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Richter H, Verlemann C, Jeibmann A, Martin LF, Luebke AM, Karol A, Sperling M, Radbruch A, Karst U. Elemental Bioimaging of Sheep Bone and Articular Cartilage After Single Application of Gadolinium-Based Contrast Agents. Invest Radiol 2024; 59:287-292. [PMID: 37747456 DOI: 10.1097/rli.0000000000001020] [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: 09/26/2023]
Abstract
BACKGROUND Gadolinium-based contrast agents (GBCAs) are applied to enhance magnetic resonance imaging. Gadolinium (Gd), a rare earth metal, is used in a chelated form when administered as GBCA to patients. There is an ongoing scientific debate about the clinical significance of Gd retention in tissues after administration of GBCAs. It is known that bone serves as Gd reservoir, but only sparse information on localization of Gd in bone is available. PURPOSE The aim of this study was to compare Gd tissue concentration and spatial distribution in femoral epiphysis and diaphysis 10 weeks after single-dose injection of linear and macrocyclic GBCAs in a large animal model. MATERIALS AND METHODS In this prospective animal study, Swiss-Alpine sheep (n = 36; age range, 4-10 years) received a single injection (0.1 mmol/kg) of macrocyclic (gadobutrol, gadoteridol, and gadoterate meglumine), linear (gadodiamide and gadobenate dimeglumine) GBCAs, or saline. Ten weeks after injection, sheep were killed, and femur heads and shafts were harvested. Gadolinium spatial distribution was determined in 1 sample of each treatment group by laser ablation-inductively coupled plasma-mass spectrometry. All bone specimens were analyzed histopathologically. RESULTS Injection of GBCAs in female Swiss-Alpine sheep (n = 36) resulted in Gd localization at the endosteal and periosteal surface and in a subset of GBCAs additionally at the cement lines and the bone cartilage junction. No histopathological alterations were observed in the investigated tissue specimens. CONCLUSIONS Ten weeks after single injection of a clinically relevant dose in adult sheep, both linear species of GBCA resulted in considerably higher accumulation than macrocyclic GBCAs. Gadolinium deposits were restricted to distinct bone and cartilage compartments, such as in bone linings, cement lines, and bone cartilage junctions. Tissue histology remained unaffected.
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Affiliation(s)
- Henning Richter
- From the Diagnostic Imaging Research Unit, Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland (H.R.); Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany (H.R., A.R.); Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (C.V., M.S., U.K.); Institute of Neuropathology, University Hospital Münster, Münster Germany (A.J.); Clinic for Zoo Animals, Exotic Pets and Wildlife, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland (L.F.M.); Institute of Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (A.M.L.); and Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland (A.K.)
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Dekker HM, Stroomberg GJ, Van der Molen AJ, Prokop M. Review of strategies to reduce the contamination of the water environment by gadolinium-based contrast agents. Insights Imaging 2024; 15:62. [PMID: 38411847 PMCID: PMC10899148 DOI: 10.1186/s13244-024-01626-7] [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: 09/14/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
Gadolinium-based contrast agents (GBCA) are essential for diagnostic MRI examinations. GBCA are only used in small quantities on a per-patient basis; however, the acquisition of contrast-enhanced MRI examinations worldwide results in the use of many thousands of litres of GBCA per year. Data shows that these GBCA are present in sewage water, surface water, and drinking water in many regions of the world. Therefore, there is growing concern regarding the environmental impact of GBCA because of their ubiquitous presence in the aquatic environment. To address the problem of GBCA in the water system as a whole, collaboration is necessary between all stakeholders, including the producers of GBCA, medical professionals and importantly, the consumers of drinking water, i.e. the patients. This paper aims to make healthcare professionals aware of the opportunity to take the lead in making informed decisions about the use of GBCA and provides an overview of the different options for action.In this paper, we first provide a summary on the metabolism and clinical use of GBCA, then the environmental fate and observations of GBCA, followed by measures to reduce the use of GBCA. The environmental impact of GBCA can be reduced by (1) measures focusing on the application of GBCA by means of weight-based contrast volume reduction, GBCA with higher relaxivity per mmol of Gd, contrast-enhancing sequences, and post-processing; and (2) measures that reduce the waste of GBCA, including the use of bulk packaging and collecting residues of GBCA at the point of application.Critical relevance statement This review aims to make healthcare professionals aware of the environmental impact of GBCA and the opportunity for them to take the lead in making informed decisions about GBCA use and the different options to reduce its environmental burden.Key points• Gadolinium-based contrast agents are found in sources of drinking water and constitute an environmental risk.• Radiologists have a wide spectrum of options to reduce GBCA use without compromising diagnostic quality.• Radiology can become more sustainable by adopting such measures in clinical practice.
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Affiliation(s)
- Helena M Dekker
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Gerard J Stroomberg
- RIWA-Rijn - Association of River Water Works, Groenendael 6, 3439 LV, Nieuwegein, The Netherlands
| | - Aart J Van der Molen
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Gendron C, Bourrinet P, Dencausse A, Fretellier N. Preclinical Safety Assessment of Gadopiclenol: A High-Relaxivity Macrocyclic Gadolinium-Based MRI Contrast Agent. Invest Radiol 2024; 59:108-123. [PMID: 37921752 DOI: 10.1097/rli.0000000000001038] [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: 11/04/2023]
Abstract
OBJECTIVE Gadopiclenol is a new high-relaxivity macrocyclic gadolinium-based contrast agent for magnetic resonance imaging of the central nervous system and other body regions. The product has been approved by US Food and Drug Administration and is currently being evaluated by European Medicines Agency. For risk assessment of the single diagnostic use in humans, the safety profile of gadopiclenol was evaluated with a series of preclinical studies. MATERIALS AND METHODS With exception of dose-ranging studies, all safety pharmacology and toxicology studies were performed in compliance with Good Laboratory Practice principles. Safety pharmacology studies were conducted to assess potential effects on cardiovascular (in vitro and in dogs), respiratory (in rats and guinea pigs), neurological (in rats), and renal endpoints (in rats). Toxicology studies were also performed to investigate acute toxicity (in rats and mice), extended single-dose (in rats and dogs) and repeated-dose toxicity (in rats and dogs), reproductive (in rats), developmental (in rats and rabbits) and juvenile toxicity (in rats), as well as genotoxicity (in vitro and in rats), local tolerance (in rabbits), potential immediate hypersensitivity (in guinea pigs), and potential tissue retention of gadolinium (in rats). RESULTS Safety pharmacology studies conducted at high intravenous (IV) doses showed a satisfactory tolerance of gadopiclenol in the main body systems. After either single or repeated IV dosing (14 and 28 days) in rats and dogs, gadopiclenol was well tolerated even at high doses. The no-observed-adverse-effect level values (ie, the highest experimental dose without adverse effects) representing between 8 times in rats and 44 times in dogs (based on the exposure), the exposure achieved in humans at the intended diagnostic dose, provide a high safety margin. No or only minor and reversible effects on body weight, food consumption, clinical signs, clinical pathology parameters, or histology were observed at the highest doses. The main histological finding consists in renal tubular vacuolations (exacerbated after repeated exposure), which supports a well-known finding for this class of compounds that has no physiological consequence on kidney function. Reproductive toxicity studies showed no evidence of effects on reproductive performance, fertility, perinatal and postnatal development in rats, or reproductive development in rats or rabbits. The safety profile of gadopiclenol in juvenile rats was satisfactory like in adults. Gadopiclenol was not genotoxic in vitro in the Ames test, a mouse lymphoma assay, and a rat in vivo micronucleus test. There were no signs of local intolerance at the injection site after IV and intra-arterial administration in rabbits. However, because of minor signs of intolerance after perivenous administration, misadministration must be avoided. Gadopiclenol exhibited no signs of potential to induce immediate hypersensitivity in guinea pigs. CONCLUSIONS High safety margins were observed between the single diagnostic dose of 0.05 mmol/kg in humans and the doses showing effects in animal studies. Gadopiclenol is, therefore, well tolerated in various species (mice, rats, dogs, rabbits, and guinea pigs). All observed preclinical data support the clinical approval.
