CSB), Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
- Charité 3R|Replace, Reduce, Refine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Nicola Stolzenburg
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Radiology, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Patricia Radon
- Physikalisch-Technische Bundesanstalt, Abbestr. 2-12, 10587 Berlin, Germany; (P.R.); (M.L.); (F.W.)
| | - Maik Liebl
- Physikalisch-Technische Bundesanstalt, Abbestr. 2-12, 10587 Berlin, Germany; (P.R.); (M.L.); (F.W.)
| | - Frank Wiekhorst
- Physikalisch-Technische Bundesanstalt, Abbestr. 2-12, 10587 Berlin, Germany; (P.R.); (M.L.); (F.W.)
| | - Bernd Hamm
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Radiology, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Taupitz
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Radiology, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Jörg Schnorr
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (A.L.); (A.M.); (R.H.); (H.K.); (S.M.); (A.K.); (C.F.); (S.M.); (N.S.); (B.H.); (M.T.); (J.S.)
- Department of Radiology, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Stoltzfus MT, Capodarco MD, Anamika F, Gupta V, Jain R. Cardiac MRI: An Overview of Physical Principles With Highlights of Clinical Applications and Technological Advancements. Cureus 2024; 16:e55519. [PMID: 38576652 PMCID: PMC10990965 DOI: 10.7759/cureus.55519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
The purpose of this review is to serve as a concise learning tool for clinicians interested in quickly learning more about cardiac magnetic resonance imaging (CMR) and its physical principles. There is heavy coverage of the basic physical fundamentals of CMR as well as updates on the history, clinical indications, cost-effectiveness, role of artificial intelligence in CMR, and examples of common late gadolinium enhancement (LGE) patterns. This literature review was performed by searching the PubMed database for the most up-to-date literature regarding these topics. Relevant, less up-to-date articles, covering the history and physics of CMR, were also obtained from the PubMed database. Clinical indications for CMR include adult congenital heart disease, cardiac ischemia, cardiomyopathies, and heart failure. CMR has a projected cost-benefit ratio of 0.58, leading to potential savings for patients. Despite its utility, CMR has some drawbacks including long image processing times, large space requirements for equipment, and patient discomfort during imaging. Artificial intelligence-based algorithms can address some of these drawbacks by decreasing image processing times and may have reliable diagnostic capabilities. CMR is quickly rising as a high-resolution, non-invasive cardiac imaging modality with an increasing number of clinical indications. Thanks to technological advancements, especially in artificial intelligence, the benefits of CMR often outweigh its drawbacks.
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Affiliation(s)
| | - Matthew D Capodarco
- Radiology, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | - Fnu Anamika
- Internal Medicine, University College of Medical Sciences, New Delhi, IND
| | - Vasu Gupta
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Rohit Jain
- Internal Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
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5
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Zhang J, Zhang J, Jin J, Jiang X, Yang L, Fan S, Zhang Q, Chi M. Artificial intelligence applied in cardiovascular disease: a bibliometric and visual analysis. Front Cardiovasc Med 2024; 11:1323918. [PMID: 38433757 PMCID: PMC10904648 DOI: 10.3389/fcvm.2024.1323918] [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: 10/18/2023] [Accepted: 01/19/2024] [Indexed: 03/05/2024] Open
Abstract
Background With the rapid development of technology, artificial intelligence (AI) has been widely used in the diagnosis and prognosis prediction of a variety of diseases, including cardiovascular disease. Facts have proved that AI has broad application prospects in rapid and accurate diagnosis. Objective This study mainly summarizes the research on the application of AI in the field of cardiovascular disease through bibliometric analysis and explores possible future research hotpots. Methods The articles and reviews regarding application of AI in cardiovascular disease between 2000 and 2023 were selected from Web of Science Core Collection on 30 December 2023. Microsoft Excel 2019 was applied to analyze the targeted variables. VOSviewer (version 1.6.16), Citespace (version 6.2.R2), and a widely used online bibliometric platform were used to conduct co-authorship, co-citation, and co-occurrence analysis of countries, institutions, authors, references, and keywords in this field. Results A total of 4,611 articles were selected in this study. AI-related research on cardiovascular disease increased exponentially in recent years, of which the USA was the most productive country with 1,360 publications, and had close cooperation with many countries. The most productive institutions and researchers were the Cedar sinai medical center and Acharya, Ur. However, the cooperation among most institutions or researchers was not close even if the high research outputs. Circulation is the journal with the largest number of publications in this field. The most important keywords are "classification", "diagnosis", and "risk". Meanwhile, the current research hotpots were "late gadolinium enhancement" and "carotid ultrasound". Conclusions AI has broad application prospects in cardiovascular disease, and a growing number of scholars are devoted to AI-related research on cardiovascular disease. Cardiovascular imaging techniques and the selection of appropriate algorithms represent the most extensively studied areas, and a considerable boost in these areas is predicted in the coming years.
