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Deng G, Chen X, Shao L, Wu Q, Wang S. Effectiveness and safety of 99Tc-methylene diphosphonate as a disease-modifying anti-rheumatic drug (DMARD) in combination with conventional synthetic (cs) DMARDs in the treatment of rheumatoid arthritis: A systematic review and meta-analysis of 34 randomized controlled trials. Heliyon 2023; 9:e21691. [PMID: 37942155 PMCID: PMC10628711 DOI: 10.1016/j.heliyon.2023.e21691] [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: 06/13/2023] [Revised: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
Background Technetium [99Tc] methylene diphosphonate injection (99Tc-MDP) is widely used for the treatment of rheumatoid arthritis (RA), but there is still insufficient evidence for its application. Through the utilization of meta-analysis and systematic reviews, this study aimed to evaluate the effectiveness and safety of 99 TC-MDP in combination with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) for RA. Methods This study was registered on PROSPERO in advance (CRD42021220780). A systematic search was conducted in PubMed, Embase, the Cochrane Library, and multiple international public databases from their inception to April 2023 to identify clinical randomized controlled trials exploring the use of 99Tc-MDP combined with csDMARDs in the treatment of RA. Each outcome was subjected to meta-analysis, and the quality of evidence was assessed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The American College of Rheumatology's 50 %/70 % response criteria scores (ACR50/70) scores were utilized as the primary effectiveness outcomes, and risks were measured by assessing the rates of AEs. Moreover, secondary efficacy outcomes were evaluated, including the Disease Activity Score 28 (DAS28) and bone mineral density (BMD) as joint function indicators and the erythrocyte sedimentation rate (ESR) and interleukin-17 (IL-17) as inflammatory indicators. Results In this meta-analysis, a total of 34 studies (2296 patients) were included out of 1149 retrieved studies. The summarized results showed that the treatment group treated with the combination of 99Tc-MDP and csDMARDs had significantly higher ACR50 (RR = 1.32, 95 % CI: 1.13-1.55, P = 0.0004) and ACR70 (RR = 1.40, 95 % CI: 1.07-1.82, P = 0.01) scores than the control group receiving csDMARDs alone. In addition, the overall incidence of AEs was lower with the combination of 99Tc-MDP and csDMARDs than with csDMARDs alone (RR = 0.75, 95 % CI: 0.60-0.93, P = 0.009), but the possibility of phlebitis was higher in the treatment group (RR = 4.15, 95 % CI: 1.04-16.50, P = 0.04). In addition, the combination of 99Tc-MDP and csDMARDs had advantages over csDMARDs alone in improving DAS28 (WMD = 1.56, 95 % CI: 0.86-2.25, P < 0.0001), BMD (SMD = 1.12, 95 % CI 0.46-1.78, P = 0.0008), ESR (SMD = 0.71, 95 % CI 0.45-0.97, P < 0.00001), and IL-17 (WMD = 5.82, 95 % CI 3.86-7.77, P < 0.00001). However, the above results might have been influenced by the 99Tc-MDP dosage, csDMARD category, and treatment duration. Combining methotrexate and leflunomide, administering continuous treatment for 24 weeks, or using 3 sets of 99Tc-MDP doses (16.5 mg) may be the optimal 99Tc-MDP treatment plan for RA. Conclusion Compared with csDMARD therapy alone, the combination therapy with 99Tc-MDP is more effective for RA patients and is associated with a lower overall incidence of adverse events, although the possibility of phlebitis was higher. However, due to the inherent limitations of the included RCTs, high-quality clinical trials are still needed to further assess the effectiveness and safety of this combination therapy.
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Affiliation(s)
- Guoqian Deng
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Xinyi Chen
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Le Shao
- The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Qibiao Wu
- State Key Laboratory of Quality Research in Chinese Medicines and Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, China
- Zhuhai MUST Science and Technology Research Institute, Zhuhai, Guangdong, China
| | - Shenzhi Wang
- The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
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Xie J, Yuan X, Mao W, Cai H, Gao K, Lv Z, Wang H, Ma C. 99Tc-Methylene Diphosphonate Treatment is Safe and Efficacious for Osteoporosis in Postmenopausal Differentiated Thyroid Cancer Patients Undergoing TSH Suppression: A Three-Center Non-Randomized Clinical Study. Cancer Manag Res 2022; 14:995-1005. [PMID: 35283644 PMCID: PMC8906701 DOI: 10.2147/cmar.s354471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the effects of 99Tc-methylene diphosphonate (99Tc-MDP) on osteoporosis (OS) in postmenopausal patients with differentiated thyroid cancer (DTC) under thyroid stimulating hormone (TSH) suppression. Patients and Methods Patients (n = 142) were divided into two groups: (1) 99Tc-MDP (n = 70) and (2) alendronate (n = 72) treatments (NCT 02304757). Bone mineral density (BMD) in the lumbar spine and hip was evaluated by DXA, along with bone turnover markers, safety, and quality of life (QOL) using SF-36 at three time points: before treatment and at 6 and/or 12 months after treatment. Results The percentage change of BMD in total lumbar spine or hip showed no significant difference throughout the study (P > 0.025). 99Tc-MDP and alendronate treatment alone significantly increased BMD in the lumbar spine, but alendronate treatment also significantly increased BMD in total hip at 6 and 12 months, as compared with the baseline. There were no significant differences in the results of the SF-36 scores between the two treatment groups at any time during the whole study period. 99Tc-MDP significantly increased bone formation markers of osteocalcin at 6 and 12 months (P all < 0.05), PINP at 12 months (P = 0.001), and bone resorption markers of β-CTX at 6 and 12 months (p < 0.05) as compared with the alendronate treated group. No adverse event was observed in the 99Tc-MDP treatment group compared with alendronate (P = 0.014). Conclusion 99Tc-MDP was as efficacious as alendronate in the improvement of lumbar BMD for DTC patients with OS under TSH stimulation. 99Tc-MDP was shown to be safe and improved patients’ QOL.
