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Saxena A, Subramanyam P, Sarma M, Bhad B, Bhaskaran R, Palaniswamy SS. 18F-FDG PET imaging for treatment response assessment and management guidance in patients with skull base osteomyelitis. Nucl Med Commun 2024; 45:589-600. [PMID: 38618743 DOI: 10.1097/mnm.0000000000001847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVE The objective of this study is to evaluate the role of hybrid 18F-FDG PET for treatment response assessment and management guidance in patients with skull base osteomyelitis. MATERIALS AND METHODS Retrospectively, 33 patients, with at least a baseline and follow-up PET (computed tomography/MRI) scan, were included. Parameters like standardized uptake value (SUV) max, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) (initial, follow-up, percentage change) were analysed and outcomes based on 18F-FDG PET reports were classified into resolution (a), partial response (b), progression (c) and stable disease (d). The clinical course and response on anatomical imaging were also compared with 18F-FDG PET. RESULTS There was mild correlation between initial SUV with ESR (0.338) and CRP (0.384). Moderate correlation was seen between follow-up SUV and CRP (0.619), percentage change in SUV max (PC SUV) with percentage change in ESR (0.456) and CRP (0.668). Mean PC SUV was 70% (a), 35% (b), -40% (c) and -18% (d), respectively. 48% (16/33) (resolution, progression, stable disease) patients had clear management change with 18F-FDG PET with either escalation or stopping of antibiotics/antifungals. Management decision in partial response group (52%, 17/33) was taken clinically. On retrospective PC SUV analysis, treatment continuation group (8 patients) showed 20% decrease, whereas the group that was only monitored further (9 patients) had 48% reduction in SUV. CONCLUSION 18F-FDG PET showed a moderate association with clinical markers used in follow-up of patients with skull base osteomyelitis and is a reliable investigation for assessment of disease status. This can be used as a guide along with clinical evaluation for de-escalation of treatment.
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Affiliation(s)
- Awiral Saxena
- Department of Nuclear Medicine & Molecular Imaging and
| | | | - Manjit Sarma
- Department of Nuclear Medicine & Molecular Imaging and
| | | | - Renjitha Bhaskaran
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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Bhatt Mitra J, Chatterjee S, Kumar A, Khatoon E, Chandak A, Rakshit S, Bandyopadhyay A, Mukherjee A. Expanding a peptide-covalent probe hybrid for PET imaging of S. aureus driven focal infections. EJNMMI Radiopharm Chem 2024; 9:25. [PMID: 38530487 DOI: 10.1186/s41181-024-00252-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The urgent demand for innovative theranostic strategies to combat bacterial resistance to antibiotics is evident, with substantial implications for global health. Rapid diagnosis of life-threatening infections can expedite treatment, improving patient outcomes. Leveraging diagnostic modalities i.e., positron emission tomography (PET) and single photon emission computed tomography (SPECT) for detecting focal infections has yielded promising results. Augmenting the sensitivity of current PET and SPECT tracers could enable effective imaging of pathogenic bacteria, including drug-resistant strains.UBI (29-41), an antimicrobial peptide (AMP) fragment recognizes the S. aureus membrane through electrostatic binding. Radiolabeled UBI (29-41) is a promising SPECT and PET-based tracer for detecting focal infections. 2-APBA (2-acetyl-phenyl-boronic acid), a non-natural amino acid, specifically targets lysyl-phosphatidyl-glycerol (lysyl-PG) on the S. aureus membranes, particularly in AMP-resistant strains. We propose that combining UBI with 2-APBA could enhance the diagnostic potential of radiolabeled UBI. RESULTS Present work aimed to compare the diagnostic potential of two radiolabeled peptides, namely UBI (29-41) and 2-APBA modified UBI (29-41), referred to as UBI and UBI-APBA. APBA modification imparted antibacterial activity to the initially non-bactericidal UBI against S. aureus by inducing a loss of membrane potential. The antibacterial activity demonstrated by UBI-APBA can be ascribed to the synergistic interaction of both UBI and UBI-APBA on the bacterial membrane. To enable PET imaging, we attached the chelator 1,4,7-triazacyclononane 1-glutaric acid 4,7-acetic acid (NODAGA) to the peptides for complexation with the positron emitter Gallium-68 (68Ga). Both NODAGA conjugates were radiolabeled with 68Ga with high radiochemical purity. The resultant 68Ga complexes were stable in phosphate-buffered saline and human serum. Uptake of these complexes was observed in S. aureus but not in mice splenocytes, indicating the selective nature of their interaction. Additionally, the APBA conjugate exhibited superior uptake in S. aureus while preserving the selectivity of the parent peptide. Furthermore, [68Ga]Ga-UBI-APBA demonstrated accumulation at the site of infection in rats, with an improved target-to-non-target ratio, as evidenced by ex-vivo biodistribution and PET imaging. CONCLUSIONS Our findings suggest that linking UBI, as well as AMPs in general, with APBA shows promise as a strategy to augment the theranostic potential of these molecules.