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Affiliation(s)
- Jirong Zhang
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Jimei Zhang
- College of Public Health, The University of Sydney, NSW, Sydney, Australia
| | - Juan Jin
- The First Department of Cardiovascular, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, HL, China
| | - Xicheng Jiang
- College of basic medicine, Heilongjiang University of Chinese Medicine, Harbin, HL, China
| | - Linlin Yang
- Cardiovascular Disease Branch, Dalian Second People's Hospital, Dalian, LN, China
| | - Shiqi Fan
- Harbin hospital of traditional Chinese medicine, Harbin, HL, China
| | - Qiao Zhang
- School of Pharmacy, Harbin University of Commerce, Harbin, HL, China
| | - Ming Chi
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
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6
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Klinkhammer BM, Boor P. Kidney fibrosis: Emerging diagnostic and therapeutic strategies. Mol Aspects Med 2023; 93:101206. [PMID: 37541106 DOI: 10.1016/j.mam.2023.101206] [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: 04/28/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
An increasing number of patients worldwide suffers from chronic kidney disease (CKD). CKD is accompanied by kidney fibrosis, which affects all compartments of the kidney, i.e., the glomeruli, tubulointerstitium, and vasculature. Fibrosis is the best predictor of progression of kidney diseases. Currently, there is no specific anti-fibrotic therapy for kidney patients and invasive renal biopsy remains the only option for specific detection and quantification of kidney fibrosis. Here we review emerging diagnostic approaches and potential therapeutic options for fibrosis. We discuss how translational research could help to establish fibrosis-specific endpoints for clinical trials, leading to improved patient stratification and potentially companion diagnostics, and facilitating and optimizing development of novel anti-fibrotic therapies for kidney patients.
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Affiliation(s)
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany; Electron Microscopy Facility, RWTH Aachen University Hospital, Aachen, Germany; Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany.
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7
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Wang SH, Shyu VBH, Chiu WK, Huang RW, Lai BR, Tsai CH. An Overview of Clinical Examinations in the Evaluation and Assessment of Arterial and Venous Insufficiency Wounds. Diagnostics (Basel) 2023; 13:2494. [PMID: 37568858 PMCID: PMC10417660 DOI: 10.3390/diagnostics13152494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
Arterial and venous insufficiency are two major causes of chronic wounds with different etiology, pathophysiology, and clinical manifestations. With recent advancements in clinical examination, clinicians are able to obtain an accurate diagnosis of the underlying disease, which plays an important role in the treatment planning and management of patients. Arterial ulcers are mainly caused by peripheral artery diseases (PADs), which are traditionally examined by physical examination and non-invasive arterial Doppler studies. However, advanced imaging modalities, such as computed tomography angiography (CTA) and indocyanine green (ICG) angiography, have become important studies as part of a comprehensive diagnostic process. On the other hand, chronic wounds caused by venous insufficiency are mainly evaluated by duplex ultrasonography and venography. Several scoring systems, including Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification, the Venous Clinical Severity Score (VCSS), the Venous Disability Score, and the Venous Segmental Disease Score (VSDS) are useful in defining disease progression. In this review, we provide a comprehensive overlook of the most widely used and available clinical examinations for arterial and venous insufficiency wounds.
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Affiliation(s)
- Szu-Han Wang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 110, Taiwan
| | - Victor Bong-Hang Shyu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ren-Wen Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Bo-Ru Lai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chia-Hsuan Tsai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
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8
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Martinez de la Torre C, Freshwater KA, Looney-Sanders MA, Wang Q, Bennewitz MF. Caveat Emptor: Commercialized Manganese Oxide Nanoparticles Exhibit Unintended Properties. ACS OMEGA 2023; 8:18799-18810. [PMID: 37273625 PMCID: PMC10233837 DOI: 10.1021/acsomega.3c00892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023]
Abstract
Nano-encapsulated manganese oxide (NEMO) particles are noteworthy contrast agents for magnetic resonance imaging (MRI) due to their bright, pH-switchable signal ("OFF" to "ON" at low pH), high metal loading, and targeting capability for increased specificity. For the first time, we performed a head-to-head comparison of NEMO particles from In-house and commercialized sources (US Nano vs Nanoshel) to assess their potential as bright T1 MRI contrast agents. Manganese oxide nanocrystals (MnO, Mn2O3, and Mn3O4) were systematically evaluated for size, chemistry, release of manganese ions, and MRI signal pre- and post-encapsulation within poly(lactic-co-glycolic acid) (PLGA). Suprisingly, a majority of the commercialized formulations were not as advertised by displaying unintended sizes, morphologies, chemistry, dissolution profiles, and/or MRI signal that precludes in vivo use. US Nano's Mn3O4 and Mn2O3 nanocrystals contained impurities that impacted Mn ion release as well as micron-sized rodlike structures. Nanoshel's MnO and Mn2O3 nanoparticles had very large hydrodynamic sizes (>600 nm). In-house MnO and Nanoshel's Mn3O4 nanoparticles demonstrated the best characteristics with brighter T1 MRI signals, small hydrodynamic sizes, and high encapsulation efficiencies. Our findings highlight that researchers must confirm the properties of purchased nanomaterials before utilizing them in desired applications, as their experimental success may be impacted.
