1
|
Dondi F, Pisani AR, Lucarelli NM, Gazzilli M, Talin A, Albano D, Rubini D, Maggialetti N, Rubini G, Bertagna F. Correlation between Kidney Uptake at [18F]FDG PET/CT and Renal Function. J Pers Med 2023; 14:40. [PMID: 38248741 PMCID: PMC10817585 DOI: 10.3390/jpm14010040] [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: 12/01/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Different insights into the connection between kidney [18F]fluorodesoxyglucose ([18F]FDG) uptake at positron emission tomography/computed tomography (PET/CT) and renal function have been proposed in the past. The aim of this study was therefore to assess the presence of a correlation between these two parameters. Kidney uptakes were assessed and compared to the creatinine (Cr) values and estimated glomerular filtration rate (EGFR) among different classes of renal functional impairment or kidney status. A total of 339 patients and 385 different PET/CT scans were included in this study. Significant correlations between kidney uptakes and renal function parameters were reported in most of the groups studied, with the exception of patients with Cr < 1.2 mg/dL and subjects with a kidney transplantation. Strong concordance in the assessment of renal parenchymal uptakes between the different readers was reported. To conclude, strong correlations for renal [18F]FDG uptake with Cr levels and the EGFR were reported, with the exception of the group of patients with a Cr value < 1.2 mg/dL and for the group with a kidney transplantation.
Collapse
Affiliation(s)
- Francesco Dondi
- Nuclear Medicine, Università Degli Studi di Brescia and ASST Spedali Civili Brescia, 25123 Brescia, Italy; (F.D.); (A.T.); (D.A.); (F.B.)
| | - Antonio Rosario Pisani
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.R.P.); (N.M.); (G.R.)
| | - Nicola Maria Lucarelli
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.R.P.); (N.M.); (G.R.)
| | - Maria Gazzilli
- Nuclear Medicine, ASL Bari—P.O. Di Venere, 70012 Bari, Italy
| | - Anna Talin
- Nuclear Medicine, Università Degli Studi di Brescia and ASST Spedali Civili Brescia, 25123 Brescia, Italy; (F.D.); (A.T.); (D.A.); (F.B.)
| | - Domenico Albano
- Nuclear Medicine, Università Degli Studi di Brescia and ASST Spedali Civili Brescia, 25123 Brescia, Italy; (F.D.); (A.T.); (D.A.); (F.B.)
| | - Dino Rubini
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
| | - Nicola Maggialetti
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.R.P.); (N.M.); (G.R.)
| | - Giuseppe Rubini
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.R.P.); (N.M.); (G.R.)
| | - Francesco Bertagna
- Nuclear Medicine, Università Degli Studi di Brescia and ASST Spedali Civili Brescia, 25123 Brescia, Italy; (F.D.); (A.T.); (D.A.); (F.B.)
| |
Collapse
|
2
|
Fank H, Weekers L, Lovinfosse P, Pottel H, Seidel L, Jadoul A, Bouquegneau A, Bonvoisin C, Bovy C, Grosch S, Erpicum P, Hustinx R, Jouret F. The uptake of [ 18F]-fluorodeoxyglucose by the renal allograft correlates with the acute Banff scores of cortex inflammation but not with the 1-year graft outcomes. FRONTIERS IN TRANSPLANTATION 2023; 2:1236751. [PMID: 38993925 PMCID: PMC11235230 DOI: 10.3389/frtra.2023.1236751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/21/2023] [Indexed: 07/13/2024]
Abstract
Introduction [18F]FDG PET/CT noninvasively disproves acute kidney allograft rejection (AR) in kidney transplant recipients (KTRs) with suspected AR. However, the correlation of biopsy-based Banff vs. PET/CT-based scores of acute inflammation remains unknown, as does the prognostic performance of [18F]FDG PET/CT at one year post suspected AR. Methods From 2012 to 2019, 114 [18F]FDG-PET/CTs were prospectively performed in 105 adult KTRs who underwent per cause transplant biopsies. Ordinal logistic regression assessed the correlation between the extent of histological inflammation and the mean standardized [18F]FDG uptake values (mSUVmean). Functional outcomes of kidney allografts were evaluated at one year post per cause biopsy and correlated to mSUVmean. Results A significant correlation between mSUVmean and acute Banff score was found, with an adjusted R 2 of 0.25. The mSUVmean was significantly different between subgroups of "total i", with 2.30 ± 0.71 in score 3 vs. 1.68 ± 0.24 in score 0. Neither the function nor the survival of the graft at one year was statistically related to mSUVmean. Discussion [18F]FDG-PET/CT may help noninvasively assess the severity of kidney allograft inflammation in KTRs with suspected AR, but it does not predict graft outcomes at one year.