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Affiliation(s)
- Jianhao Xie
- Department of Nuclear Medicine, Tenth People’s Hospital of Tongji University, Shanghai, People’s Republic of China
- Department of Orthopaedic, Beijing Jishuitan Hospital, Beijing, People’s Republic of China
| | - XueYu Yuan
- Department of Nuclear Medicine, Tenth People’s Hospital of Tongji University, Shanghai, People’s Republic of China
| | - Weiqing Mao
- Department of Nuclear Medicine, Tenth People’s Hospital of Tongji University, Shanghai, People’s Republic of China
| | - Haidong Cai
- Department of Nuclear Medicine, Tenth People’s Hospital of Tongji University, Shanghai, People’s Republic of China
| | - Kejia Gao
- Department of Nuclear Medicine, Shanghai No. 4 People’s Hospital, Shanghai, People’s Republic of China
| | - Zhongwei Lv
- Department of Nuclear Medicine, Tenth People’s Hospital of Tongji University, Shanghai, People’s Republic of China
- Correspondence: Zhongwei Lv; Chao Ma, Tel/Fax +86-21-66302075, Email ;
| | - Hui Wang
- Department of Nuclear Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Chao Ma
- Department of Nuclear Medicine, Tenth People’s Hospital of Tongji University, Shanghai, People’s Republic of China
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Shen S, Wang W, Yang C, Xu B, Zeng L, Qian Y. Effect of technetium-99 conjugated with methylene diphosphonate ( 99 Tc-MDP) on OPG/RANKL/RANK system in vitro. J Oral Pathol Med 2018; 48:129-135. [PMID: 30421571 DOI: 10.1111/jop.12801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND RANKL and RANK play an important role in jaw resorption during the development of the ameloblastomas. Therefore, the aim of this study was to explore the effect of 99 Tc-MDP on OPG/RANKL/RANK system on RAW264.7 and MC3T3-E1 cell lines in vitro and provide the theoretical basis for the clinical treatment of the jaw ameloblastoma. METHODS Different concentrations of 99 Tc-MDP were used to treat RAW264.7 and MC3T3-E1 cell lines. The cell proliferative inhibition rate was analyzed by CCK-8. Cell apoptosis and cell cycle were detected by flow cytometry. Western blot was used to detect the expression of OPG, RANKL, and RANK. RESULTS Treatment of RAW264.7 cell lines with different concentrations of 99 Tc-MDP had inhibitory effects and decreased the expression of RANK protein. The cell proliferation of 99 Tc-MDP on MC3T3-E1 cell lines was stronger at 48 hours than at 24 hours except for 100 μg/mL concentration group. Compared with the concentration of 0.01 μg/mL, the treatment of MC3T3-E1 cells with 100 μg/mL 99 Tc-MDP showed that the cell proliferative effect decreased at 24 hours and 48 hours (P < 0.05). After treatment with 0.01 μg/mL 99 Tc-MDP, the expression of OPG in MC3T3-E1 cells was significantly increased (P < 0.05). Compared with 0.01 μg/mL, the expression of RANKL was decreased after treatment with 100 μg/mL 99 Tc-MDP (P < 0.05). CONCLUSION 99 Tc-MDP can induce apoptosis of RAW264.7 cells and inhibit the expression of RANK protein. The effect of 0.01 μg/mL of low concentration of 99 Tc-MDP can promote the proliferation of MC3T3-E1 cells and increase the expression of OPG and RANKL protein. 99 Tc-MDP may have adjuvant therapeutic effects on the treatment of jaw ameloblastoma.