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Affiliation(s)
- Célia Gendron
- From the Research and Innovation Department, Guerbet, Aulnay-sous-Bois, France
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Lewis EM, Jones P, Clemens G, Fretellier N, Bussi S, Hirani E, Czupalla O, Tedoldi F, Bourrinet P, Hoberman AM. Evaluation of gadolinium-based contrast agents in juvenile CD-1 mice including behavioral evaluations. Birth Defects Res 2024; 116:e2284. [PMID: 38158745 DOI: 10.1002/bdr2.2284] [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: 05/27/2023] [Revised: 11/12/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Seven gadolinium-based contrast agents (GBCAs), four linear and three macrocyclic, were evaluated for potential effects on development, including behavior of juvenile CD-1 mice. METHODS The GBCAs were administered via intravenous injection once daily on postnatal day (PND) 9, 12, 15, 18, and 21 (PND 1 was the day of delivery) at doses up to twice the human equivalent clinical dose (i.e., 0.63 mmol Gd/kg for gadoxetate disodium and 2.5 mmol Gd/kg for the other GBCAs). Mice were bled for evaluation of exposure (plasma) to gadolinium (Gd) on PND 9, 12, and 70. At scheduled euthanasia, the liver, spleen, brain, skin (dorsal surface), bone (left femur), and kidneys were excised from up to six mice/sex/group on PND 10, 22, or 70 for the determination of Gd levels and histopathological analysis. All mice were monitored for toxicity, growth and survival, sexual maturation, and behavior. CONCLUSION Gd was quantifiable in the brain tissues with levels declining over time. There was no long-term effect on the growth and development for mice exposed to any of the GBCAs. There was no impact on neurodevelopment as assessed by brain histology and validated neurobehavioral tests, including a functional observational battery, motor activity, and learning and memory as evaluated in the Morris water maze. For all GBCAs, the highest dose tested represented the no-observable-adverse-effect level in juvenile mice.
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Affiliation(s)
- Elise M Lewis
- Charles River Laboratories, Inc., Safety Assessment, Horsham, Pennsylvania, USA
| | - Paul Jones
- GE Healthcare, Pharmaceutical Diagnostics, Chalfont St. Giles, UK
| | - Guenther Clemens
- Bayer AG, Pharmaceuticals Research and Development, Berlin, Germany
| | | | | | - Ella Hirani
- GE Healthcare, Pharmaceutical Diagnostics, Chalfont St. Giles, UK
| | - Oliver Czupalla
- Bayer AG, Pharmaceuticals Research and Development, Berlin, Germany
| | | | | | - Alan M Hoberman
- Charles River Laboratories, Inc., Safety Assessment, Horsham, Pennsylvania, USA
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van der Molen AJ, Quattrocchi CC, Mallio CA, Dekkers IA. Ten years of gadolinium retention and deposition: ESMRMB-GREC looks backward and forward. Eur Radiol 2024; 34:600-611. [PMID: 37804341 PMCID: PMC10791848 DOI: 10.1007/s00330-023-10281-3] [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: 03/13/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 10/09/2023]
Abstract
In 2014, for the first time, visible hyperintensities on unenhanced T1-weighted images in the nucleus dentatus and globus pallidus of the brain were associated with previous Gadolinium-based contrast agent (GBCA) injections and gadolinium deposition in patients with normal renal function. This led to a frenzy of retrospective studies with varying methodologies that the European Society of Magnetic Resonance in Medicine and Biology Gadolinium Research and Educational Committee (ESMRMB-GREC) summarised in 2019. Now, after 10 years, the members of the ESMRMB-GREC look backward and forward and review the current state of knowledge of gadolinium retention and deposition. CLINICAL RELEVANCE STATEMENT: Gadolinium deposition is associated with the use of linear GBCA but no clinical symptoms have been associated with gadolinium deposition. KEY POINTS : • Traces of Gadolinium-based contrast agent-derived gadolinium can be retained in multiple organs for a prolonged time. • Gadolinium deposition is associated with the use of linear Gadolinium-based contrast agents. • No clinical symptoms have been associated with gadolinium deposition.
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Affiliation(s)
- Aart J van der Molen
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands.
| | - Carlo C Quattrocchi
- Centre for Medical Sciences CISMed, University of Trento, 38122, Trento, Italy
| | - Carlo A Mallio
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Operative Research Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Ilona A Dekkers
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands
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Lewis EM, Bussi S, Fretellier N, Clemens G, Jones P, Tedoldi F, Bourrinet P, Czupalla O, Hirani E, Hoberman AM. Evaluation of gadolinium-based contrast agents in pregnant CD-1 mice and subsequent in utero exposure of the developing offspring, including behavioral evaluations. Birth Defects Res 2024; 116:e2291. [PMID: 38158716 DOI: 10.1002/bdr2.2291] [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: 06/11/2023] [Revised: 09/12/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The offspring of CD-1 mice exposed during pregnancy to one of seven gadolinium-based contrast agents (GBCAs) were evaluated for potential effects on postnatal development and behavior. The GBCAs, comprising four linear (gadopentetate dimeglumine, gadodiamide, gadobenate dimeglumine, and gadoxetate disodium) and three macrocyclic (gadoterate meglumine, gadoteridol, and gadobutrol), were administered via intravenous injection once daily from Gestation Day 6 through 17 following confirmed mating (Day 0) at doses of at least twice the human equivalent recommended clinical dose (i.e., 0.63 mmol Gd/kg for gadoxetate disodium and 2.5 mmol Gd/kg for the other GBCAs). All dams were allowed to deliver naturally. F0 generation females were monitored for maternal toxicity and gadolinium (Gd) levels in blood and brain. Offspring were evaluated for Gd levels in blood and brain at birth and on Day 70 postpartum. F1 generation mice were evaluated for survival and growth preweaning. Selected pups/litter were evaluated postweaning for sexual maturation, growth, and behavior. Gd was quantifiable in the brain of the F1 offspring on PND 1, with levels declining over time. There was no long-term effect of any GBCA on the growth and development of any offspring. There was no impact on neurodevelopment, as assessed by brain histology and validated neurobehavioral tests, including a battery of functional observational tests, motor activity, and learning and memory as evaluated in the Morris water maze. CONCLUSION At the end of the postweaning period, the highest dose tested was considered the no-observable-adverse-effect level (NOAEL) in the F0 and F1 offspring for all tested GBCAs.
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Affiliation(s)
- Elise M Lewis
- Charles River Laboratories, Inc., Safety Assessment, Horsham, Pennsylvania, USA
| | | | | | - Guenther Clemens
- Bayer AG, Pharmaceuticals Research & Development, Berlin, Germany
| | - Paul Jones
- GE Healthcare, Pharmaceutical Diagnostics, Chalfont St. Giles, United Kingdom
| | | | | | - Oliver Czupalla
- Bayer AG, Pharmaceuticals Research & Development, Berlin, Germany
| | - Ella Hirani
- GE Healthcare, Pharmaceutical Diagnostics, Chalfont St. Giles, United Kingdom
| | - Alan M Hoberman
- Charles River Laboratories, Inc., Safety Assessment, Horsham, Pennsylvania, USA
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Sharma P, Cheng J, Coulthard A. Where does the gadolinium go? A review into the excretion and retention of intravenous gadolinium. J Med Imaging Radiat Oncol 2023; 67:742-752. [PMID: 37665796 DOI: 10.1111/1754-9485.13581] [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: 06/23/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) are commonly used in medical imaging. Most intravenously (IV) administered gadolinium is excreted via the kidneys, and pathological retention in renal failure leading to nephrogenic systemic fibrosis (NSF) is well described. More recently, retention of gadolinium in the body in the absence of renal disease has been identified, with unknown clinical consequences. Many patients are aware of this, either through the media or via comprehensive consent documentation. Some internet sites, without hard evidence, have suggested a constellation of possible symptoms associated with GBCA retention. Recent experience with patients ascribing symptoms to a contrast-enhanced MRI examination prompted this review of the fate of injected GBCA after MRI study, and of information available to patients online regarding gadolinium retention.