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Affiliation(s)
- Jyotsna Bhatt Mitra
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC), Mumbai, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, India
| | - Saurav Chatterjee
- Biomimetic Peptide Engineering Laboratory, Department of Chemistry, Indian Institute of Technology Ropar, Ropar, Punjab, India
| | - Anuj Kumar
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC), Mumbai, India
| | - Elina Khatoon
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC), Mumbai, India
| | - Ashok Chandak
- Board of Radiation and Isotope Technology, Navi Mumbai, India
| | | | - Anupam Bandyopadhyay
- Biomimetic Peptide Engineering Laboratory, Department of Chemistry, Indian Institute of Technology Ropar, Ropar, Punjab, India.
| | - Archana Mukherjee
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC), Mumbai, India.
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, India.
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Vatakara A, Damle NA, Khurana A, Sagar S, Kumar R, Verma H. 99mTechnetium-Ubiquicidin Scan with Single-Photon Emission Computed Tomography/Computed Tomography in Skull Base Osteomyelitis. Indian J Nucl Med 2023; 38:297-300. [PMID: 38046968 PMCID: PMC10693375 DOI: 10.4103/ijnm.ijnm_192_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 12/05/2023] Open
Abstract
Malignant otitis externa (MOE) with skull base osteomyelitis (SBO) is an aggressive infection that predominantly affects elderly, diabetic, or immunocompromised patients, and is associated with high disease-specific mortality. Pseudomonas aeruginosa is the most isolated microorganism. External otitis associated with granulation tissue and pain is the most common presenting feature; a biopsy is obtained to rule out malignancy. A proper consensus is lacking regarding the best imaging modality for early initial diagnosis and follow-up. 99mTechnetium (99mTc)-labeled ubiquicidin (UBI) 29-41 is a bacterial attaching peptide that does not bind to activated leukocytes. We report a case of SBO initially misdiagnosed as a chronic otitis media, but later proved to be a case of MOE. 99mTc methylene diphosphonate bone scan and 99mTc-UBI 29-41 scan with single-photon emission computed tomography/computed tomography scans were performed to corroborate the clinical diagnosis. SBO remains a great challenge due to its increasing prevalence and high morbidity are difficult to diagnose and are often confused with cholesteatoma and neoplastic process. The UBI scan could be an auxiliary noninvasive diagnostic alternative in early diagnosis.
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Affiliation(s)
- Arunraj Vatakara
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | | | - Aditi Khurana
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sambit Sagar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh Verma
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
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Hong Q, Huo S, Guo J, Li B, Sun Y, Nie B, Liang S, Yang J, Yue B. Core–Shell Nanoparticle Combined with Bacterial Targeting and Antibiotic Loading for Bacteria Tracing and Clearing. ADVANCED NANOBIOMED RESEARCH 2022. [DOI: 10.1002/anbr.202200084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Qimin Hong
- Department of Bone and Joint Surgery Department of Orthopedics Renji Hospital School of Medicine Shanghai Jiaotong University Shanghai 200127 China
| | - Shicheng Huo
- Department of Bone and Joint Surgery Department of Orthopedics Renji Hospital School of Medicine Shanghai Jiaotong University Shanghai 200127 China
| | - Jingjing Guo
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials College of Materials Science and Engineering Donghua University Shanghai 201620 China
| | - Bo Li
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials College of Materials Science and Engineering Donghua University Shanghai 201620 China
| | - Yanping Sun
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials College of Materials Science and Engineering Donghua University Shanghai 201620 China
| | - Bin'en Nie
- Department of Bone and Joint Surgery Department of Orthopedics Renji Hospital School of Medicine Shanghai Jiaotong University Shanghai 200127 China
| | - Shanhui Liang
- Department of Gynecological Oncology Fudan University Shanghai Cancer Center Fudan University Shanghai 200032 China
- Department of Oncology Shanghai Medical College Fudan University Shanghai 200032 China
| | - Jianping Yang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials College of Materials Science and Engineering Donghua University Shanghai 201620 China
| | - Bing Yue
- Department of Bone and Joint Surgery Department of Orthopedics Renji Hospital School of Medicine Shanghai Jiaotong University Shanghai 200127 China
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Bhatt Mitra J, Chatterjee S, Kumar A, Bandyopadhyay A, Mukherjee A. Integrating a covalent probe with ubiquicidin fragment enables effective bacterial infection imaging. RSC Med Chem 2022; 13:1239-1245. [PMID: 36325398 PMCID: PMC9579938 DOI: 10.1039/d2md00190j] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 08/03/2023] Open
Abstract
Developing potent and novel bacterial imaging agents remains formidable due to the rapid development of bacterial resistance. Ubiquicidin and its derivatives are the most studied antimicrobial peptides that bind to anionic membranes of a broad range of bacterial pathogens. Studies reveal that UBI (29-41) labeled with 99mTc and 68Ga could distinguish sterile inflammation from infection. A significant challenge that remains for cationic peptides is their poor salt tolerance. The present study deliberates the increment of UBI (29-41) peptide interaction with the bacterial membrane by incorporating 2-acetylphenylboronic acid (2-APBA) as a covalent probe and developing infection imaging probes with improved retention at the target. Given that both 99mTc-UBI (29-41) and 99mTc-UBI (29-41)-2-APBA peptide complexes are stable in serum over 16 h, 99mTc-UBI (29-41)-2-APBA shows enhanced uptake in S. aureus cells as compared to 99mTc-UBI (29-41). SPECT imaging in a mouse model of infection exhibited a higher target to non-target ratio after 2 h in the case of 99mTc-UBI (29-41)-2-APBA. The present study reveals a synergistic mechanism of target binding through covalent conjugation and non-covalent interaction, which could be a potential strategy for improving bacterial infection imaging. As a proof of concept, 99mTc-UBI (29-41)-2-APBA elicits our hypothesis by in vivo imaging of bacterial infection.