Collapse
Affiliation(s)
- Hélène Fank
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULiège CHU), Liège, Belgium
| | - Laurent Weekers
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULiège CHU), Liège, Belgium
| | - Pierre Lovinfosse
- Division of Nuclear Medicine and Oncological Imaging, University of Liège Hospital (ULiège CHU), Liège, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk (KULAK), Kortrijk, Belgium
| | - Laurence Seidel
- Department of Medico-Economic Information and Biostatistic, University of Liège Hospital (ULiège CHU), Liège, Belgium
| | - Alexandre Jadoul
- Division of Nuclear Medicine and Oncological Imaging, University of Liège Hospital (ULiège CHU), Liège, Belgium
| | - Antoine Bouquegneau
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULiège CHU), Liège, Belgium
| | - Catherine Bonvoisin
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULiège CHU), Liège, Belgium
| | - Christophe Bovy
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULiège CHU), Liège, Belgium
- Division of Renal Pathology, Unilab, University of Liège Hospital (ULiège CHU), Liège, Belgium
| | - Stephanie Grosch
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULiège CHU), Liège, Belgium
- Division of Renal Pathology, Unilab, University of Liège Hospital (ULiège CHU), Liège, Belgium
| | - Pauline Erpicum
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULiège CHU), Liège, Belgium
- Division of Renal Pathology, Unilab, University of Liège Hospital (ULiège CHU), Liège, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, University of Liège Hospital (ULiège CHU), Liège, Belgium
| | - François Jouret
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULiège CHU), Liège, Belgium
| |
Collapse
|
3
|
Klinkhammer BM, Lammers T, Mottaghy FM, Kiessling F, Floege J, Boor P. Non-invasive molecular imaging of kidney diseases. Nat Rev Nephrol 2021; 17:688-703. [PMID: 34188207 PMCID: PMC7612034 DOI: 10.1038/s41581-021-00440-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 02/05/2023]
Abstract
In nephrology, differential diagnosis or assessment of disease activity largely relies on the analysis of glomerular filtration rate, urinary sediment, proteinuria and tissue obtained through invasive kidney biopsies. However, currently available non-invasive functional parameters, and most serum and urine biomarkers, cannot capture intrarenal molecular disease processes specifically. Moreover, although histopathological analyses of kidney biopsy samples enable the visualization of pathological morphological and molecular alterations, they only provide information about a small part of the kidney and do not allow longitudinal monitoring. These limitations not only hinder understanding of the dynamics of specific disease processes in the kidney, but also limit the targeting of treatments to active phases of disease and the development of novel targeted therapies. Molecular imaging enables non-invasive and quantitative assessment of physiological or pathological processes by combining imaging technologies with specific molecular probes. Here, we discuss current preclinical and clinical molecular imaging approaches in nephrology. Non-invasive visualization of the kidneys through molecular imaging can be used to detect and longitudinally monitor disease activity and can therefore provide companion diagnostics to guide clinical trials, as well as the safe and effective use of drugs.
Collapse
Affiliation(s)
| | - Twan Lammers
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, Aachen, Germany,Department of Pharmaceutics, Utrecht University, The Netherlands,Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands
| | - Felix M. Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Germany,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, Aachen, Germany,Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Jürgen Floege
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany,Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany,Electron Microscopy Facility, RWTH Aachen University Hospital, Aachen, Germany,
| |
Collapse
|
4
|
Hirai T, Mayer AT, Nobashi TW, Lin PY, Xiao Z, Udagawa T, Seo K, Simonetta F, Baker J, Cheng AG, Negrin RS, Gambhir SS. Imaging alloreactive T cells provides early warning of organ transplant rejection. JCI Insight 2021; 6:e145360. [PMID: 34236044 PMCID: PMC8410037 DOI: 10.1172/jci.insight.145360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Diagnosis of organ transplant rejection relies upon biopsy approaches to confirm alloreactive T cell infiltration in the graft. Immune molecular monitoring is under investigation to screen for rejection, though these techniques have suffered from low specificity and lack of spatial information. ImmunoPET utilizing antibodies conjugated to radioisotopes has the potential to improve early and accurate detection of graft rejection. ImmunoPET is capable of noninvasively visualizing the dynamic distribution of cells expressing specific immune markers in the entire body over time. In this work, we identify and characterize OX40 as a surrogate biomarker for alloreactive T cells in organ transplant rejection and monitor its expression by utilizing immunoPET. In a dual murine heart transplant model that has both syngeneic and allogeneic hearts engrafted in bilateral ear pinna on the recipients, OX40 immunoPET clearly depicted alloreactive T cells in the allograft and draining lymph node that were not observed in their respective isograft counterparts. OX40 immunoPET signals also reflected the subject’s immunosuppression level with tacrolimus in this study. OX40 immunoPET is a promising approach that may bridge molecular monitoring and morphological assessment for improved transplant rejection diagnosis.