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Affiliation(s)
- Pranav Sharma
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jeffrey Cheng
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Alan Coulthard
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Bonafè R, Coppo A, Queliti R, Bussi S, Maisano F, Kirchin MA, Tedoldi F. Gadolinium retention in a rat model of subtotal renal failure: are there differences among macrocyclic GBCAs? Eur Radiol Exp 2023; 7:7. [PMID: 36855001 PMCID: PMC9975137 DOI: 10.1186/s41747-023-00324-1] [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: 09/12/2022] [Accepted: 01/11/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Gd levels are higher in tissues of animals with compromised renal function, but studies to compare levels after exposure to different macrocyclic gadolinium-based contrast agents (GBCAs) are lacking. We compared Gd levels in tissues of subtotally nephrectomised (SN) rats after repeated exposure to macrocyclic GBCAs. METHODS Sprague-Dawley SN male rats (19 per group) received 16 injections of gadoteridol, gadobutrol, or gadoterate meglumine at 0.6 mmol Gd/kg 4 times/weeks over 4 weeks. A control group of healthy male rats (n = 10) received gadoteridol at the same dosage. Plasma urea and creatinine levels were monitored. Blood, cerebrum, cerebellum, liver, femur, kidney(s), skin and peripheral nerves were harvested for Gd determination by inductively coupled plasma-mass spectrometry at 28 and 56 days after the end of treatment. RESULTS Plasma urea and creatinine levels were roughly twofold higher in SN rats than in healthy rats at all timepoints. At day 28, Gd levels in the peripheral nerves of gadobutrol- or gadoterate-treated SN animals were 5.4 or 7.2 times higher than in gadoteridol-treated animals (p < 0.001). Higher Gd levels after administration of gadobutrol or gadoterate versus gadoteridol were also determined in kidneys (p ≤ 0.002), cerebrum (p ≤ 0.001), cerebellum (p ≤ 0.003), skin (p ≥ 0.244), liver (p ≥ 0.053), and femur (p ≥ 0.271). At day 56, lower Gd levels were determined both in SN and healthy rats for all GBCAs and tissues, except the femur. CONCLUSIONS Gd tissue levels were lower following gadoteridol exposure than following gadobutrol or gadoterate exposure.
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Affiliation(s)
- Roberta Bonafè
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
| | - Alessandra Coppo
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
| | - Roberta Queliti
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
| | - Simona Bussi
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
| | - Federico Maisano
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
| | - Miles A. Kirchin
- grid.476177.40000 0004 1755 9978Bracco Imaging SpA, Global Medical & Regulatory Affairs, Milan, Italy
| | - Fabio Tedoldi
- Bracco Imaging SpA, Bracco Research Centre, Via Ribes 5, 10010, Colleretto Giacosa, TO Italy
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Funke SKI, Factor C, Rasschaert M, Robert P, van Dijk NWM, Hußock M, Sperling M, Karst U. Elemental Imaging of Long-term Gadolinium Retention in Rodent Femur. Radiology 2023; 306:e213107. [PMID: 36194115 DOI: 10.1148/radiol.213107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background The use of gadolinium-based contrast agents (GBCAs) is linked to gadolinium retention in the skeleton of healthy individuals. The mechanism of gadolinium incorporation into bone tissue is not fully understood and requires spatially resolved analysis to locate the gadolinium. Purpose To compare the quantitative distribution of gadolinium retained over time in rodent femur following the administration of gadodiamide and gadobutrol at three different time points. Materials and Methods In this animal study conducted between May 2018 and April 2020, 108 9-week-old healthy rats were repeatedly injected with either gadodiamide, gadobutrol, or saline solution and were killed 1, 3, or 12 months after the last injection. The femurs of six female and six male rats per each group and time point were collected. Quantitative elemental imaging of gadolinium in longitudinal thin sections was performed on one sample per sex with use of laser ablation inductively coupled plasma mass spectrometry (ICP-MS). Gadolinium concentration was determined with use of ICP-MS on the samples of all animals (six per group). Mann-Whitney U tests were applied on pairwise comparisons to determine potential sex effect and GBCA effect on gadolinium concentrations. Results The highest gadolinium retention was observed in the gadodiamide group (concentration, 97-200 nmol · g-1), exceeding the mean concentration in the gadobutrol group (6.5-17 nmol · g-1). However, the gadolinium distribution pattern was similar for both contrast agents, showing prominent gadolinium retention at endosteal surfaces, in the bone marrow, and in small tissue pores. Gadolinium distribution in cortical bone changed over time, initially showing a thin rim of higher concentration close to the periosteum, which appeared to grow wider and move toward the interior of the femur over 1 year. Conclusion For both gadolinium-based contrast agents, gadolinium retention in rat bone was initially located close to the periosteum and bone cavities and changed with bone remodeling processes. The relevance to long-term storage of gadolinium in humans remains to be determined. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Sabrina K I Funke
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstrasse 48, 48149 Münster, Germany (S.K.I.F., M.H., M.S., U.K.); Department of Research and Innovation, Guerbet Group, Roissy, France (C.F., M.R., P.R.); and Department of Dentistry, Dental Research Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (N.W.M.v.D.)
| | - Cécile Factor
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstrasse 48, 48149 Münster, Germany (S.K.I.F., M.H., M.S., U.K.); Department of Research and Innovation, Guerbet Group, Roissy, France (C.F., M.R., P.R.); and Department of Dentistry, Dental Research Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (N.W.M.v.D.)
| | - Marlène Rasschaert
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstrasse 48, 48149 Münster, Germany (S.K.I.F., M.H., M.S., U.K.); Department of Research and Innovation, Guerbet Group, Roissy, France (C.F., M.R., P.R.); and Department of Dentistry, Dental Research Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (N.W.M.v.D.)
| | - Philippe Robert
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstrasse 48, 48149 Münster, Germany (S.K.I.F., M.H., M.S., U.K.); Department of Research and Innovation, Guerbet Group, Roissy, France (C.F., M.R., P.R.); and Department of Dentistry, Dental Research Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (N.W.M.v.D.)
| | - Natasja W M van Dijk
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstrasse 48, 48149 Münster, Germany (S.K.I.F., M.H., M.S., U.K.); Department of Research and Innovation, Guerbet Group, Roissy, France (C.F., M.R., P.R.); and Department of Dentistry, Dental Research Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (N.W.M.v.D.)
| | - Michelle Hußock
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstrasse 48, 48149 Münster, Germany (S.K.I.F., M.H., M.S., U.K.); Department of Research and Innovation, Guerbet Group, Roissy, France (C.F., M.R., P.R.); and Department of Dentistry, Dental Research Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (N.W.M.v.D.)
| | - Michael Sperling
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstrasse 48, 48149 Münster, Germany (S.K.I.F., M.H., M.S., U.K.); Department of Research and Innovation, Guerbet Group, Roissy, France (C.F., M.R., P.R.); and Department of Dentistry, Dental Research Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (N.W.M.v.D.)
| | - Uwe Karst
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstrasse 48, 48149 Münster, Germany (S.K.I.F., M.H., M.S., U.K.); Department of Research and Innovation, Guerbet Group, Roissy, France (C.F., M.R., P.R.); and Department of Dentistry, Dental Research Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (N.W.M.v.D.)