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Affiliation(s)
- Jyotsna Bhatt Mitra
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC) Mumbai 400085 India
- Homi Bhabha National Institute Anushaktinagar Mumbai-400094 India
| | - Saurav Chatterjee
- Biomimetic Peptide Engineering Laboratory, Department of Chemistry, Indian Institute of Technology Ropar Rupnagar Punjab 140001 India
| | - Anuj Kumar
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC) Mumbai 400085 India
| | - Anupam Bandyopadhyay
- Biomimetic Peptide Engineering Laboratory, Department of Chemistry, Indian Institute of Technology Ropar Rupnagar Punjab 140001 India
| | - Archana Mukherjee
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC) Mumbai 400085 India
- Homi Bhabha National Institute Anushaktinagar Mumbai-400094 India
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Welling MM, Duszenko N, van Willigen DM, Hensbergen AW, Buckle T, Rietbergen DDD, Roestenberg M, van Leeuwen FWB. Interventional nuclear medicine: "click" chemistry as an in vivo targeting strategy for imaging microspheres and bacteria. Biomater Sci 2021; 9:1683-1690. [PMID: 33410436 DOI: 10.1039/d0bm01823f] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Pre-targeting is a proven strategy for in vivo delivery of a diagnostic or therapeutic payload. The pre-targeting concept can be realized through various conjugation strategies, one of which is based on copper-free "click" chemistry. Copper-free click reactions have shown in vivo potential for imaging and radionuclide therapy, but this conjugation strategy has not yet been explored in combination with microspheres or unicellular organisms. This study aims to evaluate the in vivo efficacy of strain-promoted azide-alkyne cycloaddition (SPAAC) reactions to achieve imaging and targeting of azide-functionalized macro-aggregated albumin (MAA) microspheres and Staphylococcus aureus bacteria. METHODS MAA microspheres (diameter 10-90 μm) were functionalized with a biorthogonal Cy5 fluorophore, bearing an azide functionality (N3), to generate MAA-Cy5-N3. S. aureus (diameter ∼1 μm) were functionalized with 99mTc-UBI29-41-Cy5-N3, generating S. aureus-99mTc-UBI29-41-Cy5-N3. In situ and in vitro click conjugation on the -N3 moieties was studied for 20 h using a radioactivity-based assay and fluorescence microscopy. For in vivo validation, both primary entities, radiolabeled with 99mTc, were deposited into the microvasculature of the liver via intrasplenic injections. Secondary targeting was realized following the intravenous administration of indium-111-radiolabeled diethylenetriaminepentaacetic acid-dibenzocyclooctyne (111In-DTPA-DBCO). To assess click reaction efficiency in vivo, 99mTc and 111In-biodistributions were measured (SPECT and %ID g-1). Use of 111In-DTPA-DBCO in mice without MAA deposits or mice infected with non-functionalized S. aureus served as controls. Ex vivo confocal fluorescence imaging was carried out in excised tissues to confirm the presence of functionalized MAA and bacteria. RESULTS In vitro data confirmed effective click reactions on both the MAA particles and the bacterial membrane. SPECT imaging and biodistribution studies revealed significantly (p < 0.05) increased accumulation of 111In-DTPA-DBCO at the sites where MAA-Cy5-N3 (7.5 ± 1.5%ID g-1vs. 3.5 ± 0.5%ID g-1 in control mice) and S. aureus-99mTc-UBI29-41-Cy5-N3 (9.3 ± 1.3%ID g-1vs. 6.0 ± 0.5%ID g-1 in control mice) resided. Ex vivo fluorescence imaging confirmed the presence of either functionalized MAA or S. aureus in excised spleens and livers of mice. CONCLUSION Copper-free click chemistry between a DBCO moiety and Cy5-N3-functionalized microspheres or bacterial entities in the liver can be used to realize in vivo imaging and targeting.
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Affiliation(s)
- M M Welling
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands.
| | - N Duszenko
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands. and Departments of Parasitology and Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - D M van Willigen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands.
| | - A W Hensbergen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands.
| | - T Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands.
| | - D D D Rietbergen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands. and Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - M Roestenberg
- Departments of Parasitology and Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - F W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands.
