Imaging brain tumors with ferumoxtran-10, a nanoparticle magnetic resonance contrast agent

Brain Tumor Diagnostics and Therapeutics with Superparamagnetic Ferrite Nanoparticles

Ferrite nanoparticles (F-NPs) can transform both cancer diagnostics and therapeutics. Superparamagnetic F-NPs exhibit high magnetic moment and susceptibility such that in presence of a static magnetic field transverse relaxation rate of water protons for MRI contrast is augmented to locate F-NPs (i.e., diagnostics) and exposed to an alternating magnetic field local temperature is increased to induce tissue necrosis (i.e., thermotherapy). F-NPs are modified by chemical synthesis of mixed spinel ferrites as well as their size, shape, and coating. Purposely designed drug-containing nanoparticles (D-NPs) can slowly deliver drugs (i.e., chemotherapy). Convection-enhanced delivery (CED) of D-NPs with MRI guidance improves glioblastoma multiforme (GBM) treatment. MRI monitors the location of chemotherapy when D-NPs and F-NPs are coadministered with CED. However superparamagnetic field gradients produced by F-NPs complicate MRI readouts (spatial distortions) and MRS (extensive line broadening). Since extracellular pH (pH_e) is a cancer hallmark, pH_e imaging is needed to screen cancer treatments. Biosensor imaging of redundant deviation in shifts (BIRDS) extrapolates pH_e from paramagnetically shifted signals and the pH_e accuracy remains unaffected by F-NPs. Hence effect of both chemotherapy and thermotherapy can be monitored (by BIRDS), whereas location of F-NPs is revealed (by MRI). Smarter tethering of nanoparticles and agents will impact GBM theranostics.

Metal Nanoparticles as Targeted Carriers Circumventing the Blood-Brain Barrier

Metal nanoparticles have been proposed as a carrier and a therapeutic agent in biomedical field because of their unique physiochemical properties. Due to these physicochemical properties, they can be used in different fields of biomedicine. In relation to this, plasmonic nanoparticles can be used for detection and photothermal destruction of tumor cells or toxic protein aggregates, and magnetic iron nanoparticles can be used for imaging and for hyperthermia of tumor cells. In addition, both therapy and imaging can be combined in one nanoparticle system, in a process called theranostics. Metal nanoparticles can be synthesized to modulate their size and shape, and conjugated with different ligands, which allow their application in drug delivery, diagnostics, and treatment of central nervous system diseases. This review is focused on the potential applications of metal nanoparticles and their capability to circumvent the blood-brain barrier (BBB). Although many articles have demonstrated delivery of metal nanoparticles to the brain by crossing the BBB after systemic administration, the percentage of the injected dose that reaches this organ is low in comparison to others, especially the liver and spleen. In connection with this drawback, we elaborate the architecture of the BBB and review possible mechanisms to cross this barrier by engineered nanoparticles. The potential uses of metal nanoparticles for treatment of disorders as well as related neurotoxicological considerations are also discussed. Finally, we bring up for discussion a direct and relatively simpler solution to the problem. We discuss this in detail after having proposed the use of the intranasal administration route as a way to circumvent the BBB. This route has not been extensively studied yet for metal nanoparticles, although it could be used as a research tool for mechanistic understanding and toxicity as well as an added value for medical practice.

Application of iron oxide nanoparticles in glioma imaging and therapy: from bench to bedside

Gliomas are the most common primary brain tumors and have a very dismal prognosis. However, recent advancements in nanomedicine and nanotechnology provide opportunities for personalized treatment regimens to improve the poor prognosis of patients suffering from glioma. This comprehensive review starts with an outline of the current status facing glioma. It then provides an overview of the state-of-the-art applications of iron oxide nanoparticles (IONPs) to glioma diagnostics and therapeutics, including MR contrast enhancement, drug delivery, cell labeling and tracking, magnetic hyperthermia treatment and magnetic particle imaging. It also addresses current challenges associated with the biological barriers and IONP design with an emphasis on recent advances and innovative approaches for glioma targeting strategies. Opportunities for future development are highlighted.