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Funke SKI, Factor C, Rasschaert M, Lezius L, Sperling M, Karst U, Robert P. Long-term Gadolinium Retention in the Healthy Rat Brain: Comparison between Gadopiclenol, Gadobutrol, and Gadodiamide. Radiology 2022; 305:179-189. [PMID: 35727155 DOI: 10.1148/radiol.212600] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Safety concerns caused by gadolinium retention call for the development of high-relaxivity gadolinium-based contrast agents (GBCAs) allowing minimal dosing. Purpose To investigate brain gadolinium retention in healthy rats after exposure to gadopiclenol (Elucirem, Guerbet; macrocyclic GBCA) compared with gadobutrol (Gadovist or Gadavist, Bayer; macrocyclic GBCA) and gadodiamide (Omniscan, GE Healthcare; linear GBCA) over 1 year. Materials and Methods In this study conducted between May 2018 and April 2020, 9-week-old healthy Sprague Dawley rats received five injections of either gadopiclenol, gadobutrol, or gadodiamide (2.4 mmol of gadolinium per kilogram of body weight for each), or saline (control animals) over a period of 5 weeks. Rats were randomly assigned to different groups (six female and six male rats per group). MRI examinations were performed before euthanasia at 1, 3, 5, or 12 months after the last injection. Brains were sampled to determine the total gadolinium content via inductively coupled plasma mass spectrometry (ICP-MS), to characterize gadolinium species with size exclusion chromatography (SEC)-ICP-MS, and to perform elemental mapping with laser ablation (LA)-ICP-MS. Mann-Whitney tests were performed on pairwise comparisons of the same time points. Results For both macrocyclic agents, no T1 signal hyperintensities were observed in the cerebellum, and approximately 80% of gadolinium washout was found between 1 month (gadobutrol, 0.30 nmol/g; gadopiclenol, 0.37 nmol/g) and 12 months (gadobutrol, 0.062 nmol/g; gadopiclenol, 0.078 nmol/g). After 12 months, only low-molecular-weight gadolinium species were detected in the soluble fraction. Gadodiamide led to significantly higher gadolinium concentrations after 1 month in the cerebellum (gadodiamide, 2.65 nmol/g; P < .001 vs both macrocyclics) combined with only 15% washout after 12 months (gadodiamide, 2.25 nmol/g) and with gadolinium detected bound to macromolecules. Elemental bioimaging enabled visualization of gadolinium deposition patterns colocalized with iron. Conclusion Gadopiclenol and gadobutrol demonstrated similar in vivo distribution and washout of gadolinium in the healthy rat brain, markedly differing from gadodiamide up to 12 months after the last injection. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Sabrina K I Funke
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.K.I.F., L.L., M.S., U.K.); and Department of Research and Innovation, Guerbet Group, BP57400, Roissy 95943, France (C.F., M.R., P.R.)
| | - Cécile Factor
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.K.I.F., L.L., M.S., U.K.); and Department of Research and Innovation, Guerbet Group, BP57400, Roissy 95943, France (C.F., M.R., P.R.)
| | - Marlène Rasschaert
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.K.I.F., L.L., M.S., U.K.); and Department of Research and Innovation, Guerbet Group, BP57400, Roissy 95943, France (C.F., M.R., P.R.)
| | - Lena Lezius
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.K.I.F., L.L., M.S., U.K.); and Department of Research and Innovation, Guerbet Group, BP57400, Roissy 95943, France (C.F., M.R., P.R.)
| | - Michael Sperling
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.K.I.F., L.L., M.S., U.K.); and Department of Research and Innovation, Guerbet Group, BP57400, Roissy 95943, France (C.F., M.R., P.R.)
| | - Uwe Karst
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.K.I.F., L.L., M.S., U.K.); and Department of Research and Innovation, Guerbet Group, BP57400, Roissy 95943, France (C.F., M.R., P.R.)
| | - Philippe Robert
- From the Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.K.I.F., L.L., M.S., U.K.); and Department of Research and Innovation, Guerbet Group, BP57400, Roissy 95943, France (C.F., M.R., P.R.)
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Violas X, Rasschaert M, Santus R, Factor C, Corot C, Catoen S, Idée JM, Robert P. Small Brain Lesion Enhancement and Gadolinium Deposition in the Rat Brain: Comparison Between Gadopiclenol and Gadobenate Dimeglumine. Invest Radiol 2022; 57:130-139. [PMID: 34411032 PMCID: PMC8746880 DOI: 10.1097/rli.0000000000000819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/07/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the set of studies was to compare gadopiclenol, a new high relaxivity gadolinium (Gd)-based contrast agent (GBCA) to gadobenate dimeglumine in terms of small brain lesion enhancement and Gd retention, including T1 enhancement in the cerebellum. MATERIALS AND METHODS In a first study, T1 enhancement at 0.1 mmol/kg body weight (bw) of gadopiclenol or gadobenate dimeglumine was evaluated in a small brain lesions rat model at 2.35 T. The 2 GBCAs were injected in an alternated and cross-over manner separated by an interval of 4.4 ± 1.0 hours (minimum, 3.5 hours; maximum, 6.1 hours; n = 6). In a second study, the passage of the GBCAs into cerebrospinal fluid (CSF) was evaluated by measuring the fourth ventricle T1 enhancement in healthy rats at 4.7 T over 23 minutes after a single intravenous (IV) injection of 1.2 mmol/kg bw of gadopiclenol or gadobenate dimeglumine (n = 6/group). In a third study, Gd retention at 1 month was evaluated in healthy rats who had received 20 IV injections of 1 of the 2 GBCAs (0.6 mmol/kg bw) or a similar volume of saline (n = 10/group) over 5 weeks. T1 enhancement of the deep cerebellar nuclei (DCN) was assessed by T1-weighted magnetic resonance imaging at 2.35 T, performed before the injection and thereafter once a week up to 1 month after the last injection. Elemental Gd levels in central nervous system structures, in muscle and in plasma were determined by inductively coupled plasma mass spectrometry (ICP-MS) 1 month after the last injection. RESULTS The first study in a small brain lesion rat model showed a ≈2-fold higher number of enhanced voxels in lesions with gadopiclenol compared with gadobenate dimeglumine. T1 enhancement of the fourth ventricle was observed in the first minutes after a single IV injection of gadopiclenol or gadobenate dimeglumine (study 2), resulting, in the case of gadopiclenol, in transient enhancement during the injection period of the repeated administrations study (study 3). In terms of Gd retention, T1 enhancement of the DCN was noted in the gadobenate dimeglumine group during the month after the injection period. No such enhancement of the DCN was observed in the gadopiclenol group. Gadolinium concentrations 1 month after the injection period in the gadopiclenol group were slightly increased in plasma and lower by a factor of 2 to 3 in the CNS structures and muscles, compared with gadobenate dimeglumine. CONCLUSIONS In the small brain lesion rat model, gadopiclenol provides significantly higher enhancement of brain lesions compared with gadobentate dimeglumine at the same dose. After repeated IV injections, as expected for a macrocyclic GBCA, Gd retention is minimalized in the case of gadopiclenol compared with gadobenate dimeglumine, resulting in no T1 hypersignal in the DCN.
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Davies J, Siebenhandl-Wolff P, Tranquart F, Jones P, Evans P. Gadolinium: pharmacokinetics and toxicity in humans and laboratory animals following contrast agent administration. Arch Toxicol 2022; 96:403-429. [PMID: 34997254 PMCID: PMC8837552 DOI: 10.1007/s00204-021-03189-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
Abstract
Gadolinium-based contrast agents (GBCAs) have transformed magnetic resonance imaging (MRI) by facilitating the use of contrast-enhanced MRI to allow vital clinical diagnosis in a plethora of disease that would otherwise remain undetected. Although over 500 million doses have been administered worldwide, scientific research has documented the retention of gadolinium in tissues, long after exposure, and the discovery of a GBCA-associated disease termed nephrogenic systemic fibrosis, found in patients with impaired renal function. An understanding of the pharmacokinetics in humans and animals alike are pivotal to the understanding of the distribution and excretion of gadolinium and GBCAs, and ultimately their potential retention. This has been well studied in humans and more so in animals, and recently there has been a particular focus on potential toxicities associated with multiple GBCA administration. The purpose of this review is to highlight what is currently known in the literature regarding the pharmacokinetics of gadolinium in humans and animals, and any toxicity associated with GBCA use.