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la Cerda-Vargas MFD, Rangel JAC, Mata EM, Ramírez-Cárdenas A, Sandoval-Bonilla BA. 99mTc-UBI 29-41 bone SPECT/CT scan in craniofacial Actinomyces israelii: Misdiagnosis of cranial bone tumor - A case report. Surg Neurol Int 2020; 11:442. [PMID: 33408927 PMCID: PMC7771506 DOI: 10.25259/sni_684_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Actinomycosis is a rare infection, frequently misdiagnosed as a neoplasia. This chronic and granulomatous disease is caused by Actinomyces israelii species. Cervicofacial actinomycosis occurs in 60% of cases and the diagnosis is commonly made by histopathology study. Case Description: We report a case of fronto-orbital osteomyelitis initially misdiagnosed as a cranial bone meningioma, but later proved to be a case of actinomycosis. 99mTechnetium (99mTc) three-phase bone single-photon emission computed tomography/computed tomography (SPECT/CT) and 99mTc-ubiquicidin (UBI) 29-41 bone SPECT/CT scans were performed to corroborate the control of the infection. Conclusion: Craniofacial actinomycosis is the most common presentation of actinomycosis. However, it continues to be a rare and difficult disease to diagnose and is often confused with a neoplastic process. The 99mTc-UBI 29-41 bone SPECT/CT scan could be an auxiliary noninvasive diagnostic alternative and a follow-up method for these patients.
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Affiliation(s)
- María F De la Cerda-Vargas
- Department of Neurosurgery, Hospital de Especialidades No. 71, Instituto Mexicano del Seguro Social, Torreón, Coahuila, México
| | - José Antonio Candelas Rangel
- Department of Neurosurgery, Hospital de Especialidades No. 71, Instituto Mexicano del Seguro Social, Torreón, Coahuila, México
| | - Elizabeth Meza Mata
- Department of Pathology, Hospital de Especialidades No. 71, Instituto Mexicano del Seguro Social, Torreón, Coahuila, México
| | - Araceli Ramírez-Cárdenas
- Graduate School of Neural and Behavioural Sciences, International Max Planck Research School, Tuebingen University, Tuebingen, Germany
| | - Bayron A Sandoval-Bonilla
- Department of Neurosurgery, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Welling MM, de Korne CM, Spa SJ, van Willigen DM, Hensbergen AW, Bunschoten A, Duszenko N, Smits WK, Roestenberg M, van Leeuwen FWB. Multimodal Tracking of Controlled Staphylococcus aureus Infections in Mice. ACS Infect Dis 2019; 5:1160-1168. [PMID: 31016979 PMCID: PMC6630532 DOI: 10.1021/acsinfecdis.9b00015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Indexed: 12/14/2022]
Abstract
There is a need to develop diagnostic and analytical tools that allow noninvasive monitoring of bacterial growth and dissemination in vivo. For such cell-tracking studies to hold translational value to controlled human infections, in which volunteers are experimentally colonized, they should not require genetic modification, and they should allow tracking over a number of replication cycles. To gauge if an antimicrobial peptide tracer, 99mTc-UBI29-41-Cy5, which contains both a fluorescent and a radioactive moiety, could be used for such in vivo bacterial tracking, we performed longitudinal imaging of a thigh-muscle infection with 99mTc-UBI29-41-Cy5-labeled Staphylococcus aureus. Mice were imaged using SPECT and fluorescence-imaging modalities at various intervals during a 28 h period. Biodistribution analyses were performed to quantitate radioactivity in the abscess and other tissues. SPECT and fluorescence imaging in mice showed clear retention of the 99mTc-UBI29-41-Cy5-labeled bacteria following inoculation in the thigh muscle. Despite bacterial replication, the signal intensity in the abscess only modestly decreased within a 28 h period: 52% of the total injected radioactivity per gram of tissue (%ID/g) at 4 h postinfection (pi) versus 44%ID/g at 28 h pi (15% decrease). After inoculation, a portion of the bacteria disseminated from the abscess, and S. aureus cultures were obtained from radioactive urine samples. Bacterial staining with 99mTc-UBI29-41-Cy5 allowed noninvasive bacterial-cell tracking during a 28 h period. Given the versatility of the presented bacterial-tracking method, we believe that this concept could pave the way for precise imaging capabilities during controlled-human-infection studies.