Collapse
Affiliation(s)
- Toshihito Hirai
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, California, USA.,Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Aaron T Mayer
- Department of Bioengineering.,Department of Radiology.,Molecular Imaging Program at Stanford, and.,BioX Program at Stanford, Stanford University, Stanford, California, USA
| | | | - Po-Yu Lin
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, California, USA
| | - Zunyu Xiao
- Department of Radiology.,Molecular Imaging Program at Stanford, and.,Molecular Imaging Research Center of Harbin Medical University, Harbin, China
| | | | | | - Federico Simonetta
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, California, USA
| | - Jeanette Baker
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, California, USA
| | - Alan G Cheng
- Department of Otolaryngology-Head and Neck Surgery
| | - Robert S Negrin
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, California, USA
| | - Sanjiv S Gambhir
- Department of Bioengineering.,Department of Radiology.,Molecular Imaging Program at Stanford, and.,BioX Program at Stanford, Stanford University, Stanford, California, USA.,Department of Materials Science and Engineering, and.,Canary Center at Stanford, Stanford University, Stanford, California, USA
| |
Collapse
|
5
|
Katagiri D, Wang F, Gore JC, Harris RC, Takahashi T. Clinical and experimental approaches for imaging of acute kidney injury. Clin Exp Nephrol 2021; 25:685-699. [PMID: 33835326 PMCID: PMC8154759 DOI: 10.1007/s10157-021-02055-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/17/2021] [Indexed: 12/23/2022]
Abstract
Complex molecular cell dynamics in acute kidney injury and its heterogeneous etiologies in patient populations in clinical settings have revealed the potential advantages and disadvantages of emerging novel damage biomarkers. Imaging techniques have been developed over the past decade to further our understanding about diseased organs, including the kidneys. Understanding the compositional, structural, and functional changes in damaged kidneys via several imaging modalities would enable a more comprehensive analysis of acute kidney injury, including its risks, diagnosis, and prognosis. This review summarizes recent imaging studies for acute kidney injury and discusses their potential utility in clinical settings.
Collapse
Affiliation(s)
- Daisuke Katagiri
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA.
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Feng Wang
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John C Gore
- Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raymond C Harris
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA
| | - Takamune Takahashi
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA.
- Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
6
|
Matar AJ, Crepeau RL, Duran-Struuck R. Non-invasive imaging for the diagnosis of acute rejection in transplantation: The next frontier. Transpl Immunol 2021; 68:101431. [PMID: 34157374 DOI: 10.1016/j.trim.2021.101431] [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: 06/08/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
Acute rejection is a leading cause of organ transplant failure and the most common indication for re-transplantation. Clinically, suspicion of acute rejection is often dependent upon serum laboratory values which may only manifest after organ injury. The gold standard for diagnosis requires an invasive biopsy which can carry serious clinical risks including bleeding and graft loss as well as the possibility of sampling error. The use of noninvasive imaging modalities to monitor transplanted organs is of great clinical value, particularly as a tool for early detection of graft dysfunction or acute rejection. Herein, we provide an overview of the existing literature evaluating noninvasive imaging modalities of solid organ and cellular allografts after transplantation, including both preclinical and clinical studies.