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Affiliation(s)
- Celia Martinez de la Torre
- Department
of Chemical and Biomedical Engineering, Benjamin M. Statler College
of Engineering and Mineral Resources, West
Virginia University, Morgantown, West Virginia 26506, United States
| | - Kasey A. Freshwater
- Department
of Chemical and Biomedical Engineering, Benjamin M. Statler College
of Engineering and Mineral Resources, West
Virginia University, Morgantown, West Virginia 26506, United States
| | - Mara A. Looney-Sanders
- Department
of Chemical and Biomedical Engineering, Benjamin M. Statler College
of Engineering and Mineral Resources, West
Virginia University, Morgantown, West Virginia 26506, United States
| | - Qiang Wang
- Shared
Research Facilities, West Virginia University, Morgantown, West Virginia 26506, United States
| | - Margaret F. Bennewitz
- Department
of Chemical and Biomedical Engineering, Benjamin M. Statler College
of Engineering and Mineral Resources, West
Virginia University, Morgantown, West Virginia 26506, United States
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9
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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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10
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Noh TI, Shim JS, Kang SG, Sung DJ, Cheon J, Sim KC, Kang SH. Comparison between biparametric and multiparametric MRI in predicting muscle invasion by bladder cancer based on the VI-RADS. Sci Rep 2022; 12:20689. [PMID: 36450813 PMCID: PMC9712519 DOI: 10.1038/s41598-022-19273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/26/2022] [Indexed: 12/05/2022] Open
Abstract
This study aimed to compare the diagnostic validity of biparametric magnetic resonance imaging (bpMRI) with that of multiparametric MRI (mpMRI) based on the Vesicle Imaging-Reporting and Data System (VI-RADS) in predicting muscle invasion by bladder cancer (BCa). We retrospectively examined 357 patients with an initial diagnosis of BCa who underwent preoperative MRI; 257 and 100 patients underwent mpMRI and bpMRI, respectively. Two urogenital radiologists evaluated all bpMRI and mpMRI scans using VI-RADS, and the diagnostic validity of VI-RADS for predicting muscle invasion by BCa was analyzed based on histopathology of the first and/or second transurethral resection of bladder tumors and radical cystectomy. Receiver operating characteristic (ROC) curves were plotted with the calculation of area under the curves (AUCs), and the level of significance was P < 0.05. Both groups showed optimal performance with a VI-RADS score ≥ 3. BpMRI showed comparable diagnostic performance to mpMRI (reader 1: AUC, 0.903 [0.827-0.954] vs. 0.935 [0.884-0.968], p = 0.510; and reader 2: AUC, 0.901 [0.814-0.945] vs. 0.915 [0.874-0.946]; p = 0.655). The inter-reader agreement between both readers was excellent (Cohen's kappa value = 0.942 and 0.905 for bpMRI and mpMRI, respectively). This comparative study suggests that bpMRI has comparable diagnostic performance to mpMRI and may be an alternative option to predict muscle invasion by BCa.
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Affiliation(s)
- Tae Il Noh
- Department of Urology, Anam Hospital, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Korea
| | - Ji Sung Shim
- Department of Urology, Anam Hospital, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Korea
| | - Sung Gu Kang
- Department of Urology, Anam Hospital, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Korea
| | - Deuk Jae Sung
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun Cheon
- Department of Urology, Anam Hospital, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Korea
| | - Ki Choon Sim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Seok Ho Kang
- Department of Urology, Anam Hospital, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Korea.
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11
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Oluwasola IE, Ahmad AL, Shoparwe NF, Ismail S. Gadolinium based contrast agents (GBCAs): Uniqueness, aquatic toxicity concerns, and prospective remediation. JOURNAL OF CONTAMINANT HYDROLOGY 2022; 250:104057. [PMID: 36130428 DOI: 10.1016/j.jconhyd.2022.104057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/25/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
The current toxicity concerns of gadolinium-based contrast agents (GBCAs) have birthed the need to regulate and, sometimes restrict its clinical administration. However, tolerable concentration levels of Gd in the water sector have not been set. Therefore, the detection and speedy increase of the anthropogenic Gd-GBCAs in the various water bodies, including those serving as the primary source of drinking water for adults and children, is perturbing. Nevertheless, the strongly canvassed risk-benefit considerations and superior uniqueness of GBCAs compared to the other ferromagnetic metals guarantees its continuous administration for Magnetic resonance imaging (MRI) investigations regardless of the toxicity concerns. Unfortunately, findings have shown that both the advanced and conventional wastewater treatment processes do not satisfactorily remove GBCAs but rather risk transforming the chelated GBCAs to their free ionic metal (Gd 3+) through inadvertent degradation processes. This unintentional water processing-induced GBCA dechelation leads to the intricate pathway for unintentional human intake of Gd ion. Hence exposure to its probable ecotoxicity and several reported inimical effects on human health such as; digestive symptoms, twitching or weakness, cognitive flu, persistent skin diseases, body pains, acute renal and non-renal adverse reactions, chronic skin, and eyes changes. This work proposed an economical and manageable remediation technique for the potential remediation of Gd-GBCAs in wastewater, while a precautionary limit for Gd in public water and commercial drinks is advocated.
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Affiliation(s)
- Idowu Ebenezer Oluwasola
- School of Chemical Engineering, Engineering Campus, Universiti Sains Malaysia, Nibong Tebal 14300, Pulau Pinang, Malaysia; School of Science and Computer Studies, Food Technology Department, The Federal Polytechnic, Ado Ekiti, Ekiti State 360231, Nigeria.
| | - Abdul Latif Ahmad
- School of Chemical Engineering, Engineering Campus, Universiti Sains Malaysia, Nibong Tebal 14300, Pulau Pinang, Malaysia.
| | - Noor Fazliani Shoparwe
- Gold, Rare Earth, and Material Technopreneurship Centre (GREAT), Faculty of Bioengineering and Technology, Universiti Malaysia Kelantan, Jeli Campus, 17600 Jeli, Kelantan, Malaysia.
| | - Suzylawati Ismail
- School of Chemical Engineering, Engineering Campus, Universiti Sains Malaysia, Nibong Tebal 14300, Pulau Pinang, Malaysia.