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Affiliation(s)
- Julie Davies
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK.
| | | | | | - Paul Jones
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK
| | - Paul Evans
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK
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13
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Ayers-Ringler J, McDonald JS, Connors MA, Fisher CR, Han S, Jakaitis DR, Scherer B, Tutor G, Wininger KM, Dai D, Choi DS, Salisbury JL, Jannetto PJ, Bornhorst JA, Kadirvel R, Kallmes DF, McDonald RJ. Neurologic Effects of Gadolinium Retention in the Brain after Gadolinium-based Contrast Agent Administration. Radiology 2021; 302:676-683. [PMID: 34931861 PMCID: PMC8893178 DOI: 10.1148/radiol.210559] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Concerns over the neurotoxic potential of retained gadolinium in brain tissues after intravenous gadolinium-based contrast agent (GBCA) administration have led to pronounced worldwide use changes, yet the clinical sequelae of gadolinium retention remain undefined. Purpose To assess clinical and neurologic effects and potential neurotoxicity of gadolinium retention in rats after administration of various GBCAs. Materials and Methods From March 2017 through July 2018, 183 male Wistar rats received 20 intravenous injections of 2.5 mmol per kilogram of body weight (80 human equivalent doses) of various GBCAs (gadodiamide, gadobenate, gadopentetate, gadoxetate, gadobutrol, gadoterate, and gadoteridol) or saline over 4 weeks. Rats were evaluated 6 and 34 weeks after injection with five behavioral tests, and inductively coupled plasma mass spectrometry, transmission electron microscopy, and histopathology were performed on urine, serum, cerebrospinal fluid (CSF), basal ganglia, dentate nucleus, and kidney samples. Dunnett post hoc test and Wilcoxon rank sum test were used to compare differences between treatment groups. Results No evidence of differences in any behavioral test was observed between GBCA-exposed rats and control animals at either 6 or 34 weeks (P = .08 to P = .99). Gadolinium concentrations in both neuroanatomic locations were higher in linear GBCA-exposed rats than macrocyclic GBCA-exposed rats at 6 and 34 weeks (P < .001). Gadolinium clearance over time varied among GBCAs, with gadobutrol having the largest clearance (median: 62% for basal ganglia, 70% for dentate) and gadodiamide having no substantial clearance. At 34 weeks, gadolinium was largely cleared from the CSF and serum of gadodiamide-, gadobenate-, gadoterate-, and gadobutrol-exposed rats, especially for the macrocyclic agents (range: 70%-98% removal for CSF, 34%-94% removal for serum), and was nearly completely removed from urine (range: 96%-99% removal). Transmission electron microscopy was used to detect gadolinium foci in linear GBCA-exposed brain tissue, but no histopathologic differences were observed for any GBCA. Conclusion In this rat model, no clinical evidence of neurotoxicity was observed after exposure to linear and macrocyclic gadolinium-based contrast agents at supradiagnostic doses. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Jennifer Ayers-Ringler
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Jennifer S. McDonald
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Margaret A. Connors
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Cody R. Fisher
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Susie Han
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Daniel R. Jakaitis
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Bradley Scherer
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Gabriel Tutor
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Katheryn M. Wininger
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Daying Dai
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Doo-Sup Choi
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Jeffrey L. Salisbury
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Paul J. Jannetto
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Joshua A. Bornhorst
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Ram Kadirvel
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - David F. Kallmes
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Robert J. McDonald
- From the Departments of Radiology (J.A., J.S.M., M.A.C., C.R.F., S.H., D.R.J., B.S., G.T., D.D., R.K., D.F.K., R.J.M.), Molecular Pharmacology and Experimental Therapeutics (K.M.W., D.S.C.), Biochemistry and Molecular Biology (J.L.S.), Laboratory Medicine and Pathology (P.J.J., J.A.B.), and Neurosurgery, College of Medicine (D.F.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Fretellier N, Rasschaert M, Bocanegra J, Robert P, Factor C, Seron A, Idée JM, Corot C. Safety and Gadolinium Distribution of the New High-Relaxivity Gadolinium Chelate Gadopiclenol in a Rat Model of Severe Renal Failure. Invest Radiol 2021; 56:826-836. [PMID: 34091462 DOI: 10.1097/rli.0000000000000793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the toxicological profile of gadopiclenol, a new high-relaxivity macrocyclic gadolinium-based contrast agent (GBCA), in renally impaired rats, in comparison with 2 other macrocyclic GBCAs, gadoterate meglumine and gadobutrol, and 1 linear and nonionic GBCA, gadodiamide. METHODS Renal failure was induced by adding 0.75% wt/wt adenine to the diet for 3 weeks. During the second week of adenine-enriched diet, the animals (n = 8/group × 5 groups) received 5 consecutive intravenous injections of GBCA at 2.5 mmol/kg per injection, resulting in a cumulative dose of 12.5 mmol/kg or saline followed by a 3-week treatment-free period after the last injection. The total (elemental) gadolinium (Gd) concentration in different tissues (brain, cerebellum, femoral epiphysis, liver, skin, heart, kidney, spleen, plasma, urine, and feces) was measured by inductively coupled plasma mass spectrometry. Transmission electron microscopy (and electron energy loss spectroscopy analysis of metallic deposits) was used to investigate the presence and localization of Gd deposits in the skin. Relaxometry was used to evaluate the presence of dissociated Gd in the skin, liver, and bone. Skin histopathology was performed to investigate the presence of nephrogenic systemic fibrosis-like lesions. RESULTS Gadodiamide administrations were associated with high morbidity-mortality but also with macroscopic and microscopic skin lesions in renally impaired rats. No such effects were observed with gadopiclenol, gadoterate, or gadobutrol. Overall, elemental Gd concentrations were significantly higher in gadodiamide-treated rats than in rats treated with the other GBCAs for all tissues except the liver (where no significant difference was found with gadopiclenol) and the kidney and the heart (where statistically similar Gd concentrations were observed for all GBCAs). No plasma biochemical abnormalities were observed with gadopiclenol or the control GBCAs. Histopathology revealed a normal skin structure in the rats treated with gadopiclenol, gadoterate, and gadobutrol, contrary to those treated with gadodiamide. No evidence of Gd deposits on collagen fibers and inclusions in fibroblasts was found with gadopiclenol and its macrocyclic controls, unlike with gadodiamide. Animals of all test groups had Gd-positive lysosomal inclusions in the dermal macrophages. However, the textures differed for the different products (speckled texture for gadodiamide and rough-textured appearance for the 2 tested macrocyclic GBCAs). CONCLUSIONS No evidence of biochemical toxicity or pathological abnormalities of the skin was observed, and similar to other macrocyclic GBCAs, gadoterate and gadobutrol, tissue retention of Gd was found to be low (except in the liver) in renally impaired rats treated with the new high-relaxivity GBCA gadopiclenol.
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Affiliation(s)
- Nathalie Fretellier
- From the Research and Innovation Department, Guerbet, Aulnay-sous-Bois, France
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15
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Funke SKI, Sperling M, Karst U. Weighted Linear Regression Improves Accuracy of Quantitative Elemental Bioimaging by Means of LA-ICP-MS. Anal Chem 2021; 93:15720-15727. [PMID: 34784194 DOI: 10.1021/acs.analchem.1c03630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The application of ordinary least squares (OLS) linear regression is widely used in order to approximate linear external calibration data. However, the assumption of homoscedasticity is often not considered as a requirement for correct data approximation, which can result in a poor regression fit that is often more prominent in the lower concentration range. Heteroscedasticity in inductively coupled plasma-mass spectrometry (ICP-MS) data has been discussed in literature as an intrinsic problem and was found to be addressed better by the use of weighted least squares (WLS) regression in multiple studies. In this study, the effects of OLS and WLS linear regression models have been investigated for quantitative imaging experiments by means of laser ablation (LA)-ICP-MS using matrix-matched standards. The calibration data produced by this technique was found to be heteroscedastic in all 60 analyzed datasets, which yielded poor regression fits for OLS linear regression. In comparison to conventional ICP-MS analysis, the resulting negative effects were found to become even more visible in imaging LA-ICP-MS due to an inaccurate estimation of the regression line's intercept. Also, the calculation of average concentrations in selected regions of interest (ROIs) yields incorrect quantification results at the lower end of the calibration range. The application of WLS linear regression resulted in an improved goodness of fit (GOF), although the weighting factor should be selected carefully. Besides the reciprocal of the variance of each calibration standard (1/si2), more empirical weighting factors that have been discussed in the literature were also evaluated regarding the GOF.