Collapse
Affiliation(s)
- Abraham J Matar
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca L Crepeau
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Raimon Duran-Struuck
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, USA.
| |
Collapse
|
7
|
Jadoul A, Lovinfosse P, Bouquegneau A, Weekers L, Pottel H, Hustinx R, Jouret F. Observer variability in the assessment of renal 18F-FDG uptake in kidney transplant recipients. Sci Rep 2020; 10:4617. [PMID: 32165653 PMCID: PMC7067780 DOI: 10.1038/s41598-020-61032-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/12/2020] [Indexed: 02/06/2023] Open
Abstract
18F-FDG PET/CT imaging may help non-invasively disprove the diagnosis of acute kidney allograft rejection (AR) in kidney transplant recipients (KTR). The present study aims at evaluating the repeatability and reproducibility of the quantification of renal 18F-FDG uptake in KTR. We prospectively performed 18F-FDG PET/CT in 95 adult KTR who underwent surveillance transplant biopsy between 3 to 6 months post transplantation. Images were obtained 180 minutes after injecting 3 MBq 18F-FDG per kg body weight. Mean standard uptake value (SUVmean) of kidney cortex was independently measured by 2 experienced observers in 4 volumes of interest (VOI) distributed in the upper (n = 2) and lower (n = 2) poles. The first observer repeated SUV assessment in the uppermost VOI, blinded to the initial results. Intra-class correlation coefficients (ICC) and Bland-Altman plots were calculated. An ICC of 0.96 with 95%CI of [0.94; 0.97] was calculated for the intra-observer measurements. The ICC for inter-observer reproducibility for each VOI was 0.87 [0.81–0.91], 0.87 [0.81–0.91], 0.85 [0.78–0.89] and 0.83 [0.76–0.88] for the upper to the lower renal poles, respectively. The repeatability and reproducibility of the quantification of kidney allograft 18F-FDG uptake are both consistent, which makes it transferrable to the clinical routine.
Collapse
Affiliation(s)
- Alexandre Jadoul
- Division of Nuclear Medicine and oncological imaging, University Hospital of Liege, Liege, Belgium
| | - Pierre Lovinfosse
- Division of Nuclear Medicine and oncological imaging, University Hospital of Liege, Liege, Belgium
| | - Antoine Bouquegneau
- Division of Nephrology, Department of Internal Medicine, University Hospital of Liege, Liege, Belgium
| | - Laurent Weekers
- Division of Nephrology, Department of Internal Medicine, University Hospital of Liege, Liege, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine and oncological imaging, University Hospital of Liege, Liege, Belgium
| | - François Jouret
- Division of Nephrology, Department of Internal Medicine, University Hospital of Liege, Liege, Belgium. .,Groupe Interdisciplinaire de Géno-protéomique Appliquée, Cardiovascular Sciences, University of Liège, Liège, Belgium.
| |
Collapse
|
8
|
Hanssen O, Lovinfosse P, Weekers L, Hustinx R, Jouret F. [ 18F-FDG positron emission tomography in non-oncological renal pathology: Current indications and perspectives]. Nephrol Ther 2019; 15:430-438. [PMID: 30982747 DOI: 10.1016/j.nephro.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/28/2018] [Indexed: 12/26/2022]
Abstract
Positron emission tomography combined with computed tomography (PET/CT) is a nuclear imaging technique which provides anatomical and functional information. PET/CT is increasingly used in non-oncological nephrology since conventional radiological approaches after injection of contrast agents are relatively contra-indicated in patients with chronic kidney disease (CKD). PET/CT after i.v. injection of 18F-fluoro-deoxy-glucose (FDG) is not toxic and is characterized by a high sensitivity. The level of irradiation (∼5mSv) is acceptable. CKD does not significantly influence tissue uptake of 18F-FDG. The purpose of the present review aims at detailing the non-oncological indications of 18F-FDG PET/CT in general nephrology and after kidney transplantation. Particularly, 18F-FDG PET/CT appears useful in the diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease, as well as in the characterization of retroperitoneal fibrosis. In kidney transplant recipients, 18F-FDG PET/CT may help in the diagnostic work-up of suspected acute rejection, thereby eventually avoiding unnecessary kidney transplant biopsy. Perspectives in 18F-FDG PET/CT imaging are discussed, including innovative approaches of image analysis.
Collapse
Affiliation(s)
- Oriane Hanssen
- Service de néphrologie, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - Pierre Lovinfosse
- Service de médecine nucléaire et imagerie oncologique, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - Laurent Weekers
- Service de médecine nucléaire et imagerie oncologique, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - Roland Hustinx
- Service de médecine nucléaire et imagerie oncologique, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - François Jouret
- Service de néphrologie, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique; Groupe interdisciplinaire de géno-protéomique appliquée (GIGA), sciences cardiovasculaires, université de Liège, Liège, Belgique.
| |
Collapse
|
9
|
Abstract
KEY POINTS • The number of publications on imaging and kidney transplantation is low. • These publications are poorly cited, as compared with other fields of imaging. • Conversely, there is a clinical need for evidence-based recommendations. • Innovative advances for the use of imaging and kidney transplantation are essential. • An increased focus and adequate research funding are highly anticipated by clinicians.