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12
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Ozturk K, Nascene D. Diffusion Tensor Imaging of the Dentate Nucleus After Repeated Administration of Gadobutrol in Children. CEREBELLUM (LONDON, ENGLAND) 2022; 21:657-664. [PMID: 34453283 DOI: 10.1007/s12311-021-01324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to investigate possible signal changes in the dentate nucleus (DN) on diffusion tensor imaging (DTI) after administration of gadobutrol in a pediatric cohort. Total of 50 pediatric patients (mean age: 6.2 ± 4.3 years) with normal renal function exposed exclusively to the macrocyclic GBCA (mcGBCA) gadobutrol and 50 age- and sex-matched control patients with nonpathological neuroimaging findings (and no GBCA administration). Mean diffusivity (MD) and fractional anisotropy (FA) values were determined in the DN. A paired t test was performed to compare FA, MD values, and DN-to-middle cerebral peduncle (MCP) T1WI SI ratios between children exposed to gadobutrol and controls. Pearson correlation analysis was conducted to determine any correlation between FA and MD values as well as T1WI SI ratios and confounding parameters. The mean FA values of DN was significantly lower in children with mcGBCA than in the control group (p < 0.001; non-GBCA group, 0.299 ± 0.03; mcGBCA group, 0.254 ± 0.05), but no significant difference of the T1WI SI ratio was noted between the mcGBCA group (0.946 ± 0.06) and the control group (0.963 ± 0.05; p = 0.336). There was also a significant MD value difference between mcGBCA group and control group (p < 0.001; non-GBCA group, 0.152 ± 0.02 × 10-3 mm2/s; mcGBCA group, 0.173 ± 0.03 × 10-3 mm2/s). A significant correlation was identified between FA/MD values and the number of mcGBCA administration (FA; correlation coefficient = - 0.355, p = 0.011 and MD; correlation coefficient = 0.334, p = 0.018). The administration of the gadobutrol was associated with higher MD and lower FA values in DN suggesting a difference in cerebellar tissue integrity between children exposed to mcGBCAs and control group.
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Affiliation(s)
- Kerem Ozturk
- Division of Neuroradiology, Department of Radiology, University of Minnesota, B-226 Mayo Memorial Building, MMC 292, 420 Delaware Street S.E, Minneapolis, MN, 55455, USA.
| | - David Nascene
- Division of Neuroradiology, Department of Radiology, University of Minnesota, B-226 Mayo Memorial Building, MMC 292, 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
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13
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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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14
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Lee LE, Chandrasekar B, Yu P, Ma L. Quantification of myocardial fibrosis using noninvasive T2-mapping magnetic resonance imaging: Preclinical models of aging and pressure overload. NMR IN BIOMEDICINE 2022; 35:e4641. [PMID: 34729828 DOI: 10.1002/nbm.4641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 05/02/2023]
Abstract
Noninvasive imaging of cardiac fibrosis is important for early diagnosis and intervention in chronic heart diseases. Here, we investigated whether noninvasive, contrast agent-free MRI T2 -mapping can quantify myocardial fibrosis in preclinical models of aging and pressure overload. Myocardial fibrosis and remodeling were analyzed in two animal models: (i) aging (15-month-old male CF-1 mice vs. young 6- to 8-week-old mice), and (ii) pressure overload (PO; by transverse aortic constriction in 4- to 5-month-old male C57BL/6 mice vs. sham-operated for 14 days). In vivo T2 -mapping was performed by acquiring data during the isovolumic and early diastolic phases, with a modified respiratory and ECG-triggered multiecho TurboRARE sequence on a 7-T MRI. Cine MRI provided cardiac morphology and function. A quantitative segmentation method was developed to analyze the in vivo T2 -maps of hearts at midventricle, apex, and basal regions. The cardiac fibrosis area was analyzed ex vivo by picro sirius red (PSR) staining. Both aged and pressure-overloaded hearts developed significant myocardial contractile dysfunction, cardiac hypertrophy, and interstitial fibrosis. The aged mice had two phenotypes, fibrotic and mild-fibrotic. Notably, the aged fibrotic subgroup and the PO mice showed a marked decrease in T2 relaxation times (25.3 ± 0.6 in aged vs. 29.9 ± 0.7 ms in young mice, p = 0.002; and 24.3 ± 1.7 in PO vs. 28.7 ± 0.7 ms in shams, p = 0.05). However, no significant difference in T2 was detected between the aged mild-fibrotic subgroup and the young mice. Accordingly, an inverse correlation between myocardial fibrosis percentage (FP) and T2 relaxation time was derived (R2 = 0.98): T2 (ms) = 30.45 - 1.05 × FP. Thus, these results demonstrate a statistical agreement between T2 -map-quantified fibrosis and PSR staining in two different clinically relevant animal models. In conclusion, T2 -mapping MRI is a promising noninvasive contrast agent-free quantitative technique to characterize myocardial fibrosis.