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Affiliation(s)
- Mick M. Welling
- Interventional
Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Clarize M. de Korne
- Interventional
Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
- Department
of Parasitology and Department of Infectious Diseases, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Silvia J. Spa
- Interventional
Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Danny M. van Willigen
- Interventional
Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Albertus W. Hensbergen
- Interventional
Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Anton Bunschoten
- Interventional
Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
- Laboratory
of BioNanoTechnology, Department of Agrotechnology and Food Sciences, Wageningen University & Research, 6708PB Wageningen, The Netherlands
| | - Nikolas Duszenko
- Interventional
Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
- Department
of Parasitology and Department of Infectious Diseases, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Wiep Klaas Smits
- Department
of Medical Microbiology, Section Experimental Bacteriology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Meta Roestenberg
- Department
of Parasitology and Department of Infectious Diseases, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Fijs W. B. van Leeuwen
- Interventional
Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
- Laboratory
of BioNanoTechnology, Department of Agrotechnology and Food Sciences, Wageningen University & Research, 6708PB Wageningen, The Netherlands
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Selectivity of Antimicrobial Peptides: A Complex Interplay of Multiple Equilibria. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1117:175-214. [DOI: 10.1007/978-981-13-3588-4_11] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Bhatt J, Mukherjee A, Shinto A, Koramadai Karuppusamy K, Korde A, Kumar M, Sarma HD, Repaka K, Dash A. Gallium-68 labeled Ubiquicidin derived octapeptide as a potential infection imaging agent. Nucl Med Biol 2018; 62-63:47-53. [PMID: 29883883 DOI: 10.1016/j.nucmedbio.2018.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/23/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Gallium-68 based infection imaging agents are in demand to detect infection foci with high spatial resolution and sensitivity. In this study, Ubiquicidin derived octapeptide, UBI (31-38) conjugated with macrocyclic chelator NOTA was radiolabeled with 68Ga to develop infection imaging agent. METHODS Circular dichroism (CD) spectroscopy was performed to study conformational changes in UBI (31-38) and its NOTA conjugate in a "membrane like environment". Radiolabeling of NOTA-UBI (31-38) with 68Ga was optimized and quality control analysis was done by chromatography techniques. In vitro evaluation of 68Ga-NOTA-UBI (31-38) in S. aureus and preliminary biological evaluation in animal model of infection was studied. Initial clinical evaluation in three patients with suspected infection was carried out. RESULTS 68Ga-NOTA-UBI (31-38) was prepared in high radiochemical yields and high radiochemical purity. In vitro evaluation of 68Ga-NOTA-UBI (31-38) complex in S. aureus confirmed specificity of the agent for bacteria. Biodistribution studies with 68Ga-NOTA-UBI (31-38) revealed specific uptake of the complex in infected muscle compared to inflamed muscle with T/NT ratio of 3.24 ± 0.7 at 1 h post-injection. Initial clinical evaluation in two patients with histopathologically confirmed infective foci conducted after intravenous injection of 130-185 MBq of 68Ga-NOTA-UBI (31-38) and imaging at 45-60 min post-injection revealed specific uptake at the sites of infection and clearance from vital organs. No uptake of tracer was observed in suspected infection foci in one patient, which was proven to be aseptic and served as negative control. CONCLUSION This is the first report on 68Ga labeled NOTA-UBI (31-38) fragment for prospective infection imaging.
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Affiliation(s)
- Jyotsna Bhatt
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC), Mumbai 400085, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai 400094, India
| | - Archana Mukherjee
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC), Mumbai 400085, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai 400094, India.
| | - Ajit Shinto
- Dept of Nuclear Medicine and PET-CT, Kovai Medical Center and Hospital Limited, Coimbatore, India
| | | | - Aruna Korde
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC), Mumbai 400085, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai 400094, India; Quality control, Board of Radiation and Isotope Technology, Vashi, Navi Mumbai, India
| | - Mukesh Kumar
- Radiation Biology & Health Sciences Division, Bhabha Atomic Research Centre (BARC), Mumbai 400085, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai 400094, India
| | - Haladhar Dev Sarma
- Radiation Biology & Health Sciences Division, Bhabha Atomic Research Centre (BARC), Mumbai 400085, India
| | - Krishnamohan Repaka
- Quality control, Board of Radiation and Isotope Technology, Vashi, Navi Mumbai, India
| | - Ashutosh Dash
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC), Mumbai 400085, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai 400094, India
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Bhatt J, Mukherjee A, Korde A, Kumar M, Sarma HD, Dash A. Radiolabeling and Preliminary Evaluation of Ga-68 Labeled NODAGA-Ubiquicidin Fragments for Prospective Infection Imaging. Mol Imaging Biol 2016; 19:59-67. [DOI: 10.1007/s11307-016-0983-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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14
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Arjun C, Mukherjee A, Bhatt J, Chaudhari P, Repaka KM, Venkatesh M, Samuel G. Studies on batch formulation of a kit for the preparation of the 99m Tc-Ubiquicidin (29-41): An infection imaging agent. Appl Radiat Isot 2016; 107:8-12. [DOI: 10.1016/j.apradiso.2015.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/01/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
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15