Collapse
|
10
|
Kentrup D, Bovenkamp P, Busch A, Schuette-Nuetgen K, Pawelski H, Pavenstädt H, Schlatter E, Herrmann KH, Reichenbach JR, Löffler B, Heitplatz B, Van Marck V, Yadav NN, Liu G, van Zijl PCM, Reuter S, Hoerr V. GlucoCEST magnetic resonance imaging in vivo may be diagnostic of acute renal allograft rejection. Kidney Int 2017; 92:757-764. [PMID: 28709641 DOI: 10.1016/j.kint.2017.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/20/2017] [Accepted: 04/06/2017] [Indexed: 11/29/2022]
Abstract
Acute cellular renal allograft rejection (AR) frequently occurs after kidney transplantations. It is a sterile T-cell mediated inflammation leading to increased local glucose metabolism. Here we demonstrate in an allogeneic model of Brown Norway rat kidneys transplanted into uninephrectomized Lewis rats the successful implementation of the recently developed glucose chemical exchange saturation transfer (glucoCEST) magnetic resonance imaging. This technique is a novel method to assess and differentiate AR. Renal allografts undergoing AR showed significantly increased glucoCEST contrast ratios of cortex to medulla of 1.61 compared to healthy controls (1.02), syngeneic Lewis kidney to Lewis rat transplants without rejection (0.92), kidneys with ischemia reperfusion injury (0.99) and kidneys affected by cyclosporine A toxicity (1.10). Receiver operating characteristic curve analysis showed an area under the curve value of 0.92, and the glucoCEST contrast ratio predicted AR with a sensitivity of 100% and a specificity of 69% at a threshold level over 1.08. In defined animal models of kidney injuries, the glucoCEST contrast ratios of cortex to medulla correlated positively with mRNA expression levels of T-cell markers (CD3, CD4, CD8a/b), but did not correlate to impaired renal perfusion. Thus, the glucoCEST parameter may be valuable for the assessment and follow up treatment of AR.
Collapse
Affiliation(s)
- Dominik Kentrup
- Medical Clinic D, University of Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany
| | - Philipp Bovenkamp
- Department of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany
| | - Annika Busch
- Department of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany
| | | | - Helga Pawelski
- Medical Clinic D, University of Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany
| | - Hermann Pavenstädt
- Medical Clinic D, University of Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany
| | - Eberhard Schlatter
- Medical Clinic D, University of Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany
| | - Karl-Heinz Herrmann
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller-University Jena, Philosophenweg 3, 07743 Jena, Germany
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller-University Jena, Philosophenweg 3, 07743 Jena, Germany
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
| | - Barbara Heitplatz
- Department of Pathology, University of Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany
| | - Veerle Van Marck
- Department of Pathology, University of Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany
| | - Nirbhay N Yadav
- Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans St., Baltimore, Maryland 21287, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, 707 N. Broadway, Baltimore, Maryland 21205, USA
| | - Guanshu Liu
- Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans St., Baltimore, Maryland 21287, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, 707 N. Broadway, Baltimore, Maryland 21205, USA
| | - Peter C M van Zijl
- Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans St., Baltimore, Maryland 21287, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, 707 N. Broadway, Baltimore, Maryland 21205, USA
| | - Stefan Reuter
- Medical Clinic D, University of Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany.
| | - Verena Hoerr
- Department of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; Institute of Medical Microbiology, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
| |
Collapse
|
11
|
Wareham NE, Lundgren JD, Da Cunha-Bang C, Gustafsson F, Iversen M, Johannesen HH, Kjær A, Rasmussen A, Sengeløv H, Sørensen SS, Fischer BM. The clinical utility of FDG PET/CT among solid organ transplant recipients suspected of malignancy or infection. Eur J Nucl Med Mol Imaging 2017; 44:421-431. [PMID: 27838763 PMCID: PMC5281676 DOI: 10.1007/s00259-016-3564-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/28/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE Solid organ transplant (SOT) recipients are at high risk of developing infections and malignancies. 18F-FDG PET/CT may enable timely detection of these diseases and help to ensure early intervention. We aimed to describe the clinical utility of FDG PET/CT in consecutive, diagnostic unresolved SOT recipients transplanted from January 2004 to May 2015. METHODS Recipients with a post-transplant FDG PET/CT performed as part of diagnostic work-up were included. Detailed chart reviews were done to extract relevant clinical information and determine the final diagnosis related to the FDG PET/CT. Based on á priori defined criteria and the final diagnosis, results from each scan were classified as true or false, and diagnostic values determined. RESULTS Among the 1,814 recipients in the cohort, 145 had an FDG PET/CT performed; 122 under the indication of diagnostically unresolved symptoms with a suspicion of malignancy or infection. The remaining (N = 23) had an FDG PET/CT to follow-up on a known disease or to stage a known malignancy. The 122 recipients underwent a total of 133 FDG PET/CT scans performed for a suspected malignancy (66 %) or an infection (34 %). Sensitivity, specificity, and positive and negative predictive values of the FDG PET/CT in diagnosing these conditions were 97, 84, 87, and 96 %, respectively. CONCLUSION FDG PET/CT is an accurate diagnostic tool for the work-up of diagnostic unresolved SOT recipients suspected of malignancy or infection. The high sensitivity and NPV underlines the potential usefulness of PET/CT for excluding malignancy or focal infections in this often complex clinical situation.