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Affiliation(s)
- Li E Lee
- Research Division/Biomolecular Imaging Center, Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Department of Physics and Astronomy, University of Missouri, Columbia, Missouri, USA
| | - Bysani Chandrasekar
- Research Division/Biomolecular Imaging Center, Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Ping Yu
- Department of Physics and Astronomy, University of Missouri, Columbia, Missouri, USA
| | - Lixin Ma
- Research Division/Biomolecular Imaging Center, Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Department of Physics and Astronomy, University of Missouri, Columbia, Missouri, USA
- Department of Radiology, University of Missouri, Columbia, Missouri, USA
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15
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Inorganic Nanomaterial for Biomedical Imaging of Brain Diseases. Molecules 2021; 26:molecules26237340. [PMID: 34885919 PMCID: PMC8658999 DOI: 10.3390/molecules26237340] [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: 08/04/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 01/10/2023] Open
Abstract
In the past few decades, brain diseases have taken a heavy toll on human health and social systems. Magnetic resonance imaging (MRI), photoacoustic imaging (PA), computed tomography (CT), and other imaging modes play important roles in disease prevention and treatment. However, the disadvantages of traditional imaging mode, such as long imaging time and large noise, limit the effective diagnosis of diseases, and reduce the precision treatment of diseases. The ever-growing applications of inorganic nanomaterials in biomedicine provide an exciting way to develop novel imaging systems. Moreover, these nanomaterials with special physicochemical characteristics can be modified by surface modification or combined with functional materials to improve targeting in different diseases of the brain to achieve accurate imaging of disease regions. This article reviews the potential applications of different types of inorganic nanomaterials in vivo imaging and in vitro detection of different brain disease models in recent years. In addition, the future trends, opportunities, and disadvantages of inorganic nanomaterials in the application of brain diseases are also discussed. Additionally, recommendations for improving the sensitivity and accuracy of inorganic nanomaterials in screening/diagnosis of brain diseases.
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16
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Wong LM, Ai QYH, Poon DMC, Tong M, Ma BBY, Hui EP, Shi L, King AD. A convolutional neural network combined with positional and textural attention for the fully automatic delineation of primary nasopharyngeal carcinoma on non-contrast-enhanced MRI. Quant Imaging Med Surg 2021; 11:3932-3944. [PMID: 34476179 PMCID: PMC8339644 DOI: 10.21037/qims-21-196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Convolutional neural networks (CNNs) have the potential to automatically delineate primary nasopharyngeal carcinoma (NPC) on magnetic resonance imaging (MRI), but currently, the literature lacks a module to introduce valuable pre-computed features into a CNN. In addition, most CNNs for primary NPC delineation have focused on contrast-enhanced MRI. To enable the use of CNNs in clinical applications where it would be desirable to avoid contrast agents, such as cancer screening or intra-treatment monitoring, we aim to develop a CNN algorithm with a positional-textural fully-connected attention (FCA) module that can automatically delineate primary NPCs on contrast-free MRI. METHODS This retrospective study was performed in 404 patients with NPC who had undergone staging MRI. A proposed CNN algorithm incorporated with our positional-textural FCA module (Aproposed ) was trained on manually delineated tumours (M1st ) to automatically delineate primary NPCs on non-contrast-enhanced T2-weighted fat-suppressed (NE-T2W-FS) images. The performance of Aproposed , three well-established CNNs, Unet (Aunet ), Attention-Unet (Aatt ) and Dense-Unet (Adense ), and a second manual delineation repeated to evaluate human variability (M 2 nd ) were measured by comparing to the reference standard M 1 st to obtain the Dice similarity coefficient (DSC) and average surface distance (ASD). The Wilcoxon rank test was used to compare the performance of Aproposed against Aunet , Aatt , Adense and M 2 nd . RESULTS Aproposed showed a median DSC of 0.79 (0.10) and ASD of 0.66 (0.84) mm. It performed better than the well-established networks Aunet [DSC =0.75 (0.12) and ASD =1.22 (1.73) mm], Aatt [DSC =0.75 (0.10) and ASD =0.96 (1.16) mm] and Adense [DSC =0.71 (0.14) and ASD =1.67 (1.92) mm] (all P<0.01), but slightly worse when compared to M 2 nd [DSC =0.81 (0.07) and ASD =0.56 (0.80) mm] (P<0.001). CONCLUSIONS The proposed CNN algorithm has potential to accurately delineate primary NPCs on non-contrast-enhanced MRI.
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Affiliation(s)
- Lun M. Wong
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Qi Yong H. Ai
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Darren M. C. Poon
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Macy Tong
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Brigette B. Y. Ma
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Edwin P. Hui
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Ann D. King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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17
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Bays HE, Khera A, Blaha MJ, Budoff MJ, Toth PP. Ten things to know about ten imaging studies: A preventive cardiology perspective ("ASPC top ten imaging"). Am J Prev Cardiol 2021; 6:100176. [PMID: 34327499 PMCID: PMC8315431 DOI: 10.1016/j.ajpc.2021.100176] [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: 12/01/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
Knowing the patient's current cardiovascular disease (CVD) status, as well as the patient's current and future CVD risk, helps the clinician make more informed patient-centered management recommendations towards the goal of preventing future CVD events. Imaging tests that can assist the clinician with the diagnosis and prognosis of CVD include imaging studies of the heart and vascular system, as well as imaging studies of other body organs applicable to CVD risk. The American Society for Preventive Cardiology (ASPC) has published "Ten Things to Know About Ten Cardiovascular Disease Risk Factors." Similarly, this "ASPC Top Ten Imaging" summarizes ten things to know about ten imaging studies related to assessing CVD and CVD risk, listed in tabular form. The ten imaging studies herein include: (1) coronary artery calcium imaging (CAC), (2) coronary computed tomography angiography (CCTA), (3) cardiac ultrasound (echocardiography), (4) nuclear myocardial perfusion imaging (MPI), (5) cardiac magnetic resonance (CMR), (6) cardiac catheterization [with or without intravascular ultrasound (IVUS) or coronary optical coherence tomography (OCT)], (7) dual x-ray absorptiometry (DXA) body composition, (8) hepatic imaging [ultrasound of liver, vibration-controlled transient elastography (VCTE), CT, MRI proton density fat fraction (PDFF), magnetic resonance spectroscopy (MRS)], (9) peripheral artery / endothelial function imaging (e.g., carotid ultrasound, peripheral doppler imaging, ultrasound flow-mediated dilation, other tests of endothelial function and peripheral vascular imaging) and (10) images of other body organs applicable to preventive cardiology (brain, kidney, ovary). Many cardiologists perform cardiovascular-related imaging. Many non-cardiologists perform applicable non-cardiovascular imaging. Cardiologists and non-cardiologists alike may benefit from a working knowledge of imaging studies applicable to the diagnosis and prognosis of CVD and CVD risk - both important in preventive cardiology.