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Welling MM, Bunschoten A, Kuil J, Nelissen RGHH, Beekman FJ, Buckle T, van Leeuwen FWB. Development of a Hybrid Tracer for SPECT and Optical Imaging of Bacterial Infections. Bioconjug Chem 2015; 26:839-49. [PMID: 25853214 DOI: 10.1021/acs.bioconjchem.5b00062] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In trauma and orthopedic surgery, infection of implants has a major impact on the outcome for patients. Infections may develop either during the initial implantation or during the lifetime of an implant. Both infections, as well as aseptic loosening of the implant, are reasons for revision of the implants. Therefore, discrimination between aseptic-mechanical-loosening and septic-bacterial-loosening of implants is critical during selection of a patient-tailored treatment policy. Specific detection and visualization of infections is a challenge because it is difficult to discriminate infections from inflammation. An imaging tracer that facilitates bacterial identification in a pre- and intraoperative setting may aid the workup for patients suspicious of bacterial infections. In this study we evaluated an antimicrobial peptide conjugated to a hybrid label, which contains both a radioisotope and a fluorescent dye. After synthesis of DTPA-Cy5-UBI29-41 and-when necessary-radiolabeling with (111)In (yield 96.3 ± 2.7%), in vitro binding to various bacterial strains was evaluated using radioactivity counting and confocal fluorescence microscopy. Intramuscular bacterial infections (S. aureus or K. pneumoniae) were also visualized in vivo using a combined nuclear and fluorescence imaging system. The indium-111 was chosen as label as it has a well-defined coordination chemistry, and in pilot studies labeling DTPA-Cy5-UBI29-41 with technetium-99m, we encountered damage to the Cy5 dye after the reduction with SnCl2. As a reference, we used the validated tracer (99m)Tc-UBI29-41. Fast renal excretion of (111)In-DTPA-Cy5-UBI29-41 was observed. Target to nontarget (T/NT) ratios were highest at 2 h post injection: radioactivity counting yielded T/NT ratios of 2.82 ± 0.32 for S. aureus and 2.37 ± 0.05 for K. pneumoniae. Comparable T/NT ratios with fluorescence imaging of 2.38 ± 0.09 for S. aureus and 3.55 ± 0.31 for K. pneumoniae were calculated. Ex vivo confocal microscopy of excised infected tissues showed specific binding of the tracer to bacteria. Using a combination of nuclear and fluorescence imaging techniques, the hybrid antimicrobial peptide conjugate DTPA-Cy5-UBI29-41 was shown to specifically accumulate in bacterial infections. This hybrid tracer may facilitate integration of noninvasive identification of infections and their extent as well as real-time fluorescence guidance during surgical resection of infected areas.
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Affiliation(s)
| | | | | | | | - Freek J Beekman
- §Delft University of Technology, 2628 CD Delft, The Netherlands.,∥MILabs, 3584 CX Utrecht, The Netherlands
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16
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Chest wall osteomyelitis after breast cancer surgery. A case series. Enferm Infecc Microbiol Clin 2014; 33:210-1. [PMID: 25200215 DOI: 10.1016/j.eimc.2014.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 04/21/2014] [Accepted: 05/12/2014] [Indexed: 11/24/2022]
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17
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Antimicrobial peptides: their role as infection-selective tracers for molecular imaging. BIOMED RESEARCH INTERNATIONAL 2014; 2014:867381. [PMID: 25243191 PMCID: PMC4163393 DOI: 10.1155/2014/867381] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 07/29/2014] [Indexed: 12/22/2022]
Abstract
Antimicrobial peptides (AMPs) are a heterogeneous class of compounds found in a variety of organisms including humans and, so far, hundreds of these structures have been isolated and characterised. They can be described as natural microbicide, selectively cytotoxic to bacteria, whilst showing minimal cytotoxicity towards the mammalian cells of the host organism. They act by their relatively strong electrostatic attraction to the negatively charged bacterial cells and a relatively weak interaction to the eukaryote host cells. The ability of these peptides to accumulate at sites of infection combined with the minimal host's cytotoxicity motivated for this review to highlight the role and the usefulness of AMPs for PET with emphasis on their mechanism of action and the different interactions with the bacterial cell. These details are key information for their selective properties. We also describe the strategy, design, and utilization of these peptides as potential radiopharmaceuticals as their combination with nuclear medicine modalities such as SPECT or PET would allow noninvasive whole-body examination for detection of occult infection causing, for example, fever of unknown origin.
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18
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Kaya A, Ergul N, Kaya SY, Kilic F, Yilmaz MH, Besirli K, Ozaras R. The management and the diagnosis of fever of unknown origin. Expert Rev Anti Infect Ther 2014; 11:805-15. [PMID: 23977936 DOI: 10.1586/14787210.2013.814436] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prolonged fever presents a challenge for the patient and the physician. Fever with a temperature higher than 38.3°C on several occasions that lasts for at least 3 weeks and lacks a clear diagnosis after 1 week of study in the hospital is called a fever of unknown origin (FUO). More than 200 diseases can cause FUO, and the information gathered from history taking, physical examination, laboratory and imaging studies should be evaluated with care. History taking and physical examination may provide some localizing signs and symptoms pointing toward a diagnosis. Infection, cancers, noninfectious inflammatory diseases and some miscellaneous diseases are the main etiologies, and some patients remain undiagnosed despite investigations. Tuberculosis, lymphoma and adult-onset Still's disease are the main diseases. Fluorodeoxyglucose PET is a promising imaging modality in FUO. Establishing a uniform algorithm for FUO management is difficult. Every patient should be carefully evaluated individually considering the previous FUO management experience.