Super-Paramagnetic Nanoparticles with Spinel Structure: A Review of Synthesis and Biomedical Applications

The study of ceramic materials has attracted the attention of many researchers due to the possibility of their use in nanotechnology. The spinel ferrites form a large group of materials with a broad range of applications. Some examples include electronic devices such as high-frequency transformer cores, antenna rods, induction-tuners, among many others. However, when the ferritic materials display superparamagnetic behavior, their potential for biological applications like drug delivery, hyperthermia, resonance magnetic imaging and magnetic separation, become amazingly high. Therefore, the superparamagnetism is a characteristic strongly desired for spinel ferrites. Since this phenomenon is size-dependent, the methodologies to synthesize these materials has emerged as a crucial step in order to obtain the desired properties. In this regarding, several synthetic processes have been developed. For example, co-precipitation is a fast and cheap method to synthesize superparamagnetic spinel ferrites. However, methodologies involving microwave, ultrasound or polymers frequently result in these kind of materials. Therefore, this review brings a brief historic introduction about spinel ferrites as well as essential concepts to understand their structure and magnetic properties. In addition to this, recent advances in synthesis and applications of the superparamagnetic spinel ferrites are mentioned. Contents of Paper

Ferritin up-regulation and transient ROS production in cultured brain astrocytes after loading with iron oxide nanoparticles

To investigate the cellular consequences of a prolonged cellular presence of large amounts of iron oxide nanoparticles (IONPs) as well as the fate of such particles in brain cells, cultured primary astrocytes were loaded for 4h with dimercaptosuccinate-coated IONPs. Subsequently, the IONP-treated cells were incubated for up to 7 days in IONP-free medium and the cell viability, metabolic parameters and iron metabolism of the cells were investigated. Despite an up to 100-fold elevated specific cellular iron content, IONP-loaded cells remained viable throughout the 7 day main incubation and did not show any substantial alteration in glucose and glutathione metabolism. During the incubation, the high cellular iron content of IONP-loaded astrocytes remained almost constant. Electron microscopy revealed that after 7 days of incubation most of the cellular iron was still present in IONP-filled vesicles. However, the transient appearance of reactive oxygen species (ROS) as well as a strong increase in cellular levels of the iron storage protein ferritin suggest that at least some low-molecular-weight iron was liberated from the accumulated IONPs. These results demonstrate that even the prolonged presence of large amounts of accumulated IONPs does not harm astrocytes and that these cells store IONP-derived iron in ferritin.

Ultrasmall superparamagnetic iron oxides (USPIOs): a future alternative magnetic resonance (MR) contrast agent for patients at risk for nephrogenic systemic fibrosis (NSF)?

Gadolinium (Gd) based contrast agents (GBCAs) in magnetic resonance imaging (MRI) are used in daily clinical practice and appear safe in most patients; however, nephrogenic systemic fibrosis (NSF) is a recently recognized severe complication associated with GBCAs. It affects primarily patients with renal disease, such as stage 4 or 5 chronic kidney disease (CKD; glomerular filtration rate <30 ml/min per 1.73 m(2)), acute kidney injury, or kidney and liver transplant recipients with kidney dysfunction. Contrast-enhanced MRI and computed tomography (CT) scans provide important clinical information and influence patient management. An alternative contrast agent is needed to obtain adequate imaging results while avoiding the risk of NSF in this vulnerable patient group. One potential alternative is ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles, which provide enhancement characteristics similar to GBCAs. We review our experience in approximately 150 patients on the potential benefits of the USPIOs ferumoxtran-10 and ferumoxytol. We focus on central nervous system (CNS) MRI but also review imaging of other vascular beds. Safety studies, including USPIO administration (ferumoxytol) as iron supplement therapy in CKD patients on and not on dialysis, suggest that decreased kidney function does not alter the safety profile. We conclude that for both CNS MR imaging and MR angiography, USPIO agents like ferumoxytol are a viable option for patients at risk for NSF.