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Affiliation(s)
- Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, 3288 Illinois Avenue, Louisville KY 40213 USA
| | - Amit Khera
- UT Southwestern Medical Center, Dallas, TX USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore MD USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance CA USA
| | - Peter P. Toth
- CGH Medical Cener, Sterling, IL 61081 USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
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18
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Hou W, Jiang Y, Xie G, Zhao L, Zhao F, Zhang X, Sun SK, Yu C, Pan J. Biocompatible BSA-MnO 2 nanoparticles for in vivo timely permeability imaging of blood-brain barrier and prediction of hemorrhage transformation in acute ischemic stroke. NANOSCALE 2021; 13:8531-8542. [PMID: 33908561 DOI: 10.1039/d1nr02015c] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hemorrhage transformation (HT) is a frequent but maybe fatal complication following acute ischemic stroke due to severe damage of the blood-brain barrier (BBB). Quantitative BBB permeability imaging is a promising method to predict HT in stroke patients for a favorable prognosis. However, clinical gadolinium chelate-based magnetic resonance (MR) imaging of the stroke suffers from a relatively low sensitivity and potential side effects of nephrogenic systemic fibrosis and intracranial gadolinium deposition. Herein, BSA-MnO2 nanoparticles (BM NPs) fabricated by a facile disinfection-mimic method were employed for the permeability imaging of BBB in the stroke for the first time. The BM NPs showed a high T1 relaxivity (r1 = 5.9 mM-1 s-1), remarkable MR imaging ability, and good biocompatibility, allowing the noninvasive timely visualization of BBB permeability in the model rats of middle cerebral artery occlusion (MCAO). Furthermore, increased peak intensity, extended imaging duration, and expanded imaging region indicated by BM NPs in MR imaging showed a good prediction for the onset of HT in MCAO rats. Therefore, BM NPs hold an attractive potential to be an alternative biocompatible MR contrast agent for the noninvasive BBB permeability imaging in vivo, benefiting the fundamental research of diverse neurological disorders and the clinical treatment for stroke patients.
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Affiliation(s)
- Wenjing Hou
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Yingzong Jiang
- School of Medical Imaging, Tianjin Medical University, Tianjin 300203, China.
| | - Guangchao Xie
- School of Medical Imaging, Tianjin Medical University, Tianjin 300203, China.
| | - Lu Zhao
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Fangshi Zhao
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Xuejun Zhang
- School of Medical Imaging, Tianjin Medical University, Tianjin 300203, China.
| | - Shao-Kai Sun
- School of Medical Imaging, Tianjin Medical University, Tianjin 300203, China.
| | - Chunshui Yu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China. and School of Medical Imaging, Tianjin Medical University, Tianjin 300203, China.
| | - Jinbin Pan
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China.
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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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20
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Effect of at Least 10 Serial Gadobutrol Administrations on Brain Signal Intensity Ratios on T1-Weighted MRI in Children: A Matched Case-Control Study. AJR Am J Roentgenol 2020; 217:753-760. [PMID: 33112200 DOI: 10.2214/ajr.20.24536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND. An association is recognized between linear gadolinium-based contrast agents (GBCAs) and intracranial gadolinium retention in children. The relation between macrocyclic GBCAs and gadolinium retention remains incompletely understood. OBJECTIVE. The purpose of this study was to assess whether 10 or more administrations of the macrocyclic GBCA gadobutrol are associated with increased signal intensity (SI) in the dentate nucleus (DN) and globus pallidus (GP) on unenhanced T1-weighted MRI of children and to explore clinical variables potentially associated with T1 hyperintensity. METHODS. The case group consisted of 25 children (13 boys, 12 girls; mean age, 7 ± 4 years; range, 2-18 years) who underwent at least 10 (mean, 15 ± 6; range, 10-34) contrast-enhanced MRI examinations exclusively with gadobutrol. The control group consisted of 25 age- and sex-matched patients undergoing MRI who had never been exposed to gadolinium. Two observers in consensus using a 3-point scale assessed visual T1 hyperintensity in the DN and GP. One observer placed ROIs on T1-weighted images to mark the DN, GP, middle cerebellar peduncle (MCP), and pulvinar of the thalamus bilaterally to compute mean DN-to-MCP and GP-to-thalamus SI ratios. SI ratios were compared between the macrocyclic GBCA and control groups. In the macrocyclic GBCA group, Pearson correlation analysis was conducted between SI ratios and clinical variables. ROI measurements were repeated by the original reader and an independent reader, and interobserver and intraobserver agreement were computed by means of Lin concordance correlation coefficient (ρc). RESULTS. No patient had visual T1 hyperintensity in the DN or GP. No significant difference between the macrocyclic GBCA and control groups was observed for DN-to-MCP SI ratio (0.95 ± 0.05 vs 0.95 ± 0.03; p = .67) or GP-to-thalamus SI ratio (1.05 ± 0.06 vs 1.04 ± 0.06; p = .65). In the macrocyclic GBCA group, no significant correlation was observed between DN-to-MCP SI ratio or GP-to-thalamus SI ratio and age (r = 0.355, p = .08; r = 0.167, p = .42), number of contrast-enhanced MRI examinations (r = 0.247, p = .23; r = 0.203, p = .33), mean time between examinations (r = 0.193, p = .36; r = 0.047, p = .82), or cumulative macrocyclic GBCA dose (r = 0.434, p = .07; r = 0.270, p = .19). Interobserver and intraobserver agreement was substantial for DN-to-MCP SI and GP-to-TH SI ratios (ρc = 0.931-0.974). CONCLUSION. Ten or more serial gadobutrol administrations were not associated with T1 hyperintensity in the DN or GP of children. CLINICAL IMPACT. Selection of gadobutrol as an MRI contrast agent may reduce risk of gadolinium retention in children. The findings may help guide practices for GBCA administration to children.
