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Tyagi P, Moon CH, Connell M, Ganguly A, Cho KJ, Tarin T, Dhir R, Sholosh B, Maranchie J. Intravesical Contrast-Enhanced MRI: A Potential Tool for Bladder Cancer Surveillance and Staging. Curr Oncol 2023; 30:4632-4647. [PMID: 37232808 PMCID: PMC10217503 DOI: 10.3390/curroncol30050350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
This review article gives an overview of the current state of the art of bladder cancer imaging and then discusses in depth the scientific and technical merit of a novel imaging approach, tracing its evolution from murine cancer models to cancer patients. While the poor resolution of soft tissue obtained by widely available imaging options such as abdominal sonography and radiation-based CT leaves them only suitable for measuring the gross tumor volume and bladder wall thickening, dynamic contrast-enhanced magnetic resolution imaging (DCE MRI) is demonstrably superior in resolving muscle invasion. However, major barriers still exist in its adoption. Instead of injection for DCE-MRI, intravesical contrast-enhanced MRI (ICE-MRI) instills Gadolinium chelate (Gadobutrol) together with trace amounts of superparamagnetic agents for measurement of tumor volume, depth, and aggressiveness. ICE-MRI leverages leaky tight junctions to accelerate passive paracellular diffusion of Gadobutrol (604.71 Daltons) by treading the paracellular ingress pathway of fluorescein sodium and of mitomycin (<400 Daltons) into bladder tumor. The soaring cost of diagnosis and care of bladder cancer could be mitigated by reducing the use of expensive operating room resources with a potential non-surgical imaging option for cancer surveillance, thereby reducing over-diagnosis and over-treatment and increasing organ preservation.
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Affiliation(s)
- Pradeep Tyagi
- Department of Urology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Ganguly A, Tyagi S, Chermansky C, Kanai A, Beckel J, Hashimoto M, Cho KJ, Chancellor M, Kaufman J, Yoshimura N, Tyagi P. Treating Lower Urinary Tract Symptoms in Older Adults: Intravesical Options. Drugs Aging 2023; 40:241-261. [PMID: 36879156 PMCID: PMC11167658 DOI: 10.1007/s40266-023-01009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 03/08/2023]
Abstract
This article provides an overview of the diagnosis and the treatment of lower urinary tract symptoms in older adults complicated by the neurodegenerative changes in the micturition reflex and further confounded by age-related decline in hepatic and renal clearance raising the propensity of adverse drug reactions. The first-line drug treatment for lower urinary tract symptoms, orally administered antimuscarinics, fails to reach the equilibrium dissociation constant of muscarinic receptors even at their maximum plasma concentration and tends to evoke a half-maximal response at a muscarinic receptor occupancy of just 0.206% in the bladder with a minimal difference from exocrine glands, which raises the adverse drug reaction risk. On the contrary, intravesical antimuscarinics are instilled at concentrations 1000-fold higher than the oral maximum plasma concentration and the equilibrium dissociation constant erects a downhill concentration gradient that drives passive diffusion and achieves a mucosal concentration around ten-fold lower than the instilled concentration for a long-lasting occupation of muscarinic receptors in mucosa and sensory nerves. A high local concentration of antimuscarinics in the bladder triggers alternative mechanisms of action and is supposed to engage retrograde transport to nerve cell bodies for neuroplastic changes that underlie a long-lasting therapeutic effect, while an intrinsically lower systemic uptake of the intravesical route lowers the muscarinic receptor occupancy of exocrine glands to lower the adverse drug reaction relative to the oral route. Thus, the traditional pharmacokinetics and pharmacodynamics of oral treatment are upended by intravesical antimuscarinics to generate a dramatic improvement (~ 76%) noted in a meta-analysis of studies enrolling children with neurogenic lower urinary tract symptoms on the primary endpoint of maximum cystometric bladder capacity as well as the secondary endpoints of filling compliance and uninhibited detrusor contractions. The therapeutic success of intravesical multidose oxybutynin solution or oxybutynin entrapped in the polymer for sustained release in the pediatric population bodes well for patients with lower urinary tract symptoms at the other extreme of the age spectrum. Though generally used to predict oral drug absorption, Lipinski's rule of five can also explain the ten-fold lower systemic uptake from the bladder of positively charged trospium over oxybutynin, a tertiary amine. Chemodenervation by an intradetrusor injection of onabotulinumtoxinA is merited for patients with idiopathic overactive bladder discontinuing oral treatment because of a lack of efficacy. However, age-related peripheral neurodegeneration potentiates the adverse drug reaction risk of urinary retention that motivates the quest of liquid instillation, delivering larger fraction of onabotulinumtoxinA to the mucosa as opposed to muscle by an intradetrusor injection can also probe the neurogenic and myogenic predominance of idiopathic overactive bladder. Overall, the treatment paradigm of lower urinary tract symptoms in older adults should be tailored to individual's overall health status and the risk tolerance for adverse drug reactions.