Magnetic resonance imaging of human brain macrophage infiltration

Macrophage tracking by magnetic resonance imaging (MRI) with iron oxide nanoparticles has been developed during the last decade for numerous diseases of the CNS. Experimental studies on animal models were confirmed by first clinical applications of MRI technology of brain macrophages for multiple sclerosis, ischemic stroke lesions, and tumors. As activated macrophages act in concert with other immune competent cells, this innovative MRI approach provides new functional data on the immune reaction in these CNS diseases. The MRI detection of brain macrophages defines precise spatial and temporal patterns of macrophage involvement that helps to characterize individual neurological disorders. This approach is being explored as an in vivo marker for the clinical diagnosis of cerebral lesion activity, in experimental models for the prognosis of disease development, and to determine the efficacy of immunomodulatory treatments under clinical evaluation. Comparative brain imaging follow-up studies of blood-brain barrier leakage by MRI with gadolinium-chelates, microglia activation by positron emission tomography with radiotracer ligand PK11195 and MRI detection of macrophage infiltration provide more precise information about the pathophysiological cascade of inflammatory events in cerebral diseases. Such multimodal characterization of the inflammatory events should help in the monitoring of patients, in defining precise time intervals for therapeutic interventions, and in developing and evaluating new therapeutic strategies.

The potential of ferumoxytol nanoparticle magnetic resonance imaging, perfusion, and angiography in central nervous system malignancy: a pilot study

OBJECTIVE

Ferumoxytol, an iron oxide nanoparticle that targets phagocytic cells, can be used in magnetic resonance imaging of malignant brain tumors and can be administered as a bolus, allowing dynamic imaging. Our objectives were to determine the optimum time of delayed contrast enhancement of ferumoxytol, and to compare ferumoxytol and gadolinium contrast agents for magnetic resonance angiography and perfusion.

METHODS

Twelve patients with malignant brain tumors underwent serial magnetic resonance imaging multiple times up to 72 hours after ferumoxytol injection at both 1.5 and 3-T. The enhancement time course was determined for ferumoxytol and compared with a baseline gadolinium scan. Perfusion, time-of-flight and dynamic magnetic resonance angiography and T1-weighted scans were compared for the two agents.

RESULTS

The lesions were detectable at all field strengths, even with an intraoperative 0.15-T magnet. Maximal ferumoxytol enhancement intensity was at 24 to 28 hours after administration, and the enhancing volume subsequently expanded with time into a non-gadolinium-enhancing, high T2-weighted signal region of tumor-infiltrated brain. Dynamic studies were assessed with both agents, indicating early vascular leak with gadolinium but not with ferumoxytol.

CONCLUSION

Our most important finding was that gadolinium leaks out of blood vessels early after injection, whereas ferumoxytol stays intravascular in the "early" phase, thereby increasing the accuracy of tumor perfusion assessment. As a magnetic resonance imaging contrast agent, ferumoxytol visualizes brain tumors at all field strengths evaluated, with delayed enhancement peaking at 24 to 28 hours after administration.

Effect of heterogeneous vasculature on interstitial transport within a solid tumor

Novel strategies for cancer treatment involving macromolecular therapeutic agents have been recently developed and show promising results. Inadequate and heterogeneous uptake in tumor tissue has been shown to be a major obstacle for these compounds in clinical cancer therapy. Such distributions have been difficult to account for in predictive models. A three-dimensional computational model was developed to investigate the role of heterogeneous vasculature on interstitial transport within a murine sarcoma. The model accounts for extravasation and extracellular transport in a porous media. Spatial variation of fluid filtration rate per unit volume of tissue and vascular permeability were estimated from a dynamic contrast-enhanced (DCE)-MRI data set. Fluid filtration (L(p)S/V) and permeability (PS/V) maps were embedded in a model of tumor tissue and used to predict interstitial fluid pressure (IFP) and fluid flow. As in previous studies, pressure profiles were predicted to be elevated within the tumor. The model predicted boundary-dependent variation in outwardly directed interstitial velocity with lower velocities predicted near the skin boundary. Simulated tissue distribution of a macromolecular albumin tracer (MW approximately 60 kDa) was found to be heterogeneous with lower concentrations predicted in certain central regions. Simulated distributions of Gd-DTPA tracer (MW approximately 0.57 kDa) were less heterogeneous than albumin tracer. In sensitivity analysis, predicted tracer uptake was enhanced by increasing vascular leakiness. Increasing the interstitial hydraulic conductivity relative to the surrounding tissue reduced the overall drug uptake.