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Affiliation(s)
- Sabrina K I Funke
- Institute of Inorganic and Analytical Chemistry, University of Münster, Münster 48149, Germany
| | - Michael Sperling
- Institute of Inorganic and Analytical Chemistry, University of Münster, Münster 48149, Germany.,European Virtual Institute for Speciation Analysis (EVISA), Münster 48149, Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Münster 48149, Germany
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Schlatt L, Köhrer A, Factor C, Robert P, Rasschaert M, Sperling M, Karst U. Mild Dissolution/Recomplexation Strategy for Speciation Analysis of Gadolinium from MR Contrast Agents in Bone Tissues by Means of HPLC-ICP-MS. Anal Chem 2021; 93:11398-11405. [PMID: 34387072 DOI: 10.1021/acs.analchem.1c01100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A species-dependent and total gadolinium quantification strategy for the analysis of bone and bone marrow samples was developed and applied to femurs of rats previously treated with different gadolinium-based contrast agents (GBCAs). A combined mild dissolution/recomplexation strategy allows the quantification of total Gd as well as the quantification of intact GBCA in bones within one analysis for the first time. Samples of rat bones and bone marrow were dissolved in low concentrations of hydrochloric acid and diethylenetriamine pentaacetate (DTPA). This is followed by the addition of excess In(III) to recomplex all free ligands, previously added DTPA as well as the ligands of GBCAs that were not stable during the dissolution step. Separation and quantification were carried out by means of high-performance liquid chromatography (HPLC) on a hydrophilic interaction liquid chromatography (HILIC) column with subsequent inductively coupled plasma-mass spectrometry (ICP-MS). The results show that the investigated GBCA with a macrocyclic ligand shows a higher tendency to stay intact in the bone tissues over time, while a GBCA with a linear ligand is decomplexed more rapidly four weeks after GBCA administration. Additionally, for all macrocyclic GBCAs, a similar limited gadolinium accumulation was observed in the bone and bone marrow. Whereas linear GBCAs showed a higher gadolinium accumulation, a difference was observed between bone and bone marrow, indicating a different biodistribution behavior.
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Affiliation(s)
- Lukas Schlatt
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstraße 28/30, 49149 Münster, Germany
| | - Alexander Köhrer
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstraße 28/30, 49149 Münster, Germany
| | - Cécile Factor
- Department of Research and Innovation, Guerbet Group, BP57400, 95943 Roissy CDG, France
| | - Philippe Robert
- Department of Research and Innovation, Guerbet Group, BP57400, 95943 Roissy CDG, France
| | - Marlène Rasschaert
- Department of Research and Innovation, Guerbet Group, BP57400, 95943 Roissy CDG, France
| | - Michael Sperling
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstraße 28/30, 49149 Münster, Germany.,European Virtual Institute for Speciation Analysis (EVISA), c/o IAAC, Corrensstraße 28/30, 48149 Münster, Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstraße 28/30, 49149 Münster, Germany
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MR Imaging Safety Considerations of Gadolinium-Based Contrast Agents: Gadolinium Retention and Nephrogenic Systemic Fibrosis. Magn Reson Imaging Clin N Am 2021; 28:497-507. [PMID: 33040991 DOI: 10.1016/j.mric.2020.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gadolinium (Gd)-based contrast agents (GBCAs) have revolutionized of MR imaging, enabling physicians to obtain life-saving medical information that often cannot be obtained with unenhanced MR imaging or other imaging modalities. Since regulatory approval in 1988, more than 450 million intravenous GBCA doses have been administered worldwide, with an extremely favorable pharmacologic safety profile. Recent evidence has demonstrated, however, that a small fraction of Gd is retained in human tissues. No direct correlation between Gd retention and clinical effects has been confirmed; however, a subset of patients have attributed various symptoms to GBCA exposure. This review details current knowledge regarding GBCA safety.
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Karakatsani ME, Pouliopoulos AN, Liu M, Jambawalikar SR, Konofagou EE. Contrast-Free Detection of Focused Ultrasound-Induced Blood-Brain Barrier Opening Using Diffusion Tensor Imaging. IEEE Trans Biomed Eng 2021; 68:2499-2508. [PMID: 33360980 DOI: 10.1109/tbme.2020.3047575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Focused ultrasound (FUS) has emerged as a non-invasive technique to locally and reversibly disrupt the blood-brain barrier (BBB). Here, we investigate the use of diffusion tensor imaging (DTI) as a means of detecting FUS-induced BBB opening at the absence of an MRI contrast agent. A non-human primate (NHP) was repeatedly treated with FUS and preformed circulating microbubbles to transiently disrupt the BBB (n = 4). T1- and diffusion-weighted MRI scans were acquired after the ultrasound treatment, with and without gadolinium-based contrast agent, respectively. Both scans were registered with a high-resolution T1-weighted scan of the NHP to investigate signal correlations. DTI detected an increase in fractional anisotropy from 0.21 ± 0.02 to 0.38 ± 0.03 (82.6 ± 5.2% change) within the targeted area one hour after BBB opening. Enhanced DTI contrast overlapped by 77.22 ± 9.2% with hyper-intense areas of gadolinium-enhanced T1-weighted scans, indicating diffusion anisotropy enhancement only within the BBB opening volume. Diffusion was highly anisotropic and unidirectional within the treated brain region, as indicated by the direction of the principal diffusion eigenvectors. Polar and azimuthal angle ranges decreased by 35.6% and 82.4%, respectively, following BBB opening. Evaluation of the detection methodology on a second NHP (n = 1) confirmed the across-animal feasibility of the technique. In conclusion, DTI may be used as a contrast-free MR imaging modality in lieu of contrast-enhanced T1 mapping for detecting BBB opening during focused-ultrasound treatment or evaluating BBB integrity in brain-related pathologies.
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Wang X, Guo S, Li Z, Luo Q, Dai Y, Zhang H, Ye Y, Gong Q, Luo K. Amphiphilic branched polymer-nitroxides conjugate as a nanoscale agent for potential magnetic resonance imaging of multiple objects in vivo. J Nanobiotechnology 2021; 19:205. [PMID: 34243760 PMCID: PMC8272293 DOI: 10.1186/s12951-021-00951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/01/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In order to address the potential toxicity of metal-based magnetic resonance imaging (MRI) contrast agents (CAs), a concept of non-metallic MRI CAs has emerged. Currently, paramagnetic nitroxides (such as (2,2,5,5-tetramethylpyrrolidine-1-oxyl, PROXYL), (2,2,6,6-tetramethylpiperidine-1-oxide, TEMPO), etc.) are being extensively studied because their good stability and imaging mechanism are similar to metal-based contrast agents (such as Gd3+ chelate-based clinical CAs). However, a lower relaxivity and rapid in vivo metabolism of nitroxides remain to be addressed. Previous studies have demonstrated that the construction of macromolecular nitroxides contrast agents (mORCAs) is a promising solution through macromolecularization of nitroxides (i.e., use of large molecules to carry nitroxides). Macromolecular effects not only increase the stability of nitroxides by limiting their exposure to reductive substances in the body, but also improve the overall 1H water relaxation by increasing the concentration of nitroxides and slowing the molecular rotation speed. RESULTS Branched pDHPMA-mPEG-Ppa-PROXYL with a high molecular weight (MW = 160 kDa) and a nitroxides content (0.059 mmol/g) can form a nanoscale (~ 28 nm) self-assembled aggregate in a water environment and hydrophobic PROXYL can be protected by a hydrophilic outer layer to obtain strong reduction resistance in vivo. Compared with a small molecular CA (3-Carboxy-PROXYL (3-CP)), Branched pDHPMA-mPEG-Ppa-PROXYL displays three prominent features: (1) its longitudinal relaxivity (0.50 mM- 1 s- 1) is about three times that of 3-CP (0.17 mM- 1 s- 1); (2) the blood retention time of nitroxides is significantly increased from a few minutes of 3-CP to 6 h; (3) it provides long-term and significant enhancement in MR imaging of the tumor, liver, kidney and cardiovascular system (heart and aortaventralis), and this is the first report on nitroxides-based MRI CAs for imaging the cardiovascular system. CONCLUSIONS As a safe and efficient candidate metal-free magnetic resonance contrast agent, Branched pDHPMA-mPEG-Ppa-PROXYL is expected to be used not only in imaging the tumor, liver and kidney, but also the cardiovascular system, which expands the application scope of these CAs.