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21
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Lunyera J, Mohottige D, Alexopoulos AS, Campbell H, Cameron CB, Sagalla N, Amrhein TJ, Crowley MJ, Dietch JR, Gordon AM, Kosinski AS, Cantrell S, Williams JW, Gierisch JM, Ear B, Goldstein KM. Risk for Nephrogenic Systemic Fibrosis After Exposure to Newer Gadolinium Agents: A Systematic Review. Ann Intern Med 2020; 173:110-119. [PMID: 32568573 PMCID: PMC7847719 DOI: 10.7326/m20-0299] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The risk for nephrogenic systemic fibrosis (NSF) after exposure to newer versus older gadolinium-based contrast agents (GBCAs) remains unclear. PURPOSE To synthesize evidence about NSF risk with newer versus older GBCAs across the spectrum of kidney function. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science for English-language references from inception to 5 March 2020. STUDY SELECTION Randomized controlled trials, cohort studies, and case-control studies that assessed NSF occurrence after GBCA exposure. DATA EXTRACTION Data were abstracted by 1 investigator and verified by a second. Investigator pairs assessed risk of bias by using validated tools. DATA SYNTHESIS Of 32 included studies, 20 allowed for assessment of NSF risk after exposure to newer GBCAs and 12 (11 cohort studies and 1 case-control study) allowed for comparison of NSF risk between newer and older GBCAs. Among 83 291 patients exposed to newer GBCAs, no NSF cases developed (exact 95% CI, 0.0001 to 0.0258 case). Among the 12 studies (n = 118 844) that allowed risk comparison between newer and older GBCAs, 37 NSF cases developed after exposure to older GBCAs (exact CI, 0.0001 to 0.0523 case) and 4 occurred (3 confounded) after exposure to newer GBCAs (exact CI, 0.0018 to 0.0204 case). Data were scant for patients with acute kidney injury or those at risk for chronic kidney disease. LIMITATIONS Study heterogeneity prevented meta-analysis. Risk of bias was high in most studies because of inadequate exposure and outcome ascertainment. CONCLUSION Although NSF occurrence after exposure to newer GBCAs is very rare, the relatively scarce data among patients with acute kidney injury and those with risk factors for chronic kidney disease limit conclusions about safety in these populations. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs. (PROSPERO: CRD42019135783).
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Affiliation(s)
- Joseph Lunyera
- Duke University School of Medicine, Durham, North Carolina (J.L., C.B.C.)
| | - Dinushika Mohottige
- Duke University School of Medicine and Duke University Medical Center, Durham, North Carolina (D.M.)
| | - Anastasia-Stefania Alexopoulos
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Hilary Campbell
- Margolis Center for Health Policy at Duke University, Durham, North Carolina (H.C.)
| | - C Blake Cameron
- Duke University School of Medicine, Durham, North Carolina (J.L., C.B.C.)
| | - Nicole Sagalla
- Durham Veterans Affairs Health Care System and Duke University School of Medicine, Durham, North Carolina (N.S.)
| | - Timothy J Amrhein
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Matthew J Crowley
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Jessica R Dietch
- Stanford University and Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.R.D.)
| | - Adelaide M Gordon
- Durham Veterans Affairs Health Care System, Durham, North Carolina (A.M.G., B.E.)
| | - Andrzej S Kosinski
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina (A.S.K.)
| | - Sarah Cantrell
- Duke University School of Medicine and Duke University Medical Center Library and Archives, Durham, North Carolina (S.C.)
| | - John W Williams
- Duke University School of Medicine and Durham Veterans Affairs Health Care System, Durham, North Carolina (J.W.W., K.M.G.)
| | - Jennifer M Gierisch
- Duke University School of Medicine, Durham Veterans Affairs Health Care System, and Duke University, Durham, North Carolina (J.M.G.)
| | - Belinda Ear
- Durham Veterans Affairs Health Care System, Durham, North Carolina (A.M.G., B.E.)
| | - Karen M Goldstein
- Duke University School of Medicine and Durham Veterans Affairs Health Care System, Durham, North Carolina (J.W.W., K.M.G.)