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Affiliation(s)
- Abdurrahman Kaya
- Infectious Diseases Department, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
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19
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Welling MM, Nabuurs RJA, van der Weerd L. Potential role of antimicrobial peptides in the early onset of Alzheimer's disease. Alzheimers Dement 2014; 11:51-7. [PMID: 24637300 DOI: 10.1016/j.jalz.2013.12.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 11/19/2013] [Accepted: 12/11/2013] [Indexed: 12/16/2022]
Abstract
Cerebral aggregation of amyloid-β (Aβ) is thought to play a major role in the etiology of Alzheimer's disease. Environmental influences, including chronic bacterial or viral infections, are thought to alter the permeability of the blood-brain barrier (BBB) and thereby facilitate cerebral colonization by opportunistic pathogens. This may eventually trigger Aβ overproduction and aggregation. Host biomolecules that target and combat these pathogens, for instance, antimicrobial peptides (AMPs) such as Aβ itself, are an interesting option for the detection and diagnostic follow-up of such cerebral infections. As part of the innate immune system, AMPs are defensive peptides that efficiently penetrate infected cells and tissues beyond many endothelial barriers, most linings, including the BBB, and overall specifically target pathogens. Based on existing literature, we postulate a role for labeled AMPs as a marker to target pathogens that play a role in the aggregation of amyloid in the brain.
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Affiliation(s)
- Mick M Welling
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Rob J A Nabuurs
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Louise van der Weerd
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
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20
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Bunschoten A, Welling MM, Termaat MF, Sathekge M, van Leeuwen FWB. Development and Prospects of Dedicated Tracers for the Molecular Imaging of Bacterial Infections. Bioconjug Chem 2013; 24:1971-89. [PMID: 24200346 DOI: 10.1021/bc4003037] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A. Bunschoten
- Department
of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - M. M. Welling
- Department
of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - M. F. Termaat
- Department
of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M. Sathekge
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
| | - F. W. B. van Leeuwen
- Department
of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
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21
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Functional Imaging in Diagnostic of Orthopedic Implant-Associated Infections. Diagnostics (Basel) 2013; 3:356-71. [PMID: 26824928 PMCID: PMC4665528 DOI: 10.3390/diagnostics3040356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/10/2013] [Accepted: 09/22/2013] [Indexed: 12/11/2022] Open
Abstract
Surgeries’ sterile conditions and perioperative antibiotic therapies decrease implant associated infections rates significantly. However, up to 10% of orthopedic devices still fail due to infections. An implant infection generates a high socio-economic burden. An early diagnosis of an infection would significantly improve patients’ outcomes. There are numerous clinical tests to diagnose infections. The “Gold Standard” is a microbiological culture, which requires an invasive sampling and lasts up to several weeks. None of the existing tests in clinics alone is sufficient for a conclusive diagnosis of an infection. Meanwhile, there are functional imaging modalities, which hold the promise of a non-invasive, quick, and specific infection diagnostic. This review focuses on orthopedic implant-associated infections, their pathogenicity, diagnosis and functional imaging.
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A Pooled Analysis of Diagnostic Value of 99mTc-Ubiquicidin (UBI) Scintigraphy in Detection of an Infectious Process. Clin Nucl Med 2013; 38:413-6. [DOI: 10.1097/rlu.0b013e3182867d56] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Utility of 99mTc-labelled antimicrobial peptide ubiquicidin (29-41) in the diagnosis of diabetic foot infection. Eur J Nucl Med Mol Imaging 2013; 40:737-43. [DOI: 10.1007/s00259-012-2327-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 12/12/2012] [Indexed: 01/27/2023]
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24
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Gemmel F, Van den Wyngaert H, Love C, Welling MM, Gemmel P, Palestro CJ. Prosthetic joint infections: radionuclide state-of-the-art imaging. Eur J Nucl Med Mol Imaging 2012; 39:892-909. [PMID: 22361912 DOI: 10.1007/s00259-012-2062-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 01/02/2012] [Indexed: 12/27/2022]
Abstract