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Affiliation(s)
- Xiaoming Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, National Clinical Research Center for Geriatrics, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences (UCAS), No. 104 Pipashan Main Street, Yuzhong District, 400014, Chongqing, China
| | - Shiwei Guo
- Department of Pharmacy of the Affiliated Hospital of Southwest Medical University, Southwest Medical University, Sichuan Province, 646000, Luzhou, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, 646000, Luzhou, People's Republic of China
| | - Zhiqian Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, National Clinical Research Center for Geriatrics, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Qiang Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, National Clinical Research Center for Geriatrics, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yan Dai
- Department of Pharmacy of the Affiliated Hospital of Southwest Medical University, Southwest Medical University, Sichuan Province, 646000, Luzhou, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, 646000, Luzhou, People's Republic of China
| | - Hu Zhang
- Amgen Bioprocessing Centre, Keck Graduate Institute Claremont, 91711, Claremont, CA, USA
| | - Yun Ye
- Department of Pharmacy of the Affiliated Hospital of Southwest Medical University, Southwest Medical University, Sichuan Province, 646000, Luzhou, People's Republic of China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, National Clinical Research Center for Geriatrics, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, 610041, Chengdu, China
| | - Kui Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, National Clinical Research Center for Geriatrics, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China.
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, 610041, Chengdu, China.
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Davies J, Marino M, Smith APL, Crowder JM, Larsen M, Lowery L, Castle J, Hibberd MG, Evans PM. Repeat and single dose administration of gadodiamide to rats to investigate concentration and location of gadolinium and the cell ultrastructure. Sci Rep 2021; 11:13950. [PMID: 34230532 PMCID: PMC8260729 DOI: 10.1038/s41598-021-93147-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/21/2021] [Indexed: 01/20/2023] Open
Abstract
Gadolinium based contrast agents (GBCA) are used to image patients using magnetic resonance (MR) imaging. In recent years, there has been controversy around gadolinium retention after GBCA administration. We sought to evaluate the potential toxicity of gadolinium in the rat brain up to 1-year after repeated gadodiamide dosing and tissue retention kinetics after a single administration. Histopathological and ultrastructural transmission electron microscopy (TEM) analysis revealed no findings in rats administered a cumulative dose of 12 mmol/kg. TEM-energy dispersive X-ray spectroscopy (TEM-EDS) localization of gadolinium in the deep cerebellar nuclei showed ~ 100 nm electron-dense foci in the basal lamina of the vasculature. Laser ablation-ICP-MS (LA-ICP-MS) showed diffuse gadolinium throughout the brain but concentrated in perivascular foci of the DCN and globus pallidus with no observable tissue injury or ultrastructural changes. A single dose of gadodiamide (0.6 mmol/kg) resulted in rapid cerebrospinal fluid (CSF) and blood clearance. Twenty-weeks post administration gadolinium concentrations in brain regions was reduced by 16-72-fold and in the kidney (210-fold), testes (194-fold) skin (44-fold), liver (42-fold), femur (6-fold) and lung (64-fold). Our findings suggest that gadolinium does not lead to histopathological or ultrastructural changes in the brain and demonstrate in detail the kinetics of a human equivalent dose over time in a pre-clinical model.
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Affiliation(s)
- Julie Davies
- GE Healthcare, Pollards Wood, Nightingales lane, Chalfont St. Giles, UK.
| | - Michael Marino
- GE Global Research Centre, 1 Research Circle, Niskayuna, NY, USA
| | - Adrian P L Smith
- GE Healthcare, Pollards Wood, Nightingales lane, Chalfont St. Giles, UK
| | - Janell M Crowder
- GE Global Research Centre, 1 Research Circle, Niskayuna, NY, USA
| | - Michael Larsen
- GE Global Research Centre, 1 Research Circle, Niskayuna, NY, USA
| | - Lisa Lowery
- GE Global Research Centre, 1 Research Circle, Niskayuna, NY, USA
| | - Jason Castle
- GE Global Research Centre, 1 Research Circle, Niskayuna, NY, USA
| | | | - Paul M Evans
- GE Healthcare, Pollards Wood, Nightingales lane, Chalfont St. Giles, UK
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21
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Abstract
OBJECTIVES Quantitative T1 relaxometry is the benchmark in imaging potential gadolinium deposition and known to be superior to semiquantitative signal intensity ratio analyses. However, T1 relaxometry studies are rare, commonly limited to a few target structures, and reported results are inconsistent.We systematically investigated quantitative T1 relaxation times (qT1) of a variety of brain nuclei after serial application of gadobutrol. MATERIALS AND METHODS Retrospectively, qT1 measurements were performed in a patient cohort with a mean number of 11 gadobutrol applications (n = 46) and compared with a control group with no prior gadolinium-based contrast agent administration (n = 48). The following target structures were evaluated: dentate nucleus, globus pallidus, thalamus, hippocampus, putamen, caudate, amygdala, and different white matter areas. Subsequently, multivariate regression analysis with adjustment for age, presence of brain metastases and previous cerebral radiotherapy was performed. RESULTS No assessed site revealed a significant correlation between qT1 and number of gadobutrol administrations in multivariate regression analysis. However, a significant negative correlation between qT1 and age was found for the globus pallidus as well as anterior and lateral thalamus (P < 0.05 each). CONCLUSIONS No T1 relaxation time shortening due to gadobutrol injection was found in any of the assessed brain structures after serial administration of 11 doses of gadobutrol.
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Solmaz V, Köse Özlece H, Fatih Bozkurt M, Özkul B, Erbaş O. Repeated gadoteric acid and gadobutrol exposure causes deterioration of behavior and memory functions in rats: MRI, histopathological and biochemical evidence. Brain Res 2021; 1754:147256. [PMID: 33422532 DOI: 10.1016/j.brainres.2020.147256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/23/2020] [Accepted: 12/18/2020] [Indexed: 11/15/2022]
Abstract
Gadolinium-based contrast agents (GBCAs) exert effects in different regions of the brain; however, studies on this topic are mostly focused on radiological outcomes of GBCA exposure. This paper is a preliminary attempt to identify whether there are changes in behavioral, cognitive, histopathological, radiological and biochemical characteristics with repeated exposure to gadobutrol and gadoteric acid. The effects of GBCAs were tested with the assessment of 4 groups -each comprised of 6 rats [controls, gadobutrol, gadoteric acid (Doteram), and gadoteric acid (Clariscan)]. Respective treatments of 0.1 ml/kg were administered for 3 weeks, followed by a recovery period of 1 week without any treatment. At the end of this regimen, behavioral tests (open field and passive learning test) were performed. Additionally, histopathological analysis of the hippocampal CA1 and CA3 regions (GFAP measurement and total neuron count), biochemical measurements [TNF-a, Malondialdehyde (MDA), Superoxide dismutase (SOD), homovalinic acid (HVA) and choline acetyl transferase (ChAT) levels], and radiological findings (MRI-region of interest) were carried out in each group. There was a significant impairment in all groups that had received gadolinium in open field and passive avoidance learning tests. Oxidative stress and inflammation markers were significantly elevated in all gadolinium groups. Additionally, increased hippocampal gliosis and decreased MRI-ROIs were observed in rats exposed to gadolinium. Chronic gadoteric acid and gadobutrol exposure causes hippocampal gliosis and elevates oxidative stress and inflammation in rats. Radiological outcomes are also consistent with these findings. Long-term studies might be required to conclude whether gadolinium deposition in the brain causes subtle neurological deficits.