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22
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Abstract
Patients with chronic kidney disease (CKD) are at increased risk for kidney failure, cardiovascular disease (CVD), and death. In fact, the likelihood of dying from CVD is markedly higher than that for reaching end-stage renal disease. Evidence-based management of comorbidities such as CVD remains challenging in patients with advanced CKD, as they were usually excluded from randomized controlled trials. This review focuses on the epidemiology, risk factors, and clinical manifestations of CVD in patients with advanced CKD. Specific topics of interest include diagnostic and therapeutic challenges of heart failure, coronary artery disease, and atrial fibrillation.
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Affiliation(s)
- Turgay Saritas
- Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Jürgen Floege
- Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
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Lattanzio SM, Imbesi F. Fibromyalgia associated with repeated gadolinium contrast-enhanced MRI examinations. Radiol Case Rep 2020; 15:534-541. [PMID: 32180856 PMCID: PMC7063147 DOI: 10.1016/j.radcr.2020.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/28/2020] [Accepted: 02/08/2020] [Indexed: 11/14/2022] Open
Abstract
We report a case of a fibromyalgia (FM) patient with an history of brain-cancer presenting signs and symptoms of gadolinium toxicity following repeated administrations of a macrocyclic contrast agent, Gadovist. In the present report, we provide evidence supporting the hypothesis of a causal relationship linking gadolinium deposition to a clinical manifestation of disease, namely fibromyalgia. We unravel a role for gadolinium in the still unknown etiology of fibromyalgia as a metal toxicity disorder. Contrast agents are routinely administered in a clinical context. It is thus possible that the patients are mistakenly believed to show complaint of their primary disease, whereas, in some instances, their symptoms are associated with gadolinium deposition.
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Affiliation(s)
- Silvia Maria Lattanzio
- Department of Biomedical Sciences, University of Padova, Via Marzolo 3, 35131, Padova, Italy
| | - Francesca Imbesi
- Neurological Department, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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24
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Updated Clinical Practice Guideline on Use of Gadolinium-Based Contrast Agents in Kidney Disease Issued by the Canadian Association of Radiologists. Can Assoc Radiol J 2019; 70:226-232. [DOI: 10.1016/j.carj.2019.04.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
In 2017, the Canadian Association of Radiologists issued a clinical practice guideline (CPG) regarding the use of gadolinium-based contrast agents (GBCAs) in patients with acute kidney injury (AKI), chronic kidney disease (CKD), or on dialysis due to mounting evidence indicating that nephrogenic systemic fibrosis (NSF) occurs with extreme rarity or not at all when using Group II GBCAs or the Group III GBCA gadoxetic acid (compared to first generation Group I linear GBCAs). One of the goals of the work group was to re-evaluate the CPG after 24 months to determine the effect of more liberal use of GBCA on reported cases of NSF in patients with AKI, CKD Stage 4 or 5 (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2), or those that are dialysis-dependent. A comprehensive review of the literature was conducted by a subcommittee of the initial CPG panel between the dates of January 1, 2017-December 31, 2018 to identify new unconfounded cases of NSF linked to Group II or Group III GBCAs and an updated CPG developed. To our knowledge, when using a Group II or Group III GBCA between 2017-2018, only a single unconfounded case report of a fibrosing dermopathy has been reported in a patient who received gadobenate dimeglumine with Stage 2 CKD. No other unconfounded cases of NSF have been reported with Group II or III agents in during this timeframe. The subcommittee concluded that the main recommendations from the 2017 CPG should remain unaltered, but agreed that screening for renal disease in the outpatient setting is no longer justifiable, cost-effective or recommended. Patients on hemodialysis (HD) should, however, be identified prior to GBCA administration to arrange timely HD to optimize gadolinium clearance, although there remains no evidence that HD reduces the risk of NSF. When administering Group II or III GBCAs to patients with AKI, on dialysis or with severe CKD, informed consent relating to NSF is also no longer explicitly recommended.
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25
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Ureche C, Sascău R, Țăpoi L, Covic A, Moroșanu C, Voroneanu L, Burlacu A, Stătescu C, Covic A. Multi-modality cardiac imaging in advanced chronic kidney disease. Echocardiography 2019; 36:1372-1380. [DOI: 10.1111/echo.14413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Carina Ureche
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Radu Sascău
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Laura Țăpoi
- Cardiovascular Disease Institute; Iasi Romania
| | - Andreea Covic
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | | | - Luminița Voroneanu
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Nephrology Clinic, Dialysis and Renal Transplant Center - ‘C.I. Parhon’ University Hospital; Iasi Romania
| | - Alexandru Burlacu
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Department of Interventional Cardiology; Cardiovascular Diseases Institute; Iasi Romania
| | - Cristian Stătescu
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Adrian Covic
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Nephrology Clinic, Dialysis and Renal Transplant Center - ‘C.I. Parhon’ University Hospital; Iasi Romania
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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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27
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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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28
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Goldfarb DS. Editorial: Controversies in kidney stones and other chronic kidney disease topics. Curr Opin Nephrol Hypertens 2019; 28:128-129. [PMID: 30585853 PMCID: PMC6452882 DOI: 10.1097/mnh.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David S Goldfarb
- Nephrology Division, New York University Langone Health, NY Harbor VA Medical Center, NYU School of Medicine, New York, New York, USA
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