Prosthetic joint replacement surgery is performed with increasing frequency. Overall the incidence of prosthetic joint infection (PJI) and subsequently prosthesis revision failure is estimated to be between 1 and 3%. Differentiating infection from aseptic mechanical loosening, which is the most common cause of prosthetic failure, is especially important because of different types of therapeutic management. Despite a thorough patient history, physical examination, multiple diagnostic tests and complex algorithms, differentiating PJI from aseptic loosening remains challenging. Among imaging modalities, radiographs are neither sensitive nor specific and cross-sectional imaging techniques, such as computed tomography and magnetic resonance imaging, are limited by hardware-induced artefacts. Radionuclide imaging reflects functional rather than anatomical changes and is not hampered by the presence of a metallic joint prosthesis. As a result scintigraphy is currently the modality of choice in the investigation of suspected PJI. Unfortunately, there is no true consensus about the gold standard technique since there are several drawbacks and limitations inherent to each modality. Bone scintigraphy (BS) is sensitive for identifying the failed joint replacement, but cannot differentiate between infection and aseptic loosening. Combined bone/gallium scintigraphy (BS/GS) offers modest improvement over BS alone for diagnosing PJI. However, due to a number of drawbacks, BS/GS has generally been superseded by other techniques but it still may have a role in neutropenic patients. Radiolabelled leucocyte scintigraphy remains the gold standard technique for diagnosing neutrophil-mediated processes. It seems to be that combined in vitro labelled leucocyte/bone marrow scintigraphy (LS/BMS), with an accuracy of about 90%, is currently the imaging modality of choice for diagnosing PJI. There are, however, significant limitations using in vitro labelled leucocytes and considerable effort has been devoted to developing alternative radiotracers, such as radiolabelled HIGs, liposomes, antigranulocyte antibodies and fragments, as well as more investigational tracers such as radiolabelled antibiotics, antimicrobial peptides, bacteriophages and thymidine kinase. On the other hand, positron emission tomography (PET) is still growing in the field of PJI imaging with radiotracers such as (18)F-fluorodeoxyglucose (FDG), (18)F-FDG white blood cells and (18)F-fluoride. But unfortunately this superb tomographic technique will only receive full acceptance when specific PET uptake patterns can be successfully developed. The emergence of hybrid modality imaging using integrated single photon emission computed tomography (SPECT) and PET with computed tomography (SPECT/CT and PET/CT) may also have a contributing role for more accurate assessment of joint replacement complications, especially combined with new radiotracers such as (68)Ga and (64)Cu. Finally, in searching for infection-specific tracers, currently there is no such diagnostic agent available.
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Affiliation(s)
- Filip Gemmel
- Department of Nuclear Medicine, AZ Alma Campus Sijsele, Gentse Steenweg 132, 8340 Sijsele-Damme, Belgium.
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25
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Jang SJ, Lee YJ, Lim S, Kim KI, Lee KC, An GI, Lee TS, Cheon GJ, Lim SM, Kang JH. Imaging of a localized bacterial infection with endogenous thymidine kinase using radioisotope-labeled nucleosides. Int J Med Microbiol 2012; 302:101-7. [PMID: 22264560 DOI: 10.1016/j.ijmm.2011.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 09/29/2011] [Accepted: 11/06/2011] [Indexed: 02/05/2023] Open
Abstract
The importance of noninvasive imaging methods to bacterial infections is widely recognized. To obtain bacterial infection imaging with radioisotope-labeled nucleosides, bacterial thymidine kinase (tk) activities of Salmonella typhimurium with [(125)I]5-iodo-1-(2'-fluoro-2'-deoxy-β-d-arabinofuranosyl)uracil ([(125)I]FIAU) or 3'-deoxy-3'-[(18)F]fluorothymidine ([(18)F]FLT) were measured. The infection model in BALB/c mice was imaged with [(125)I]FIAU or [(18)F]FLT using small-animal Single Photon Emission Computed Tomography (SPECT) or Positron Emission Tomography (PET), respectively. The accumulated radioactivity of [(125)I]FIAU or [(18)F]FLT in the two strains showed a linearly increased pattern with increasing incubation time or bacterial numbers. The image clearly demonstrated a high uptake of [(125)I]FIAU and [(18)F]FLT in the bacterial infection site. [(18)F]FLT uptake in the infection site of was 7.286±2.405, whereas that in the uninfected site was 0.519±0.561. The relative activity ratio of the infected region in relation to the uninfected region was 2.98 at 4h after an injection with [(125)I]FIAU determined by biodistribution data. In conclusion, the bacterial tk activity was confirmed by the cellular uptake and imaging with [(125)I]FIAU or [(18)F]FLT. Therefore, a localized bacterial infection in living mice can be monitored using radioisotope-labeled nucleosides with a nuclear medicine imaging modality.
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Affiliation(s)
- Su Jin Jang
- Molecular Imaging Research Center, Seoul, Republic of Korea
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26
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Chander S, Coakley G. What's New in the Management of Bacterial Septic Arthritis? Curr Infect Dis Rep 2011; 13:478-84. [PMID: 21785928 DOI: 10.1007/s11908-011-0201-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Septic arthritis is a common rheumatological emergency requiring prompt diagnosis and treatment, since delays in management can lead to high morbidity and mortality. In this review article, we discuss the epidemiology and recent advances in knowledge of the pathogenesis of septic arthritis, with a special emphasis on various bacterial and host factors involved in mediating the inflammatory process and the potential for targeted therapy to modulate the immune response. Recent advances in laboratory and imaging techniques are reviewed along with treatment and potential new therapies.
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Affiliation(s)
- Sumeet Chander
- Queen Elizabeth Hospital, South London Healthcare NHS Trust, Stadium Road, London, SE18 4QH, UK,
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