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Affiliation(s)
- Volkan Solmaz
- Memorial Hizmet Hospital, Neurology Clinic, Istanbul, Turkey.
| | | | | | - Bahattin Özkul
- Demiroğlu Bilim University Medical Faculty, Department of Radiology, Afyon, Turkey
| | - Oytun Erbaş
- Demiroğlu Bilim University Medical School, Department of Physiology, İstanbul, Turkey
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Laniyonu A, Ouyang Y, Cohen J, Awe S, Dina O, Biade S, Hargus S, Kokate T. Nonclinical Product Developmental Strategies, Safety Considerations and Toxicity Profiles of Medical Imaging and Radiopharmaceuticals Products. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bäuerle T, Saake M, Uder M. Gadolinium-based contrast agents: What we learned from acute adverse events, nephrogenic systemic fibrosis and brain retention. ROFO-FORTSCHR RONTG 2020; 193:1010-1018. [PMID: 33348385 DOI: 10.1055/a-1328-3177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Radiologists have been administering gadolinium-based contrast agents (GBCA) in magnetic resonance imaging for several decades, so that there is abundant experience with these agents regarding allergic-like reactions, nephrogenic systemic fibrosis (NSF) and gadolinium retention in the brain. METHODS This review is based on a selective literature search and reflects the current state of research on acute adverse effects of GBCA, NSF and brain retention of gadolinium. RESULTS Due to the frequent use of GBCA, data on adverse effects of these compounds are available in large collectives. Allergic-like reactions occurred rarely, whereas severe acute reactions were very rarely observed. Systemic changes in NSF also occur very rarely, although measures to avoid NSF resulted in a significantly reduced incidence of NSF. Due to gadolinium retention in the body after administration of linear MR contrast agents, only macrocyclic preparations are currently used with few exceptions. Clear clinical correlates of gadolinium retention in the brain could not be identified so far. Although the clinical added value of GBCA is undisputed, individual risks associated with the injection of GBCA should be identified and the use of non-contrast enhanced MR techniques should be considered. Alternative contrast agents such as iron oxide nanoparticles are not clinically approved, but are currently undergoing clinical trials. CONCLUSION GBCA have a very good risk profile with a low rate of adverse effects or systemic manifestations such as NSF. Gadolinium retention in the brain can be minimized by the use of macrocyclic GBCA, although clear clinical correlates due to gadolinium retention in the brain following administration of linear GBCA could not be identified yet. KEY POINTS · Acute adverse effects are predominantly mild/moderate, rarely severe reactions occur.. · International guidelines resulted in significant reduction of nephrogenic systemic fibrosis.. · Application of macrocyclic contrast agents minimizes gadolinium retention in the brain.. CITATION FORMAT · Bäuerle T, Saake M, Uder M. Gadolinium-based contrast agents: What we learned from acute adverse events, nephrogenic systemic fibrosis and brain retention. Fortschr Röntgenstr 2021; 193: 1010 - 1018.
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Affiliation(s)
- Tobias Bäuerle
- Institute of Radiology, University Medical Center, Erlangen, Germany
| | - Marc Saake
- Institute of Radiology, University Medical Center, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Medical Center, Erlangen, Germany
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Abstract
Objectives The purpose of this manuscript is to review the successive regulatory actions and decisions following the initial publication by Kanda and colleagues in 2014 regarding gadolinium retention in the human brain after multiple gadolinium-based contrast agents (GBCAs) administrations. Materials and Methods Starting from 2014, the actions and decisions made by all regulatory authorities were collected and summarized region by region. Volumes of GBCA sales in 2018 per region and main countries are also presented as an indicator of patients’ exposure to those products. Results All regulatory authorities agreed on the absence of evidence of any harmful effect of gadolinium retention in humans. However, based on the same amount of preclinical and clinical evidence available in adults and children, regulatory authorities used different approaches resulting in different actions and decisions regarding the labeling and market authorizations of GBCAs, as well as the specific actions requested to the manufacturers. Conclusions The manufacturers of GBCAs had to face different situations according to the countries, due to the different positions and expectations from regulatory agencies. They have adapted their responses to the different positions of the regulatory agencies and conducted specific preclinical and clinical investigations to provide the expected evidence. It is also their responsibility to continuously monitor the benefit-risk balance of the products and to propose risk minimization measures to the regulatory agencies.
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Detection and imaging of gadolinium accumulation in human bone tissue by micro- and submicro-XRF. Sci Rep 2020; 10:6301. [PMID: 32286449 PMCID: PMC7156386 DOI: 10.1038/s41598-020-63325-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/21/2020] [Indexed: 12/30/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) are frequently used in patients undergoing magnetic resonance imaging. In GBCAs gadolinium (Gd) is present in a bound chelated form. Gadolinium is a rare-earth element, which is normally not present in human body. Though the blood elimination half-life of contrast agents is about 90 minutes, recent studies demonstrated that some tissues retain gadolinium, which might further pose a health threat due to toxic effects of free gadolinium. It is known that the bone tissue can serve as a gadolinium depot, but so far only bulk measurements were performed. Here we present a summary of experiments in which for the first time we mapped gadolinium in bone biopsy from a male patient with idiopathic osteoporosis (without indication of renal impairment), who received MRI 8 months prior to biopsy. In our studies performed by means of synchrotron radiation induced micro- and submicro-X-ray fluorescence spectroscopy (SR-XRF), gadolinium was detected in human cortical bone tissue. The distribution of gadolinium displays a specific accumulation pattern. Correlation of elemental maps obtained at ANKA synchrotron with qBEI images (quantitative backscattered electron imaging) allowed assignment of Gd structures to the histological bone structures. Follow-up beamtimes at ESRF and Diamond Light Source using submicro-SR-XRF allowed resolving thin Gd structures in cortical bone, as well as correlating them with calcium and zinc.
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Rasschaert M, Weller RO, Schroeder JA, Brochhausen C, Idée JM. Retention of Gadolinium in Brain Parenchyma: Pathways for Speciation, Access, and Distribution. A Critical Review. J Magn Reson Imaging 2020; 52:1293-1305. [PMID: 32246802 PMCID: PMC7687192 DOI: 10.1002/jmri.27124] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/21/2022] Open
Abstract
The unexpected appearance of T1 hyperintensities, mostly in the dentate nucleus and the globus pallidus, during nonenhanced MRI was reported in 2014. This effect is associated with prior repeated administrations of gadolinium (Gd)‐based contrast agents (GBCAs) in patients with a functional blood–brain barrier (BBB). It is widely assumed that GBCAs do not cross the intact BBB, but the observation of these hypersignals raises questions regarding this assumption. This review critically discusses the mechanisms of Gd accumulation in the brain with regard to access pathways, Gd species, tissue distribution, and subcellular location. We propose the hypothesis that there is early access of Gd species to cerebrospinal fluid, followed by passive diffusion into the brain parenchyma close to the cerebral ventricles. When accessing areas rich in endogenous metals or phosphorus, the less kinetically stable GBCAs would dissociate, and Gd would bind to endogenous macromolecules, and/or precipitate within the brain tissue. It is also proposed that Gd species enter the brain parenchyma along penetrating cortical arteries in periarterial pial‐glial basement membranes and leave the brain along intramural peri‐arterial drainage (IPAD) pathways. Lastly, Gd/GBCAs may access the brain parenchyma directly from the blood through the BBB in the walls of capillaries. It is crucial to distinguish between the physiological distribution and drainage pathways for GBCAs and the possible dissociation of less thermodynamically/kinetically stable GBCAs that lead to long‐term Gd deposition in the brain. Level of Evidence 5. Technical Efficacy Stage 3.
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Affiliation(s)
| | - Roy O Weller
- Neuropathology, Faculty of Medicine University of Southampton, Southampton General Hospital, Southampton, UK
| | - Josef A Schroeder
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | | | - Jean-Marc Idée
- Guerbet, Research and Innovation Division, Aulnay-sous-Bois, France
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Gadolinium Retention in Erythrocytes and Leukocytes From Human and Murine Blood Upon Treatment With Gadolinium-Based Contrast Agents for Magnetic Resonance Imaging. Invest Radiol 2020; 55:30-37. [DOI: 10.1097/rli.0000000000000608] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Age, But Not Repeated Exposure to Gadoterate Meglumine, Is Associated With T1- and T2-Weighted Signal Intensity Changes in the Deep Brain Nuclei of Pediatric Patients. Invest Radiol 2019; 54:537-548. [DOI: 10.1097/rli.0000000000000564] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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30
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Chehabeddine L, Al Saleh T, Baalbaki M, Saleh E, Khoury SJ, Hannoun S. Cumulative administrations of gadolinium-based contrast agents: risks of accumulation and toxicity of linear vs macrocyclic agents. Crit Rev Toxicol 2019; 49:262-279. [DOI: 10.1080/10408444.2019.1592109] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Lara Chehabeddine
- Department of Biology, American University of Beirut, Beirut, Lebanon
| | - Tala Al Saleh
- Department of Physics, American University of Beirut, Beirut, Lebanon
| | - Marwa Baalbaki
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eman Saleh
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J. Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- Abu-Haidar Neuroscience Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- Abu-Haidar Neuroscience Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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