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Affiliation(s)
- Anirban Ganguly
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Shachi Tyagi
- Department of Medicine, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Christopher Chermansky
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Anthony Kanai
- Department of Medicine, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Jonathan Beckel
- Department of Pharmacology, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Mamoru Hashimoto
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Kang Jun Cho
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | | | | | - Naoki Yoshimura
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Pradeep Tyagi
- Department of Urology, E313 Montefiore Hospital, University of Pittsburgh, 3459 Fifth Ave, Pittsburgh, PA, 15213, USA.
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Chen J, Liu J, Xu D, Liu J, Chen X, Yang S, Yin P, Jiang Z, Mei C, Zhang X, Wang L, Zhang K, Zhou B, Shan H, Li D, Pang P. Lu 3+-based nanoprobe for virtual non-contrast CT imaging of hepatocellular carcinoma. J Control Release 2022; 349:327-337. [PMID: 35787917 DOI: 10.1016/j.jconrel.2022.06.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/02/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
Transcatheter arterial chemoembolization (TACE), the mainstream treatment for hepatocellular carcinoma (HCC), is a method of blocking tumor blood vessels with a mixture of lipiodol and chemotherapeutics. And the contrast-enhanced computed tomography (CT) is the commonly used way for follow-up of HCC after TACE. However, it is noteworthy that when lipiodol deposition plays an embolic effect, it also produces high-density artifacts in CT images. These artifacts usually conceal the enhancement effect of iodine contrast agents. As a result, the residual region is difficult to be visualized. To overcome this obstacle, we developed one kind of Lu3+/Gd3+ doped fluoride nanoprobe modified with Dp-PEG2000 to realize CT/MRI dual-modality imaging of HCC. Compared with lipiodol or ioversol, the obtained PEGylated product LG-PEG demonstrated a greater density value in high keV CT images. In vitro experiments showed the lipiodol artifacts can be removed in virtual non-contrast (VNC) imaging, but the density of ioversol was also removed at the same time. However, the LG-PEG synthesized in this work can still maintain a high density in VNC imaging, which indicates that LG-PEG can exploit its advantages to the full in VNC imaging. Furthermore, LG-PEG successfully exerted tumor enhancement effects in the in vivo VNC images of HCC with lipiodol deposition. In addition, LG-PEG exhibited a strong T2 enhancement effect with low biological toxicity and less side-effect on the main organ and blood. Thus, the LG-PEG reported in this research can serve as an effective and safe VNC contrast agent for HCC imaging after TACE.
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Affiliation(s)
- Jiayao Chen
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Jiani Liu
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Duo Xu
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Junfeng Liu
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Xiaojun Chen
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Shuai Yang
- The Cancer Center of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Pan Yin
- Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Zebo Jiang
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Chaoming Mei
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Xiaoting Zhang
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Lizhu Wang
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Ke Zhang
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China
| | - Bin Zhou
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Center of Cerebrovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China.
| | - Hong Shan
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China.
| | - Dan Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China.
| | - Pengfei Pang
- Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China; Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519000, China.