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Affiliation(s)
- Shiying Shen
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China.,Department of Stomatology, Lincang People's Hospital, Lincang, China
| | - Weihong Wang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - Chun Yang
- Department of Oral Anatomy and Pathology of Kunming Medical University, Kunming, China
| | - Biao Xu
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - Ling Zeng
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
| | - Yemei Qian
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Kunming Medical University, Kunming, China
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Chen J, Lan Y, He Y, He C, Xu F, Zhang Y, Zhao Y, Liu Y. 99Tc-MDP-induced human osteoblast proliferation, differentiation and expression of osteoprotegerin. Mol Med Rep 2017; 16:1801-1809. [PMID: 28656306 PMCID: PMC5562099 DOI: 10.3892/mmr.2017.6839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/07/2016] [Indexed: 02/05/2023] Open
Abstract
The aim of the present study was to examine the influence of technetium methylenediphosphonate (99Tc-MDP) on the proliferation and differentiation of human osteoblasts. Human iliac cancellous bone was isolated and cultured with either 99Tc-MDP, β fibroblast growth factor (as a positive control) or medium only (as a negative control). Proliferation was assessed by direct cell counting, CCK-8 assay and bromodeoxyuridine staining. The cell cycle and rate of apoptosis was assessed by propidium iodide staining and flow cytometry. Alkaline phosphatase (ALP) activity was assessed by the p-nitrophenyl phosphate method and mineralized nodules were stained with Alizarin Red. Expression of osteocalcin (OCN) and bone morphogenetic protein-2 (BMP-2) was assessed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and expression levels of osteoprotegerin (OPG) and receptor activator of NF-κB ligand (RANKL) were assessed by RT-qPCR and ELISA. Isolated human osteoblasts stained positively for ALP and developed mineralized nodules. Treatment with 10−5-10−10 M 99Tc-MDP enhanced proliferation and 48 h incubation with 10−8 M 99Tc-MDP increased the proportion of cells in S-phase, decreased the proportion in G0/G1 phase, and increased the cell proliferation index. The rate of apoptosis also increased, but the increase was not significant. Cells incubated with 10−6-10−9 M 99Tc-MDP for 3–9 days exhibited increased ALP activity and mineralized nodule development. 10−8 M 99Tc-MDP increased BMP-2 and OPG expression levels and OPG secretion, but OCN mRNA expression levels and RANKL secretion were not significantly altered at 72 h. 99Tc-MDP treatment induced osteoblast proliferation and differentiation without affecting apoptosis. These findings provide proof of concept for the future use of 99Tc-MDP in the treatment of bone-destructive diseases.
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Affiliation(s)
- Jie Chen
- Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Youyu Lan
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Sichuan Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yue He
- Department of Ophthalmology, The First Affiliated Hospital of Sichuan Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Chengsong He
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Sichuan Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Fen Xu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Sichuan Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yugao Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Sichuan Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yi Zhao
- Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Mu R, Liang J, Sun L, Zhang Z, Liu X, Huang C, Zhu P, Zuo X, Gu J, Li X, Li X, Liu Y, Feng P, Li Z. A randomized multicenter clinical trial of 99 Tc-methylene diphosphonate in treatment of rheumatoid arthritis. Int J Rheum Dis 2017; 21:161-169. [PMID: 29356462 DOI: 10.1111/1756-185x.12934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To investigate the efficacy and safety of technetium-99 conjugated with methylene diphosphonate (99 Tc-MDP, Yunke Pharmaceutical industry) in the treatment of rheumatoid arthritis (RA). METHODS A total of 120 patients with active RA were randomly divided into three groups: Group A (receiving oral meloxicam tablets); Group B (receiving intravenous drip of 99 TC-MDP); Group C (receiving combination treatment of intravenous drip of 99 Tc-MDP and oral meloxicam tablets). The main clinical and laboratory parameters were evaluated at baseline and after 14 days of therapy. RESULTS After 14 days of treatment, American College of Rheumatology 20 response was 15.62%, 34.04% and 48.78% in the three groups, respectively. The incidence of adverse events in three groups were 3.13%, 8.51% and 9.76% respectly, and has no significant difference. In addition, biochemical markers of bone metabolism including bone alkaline phosphatase (BAP), tartrate resistant acid phosphatase (TRAP) and dickkopf-1 (DKK-1), all improved in the three groups, although more significant in Group B than Group A, and more significant in the combination group than monotherapy groups. CONCLUSION 99 Tc-MDP has good efficacy and safety in the treatment of active RA patients; the benefit was more remarkable when 99 Tc-MDP was combined with NSAIDs. 99 Tc-MDP may also have potential to improve bone metabolism.
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Affiliation(s)
- Rong Mu
- Department of Rheumatology & Immunology, Peking University People's Hospital, Beijing, China
| | - Jun Liang
- Department of Rheumatology & Immunology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Lingyun Sun
- Department of Rheumatology & Immunology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhuoli Zhang
- Department of Rheumatology & Immunology, Peking University First Hospital, Beijing, China
| | - Xiangyuan Liu
- Department of Rheumatology & Immunology, Peking University Third Hospital, Beijing, China
| | - Cibo Huang
- Department of Rheumatology & Immunology, Beijing Hospital, Beijing, China
| | - Ping Zhu
- Department of Rheumatology & Immunology, Xijing Hospital, Xijing, China
| | - Xiaoxia Zuo
- Department of Rheumatology & Immunology, Xiangya Hospital Central South University, Changsha, China
| | - Jieruo Gu
- Department of Rheumatology & Immunology, The Third Affiliated Hospital, Sun Yat-Sen University, Anhui, China
| | - Xiangpei Li
- Department of Rheumatology & Immunology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Xingfu Li
- Department of Rheumatology & Immunology, Qilu Hospital of Shandong University, Chengdu, Sichuan, China
| | - Yi Liu
- Department of Rheumatology & Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ping Feng
- Institute of Clinical Trials, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhanguo Li
- Department of Rheumatology & Immunology, Peking University People's Hospital, Beijing, China
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Wu Q, Ni Y, Yang Q, Sun H. 99Tc-MDP treatment for the therapy of rheumatoid arthritis, choroidal neovascularisation and Graves' ophthalmopathy. Biomed Rep 2016; 4:400-402. [PMID: 27073620 DOI: 10.3892/br.2016.609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/16/2016] [Indexed: 12/13/2022] Open
Abstract
Technetium 99 conjugated with methylene diphosphonate, which is an anti-inflammatory drug, can inhibit macrophage infiltration and downregulate a number of proinflammatory cytokines, such as tumor necrosis factor-α and interleukin-1β. Recently, numerous studies have indicated that it could improve rheumatoid arthritis (RA) activity by upregulating the frequency of peripheral γδ T cells and cluster of differentiation CD4+CD25+Foxp3+ Tregs, affecting the serum cytokine environment, inhibiting osteoclast formation and reducing the concentrations of rheumatoid factor-immunoglobulin M (IgM)/IgG/IgA. As well, it may have a therapeutic role for choroidal neovascularisation (CNV) and Graves' ophthalmopathy (GO). Therefore, it will be a valuable choice in the treatment of RA, CNV and GO.
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Affiliation(s)
- Qian Wu
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yang Ni
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Qingrui Yang
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Hongsheng Sun
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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Gong W, Hu E, Dou H, Song Y, Yang L, Ji J, Li E, Tan R, Hou Y. A novel 1,2-benzenediamine derivative FC-99 suppresses TLR3 expression and ameliorates disease symptoms in a mouse model of sepsis. Br J Pharmacol 2014; 171:4866-78. [PMID: 24903157 DOI: 10.1111/bph.12797] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 05/13/2014] [Accepted: 05/28/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Sepsis is a clinical condition characterized by overwhelming systemic inflammation with high mortality rate and high prevalence, but effective treatment is still lacking. Toll-like receptor 3 (TLR3) is an endogenous sensor, thought to regulate the amplification of immune response during sepsis. Modulators of TLR3 have an advantage in the treatment of sepsis. Here, we aimed to explore the mechanism of a monosubstituted 1,2-benzenediamine derivative FC-99 {N(1) -[(4-methoxy)methyl]-4-methyl-1,2-benzenediamine}on modulating TLR3 expression and its therapeutic potential on mouse model of sepsis. EXPERIMENTAL APPROACH Cells were pretreated with FC-99 followed by poly(I:C) or IFN-α stimulation; TLR3 and other indicators were assayed. Female C57BL/6 mice were subjected to sham or caecal ligation puncture (CLP) surgery after i.p. injection of vehicle or FC-99; serum and tissues were collected for further experiments. KEY RESULTS FC-99 suppressed inflammatory response induced by poly(I:C) with no effect on cell viability or uptake of poly(I:C). FC-99 also inhibited TLR3 expression induced by not only poly(I:C) but also by exogenous IFN-α. This inhibition of FC-99 was related to the poly(I:C)-evoked IRF3/IFN-α/JAK/STAT1 signalling pathway. In CLP-induced model of sepsis, FC-99 administration decreased mice mortality and serum levels of inflammatory factors, attenuated multiple organ dysfunction and enhanced bacterial clearance. Accordingly, systemic and local expression of TLR3 was reduced by FC-99 in vivo. CONCLUSION AND IMPLICATIONS FC-99 reversed TLR3 expression and ameliorate CLP-induced sepsis in mice. Thus, FC-99 will be a potential therapeutic candidate for sepsis.
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Affiliation(s)
- Wei Gong
- The State Key Laboratory of Pharmaceutical Biotechnology, Division of Immunology, Medical School, Nanjing University, Nanjing, China
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