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Saito T, Hitchens TK, Foley LM, Singh N, Mizoguchi S, Kurobe M, Gotoh D, Ogawa T, Minagawa T, Ishizuka O, Chermansky C, Kaufman J, Yoshimura N, Tyagi P. Functional and histologic imaging of urinary bladder wall after exposure to psychological stress and protamine sulfate. Sci Rep 2021; 11:19440. [PMID: 34593876 PMCID: PMC8484474 DOI: 10.1038/s41598-021-98504-9] [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: 02/18/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
To quantify the urinary bladder wall T1 relaxation time (T1) before and after the instillation contrast mixture in rats previously subjected to water avoidance stress (WAS) and/or acute exposure to protamine sulfate (PS). Female Wistar rats were randomized to receive either sham (control) or 1 h of WAS for ten consecutive days before the evaluation of nocturnal urination pattern in metabolic cages. T1 mapping of urinary bladder wall at 9.4 T was performed pre- and post- instillation of 4 mM Gadobutrol in a mixture with 5 mM Ferumoxytol. Subsequently, either T1 mapping was repeated after brief intravesical PS exposure or the animals were sacrificed for histology and analyzing the mucosal levels of mRNA. Compared to the control group, WAS exposure decreased the single void urine volume and shortened the post-contrast T1 relaxation time of mucosa- used to compute relatively higher ingress of instilled Gadobutrol. Compromised permeability in WAS group was corroborated by the urothelial denudation, edema and ZO-1 downregulation. PS exposure doubled the baseline ingress of Gadobutrol in both groups. These findings confirm that psychological stress compromises the paracellular permeability of bladder mucosa and its non-invasive assay with MRI was validated by PS exposure.
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Affiliation(s)
- Tetsuichi Saito
- Department of Urology, School of Medicine, University of Pittsburgh, E313 Montefiore Hospital, 3459 Fifth Avenue, Pittsburgh, PA, USA
- Department of Urology, Shinshu University, Matsumoto, Japan
| | - T Kevin Hitchens
- Animal Imaging Center, University of Pittsburgh, Pittsburgh, USA
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, USA
| | - Lesley M Foley
- Animal Imaging Center, University of Pittsburgh, Pittsburgh, USA
| | - Nishant Singh
- Department of Urology, School of Medicine, University of Pittsburgh, E313 Montefiore Hospital, 3459 Fifth Avenue, Pittsburgh, PA, USA
| | - Shinsuke Mizoguchi
- Department of Urology, School of Medicine, University of Pittsburgh, E313 Montefiore Hospital, 3459 Fifth Avenue, Pittsburgh, PA, USA
| | - Masahiro Kurobe
- Department of Urology, School of Medicine, University of Pittsburgh, E313 Montefiore Hospital, 3459 Fifth Avenue, Pittsburgh, PA, USA
| | - Daisuke Gotoh
- Department of Urology, School of Medicine, University of Pittsburgh, E313 Montefiore Hospital, 3459 Fifth Avenue, Pittsburgh, PA, USA
| | - Teruyuki Ogawa
- Department of Urology, Shinshu University, Matsumoto, Japan
| | | | - Osamu Ishizuka
- Department of Urology, Shinshu University, Matsumoto, Japan
| | - Christopher Chermansky
- Department of Urology, School of Medicine, University of Pittsburgh, E313 Montefiore Hospital, 3459 Fifth Avenue, Pittsburgh, PA, USA
| | | | - Naoki Yoshimura
- Department of Urology, School of Medicine, University of Pittsburgh, E313 Montefiore Hospital, 3459 Fifth Avenue, Pittsburgh, PA, USA
| | - Pradeep Tyagi
- Department of Urology, School of Medicine, University of Pittsburgh, E313 Montefiore Hospital, 3459 Fifth Avenue, Pittsburgh, PA, USA.
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