Collapse
Affiliation(s)
- Neval E Wareham
- Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - J D Lundgren
- Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - C Da Cunha-Bang
- Department of Haematology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - F Gustafsson
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - M Iversen
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - H H Johannesen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - A Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - A Rasmussen
- Department of Surgical Gastroenterology, Rigshospitalet, Blegdamsvek 9, 2100 Copenhagen Ø, Denmark
| | - H Sengeløv
- Department of Haematology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - S S Sørensen
- Department of Nephrology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - B M Fischer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| |
Collapse
|
12
|
Sun H, Cheng D, Ma Y, Liu H, Yang N, Zhang C, Wang K, Hou G, Wang H. Anti‑migratory effect of rapamycin impairs allograft imaging by 18F‑fluorodeoxyglucose‑labeled splenocytes. Mol Med Rep 2016; 14:2194-8. [PMID: 27432554 DOI: 10.3892/mmr.2016.5507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 05/10/2016] [Indexed: 11/06/2022] Open
Abstract
Tracking lymphocyte migration is an emerging strategy for non‑invasive nuclear imaging of allografts; however, its clinical application remains to be fully demonstrated. In the present study, the feasibility of using rapamycin‑treated 18F‑fluorodeoxyglucose (18F‑FDG)‑labeled splenocytes for the in vivo imaging of allografts was evaluated. C57BL/6 skin was heterotopically transplanted onto non‑obese diabetic/severe combined immunodeficient recipient mice. BALB/c 18F‑FDG‑labeled splenocytes with or without rapamycin pretreatment (designated as FR and FC cells, respectively) were transferred into recipient mice 30 days later. Imaging of radiolabeled cells in the skin grafts was conducted through in vivo dynamic whole‑body phosphor‑autoradiography and histological analysis. Notably, rapamycin impaired the migration of 18F‑FDG‑labeled splenocytes to the graft. At all time points, the radioactivity of allografts (digital light units/mm2) was significantly lower in the group that received FR cells, compared with the group that received FC cells (P<0.01). Furthermore, the peak allograft to native skin ratio was 1.29±0.02 at 60 min for the FR group and 3.29±0.17 at 30 min for the FC group (P<0.001). In addition, the in vivo radioactivity of the allografts was observed to be correlated with the transferred cells, which were observed histologically (r2=0.887; P<0.0001). Although 18F‑FDG‑labeled splenocytes migrated to the allograft, imaging of these cells may not be possible in the presence of rapamycin.
Collapse
Affiliation(s)
- Hukui Sun
- Nuclear Medicine Department, Central Hospital of Zibo, Shandong University, Zibo, Shandong 255036, P.R. China
| | - Dayan Cheng
- Nuclear Medicine Department, Central Hospital of Zibo, Shandong University, Zibo, Shandong 255036, P.R. China
| | - Yuanyuan Ma
- Nuclear Medicine Department, Central Hospital of Zibo, Shandong University, Zibo, Shandong 255036, P.R. China
| | - Hong Liu
- Nuclear Medicine Department, Central Hospital of Zibo, Shandong University, Zibo, Shandong 255036, P.R. China
| | - Ning Yang
- Nuclear Medicine Department, Central Hospital of Zibo, Shandong University, Zibo, Shandong 255036, P.R. China
| | - Cong Zhang
- Nuclear Medicine Department, Central Hospital of Zibo, Shandong University, Zibo, Shandong 255036, P.R. China
| | - Kai Wang
- Nuclear Medicine Department, Central Hospital of Zibo, Shandong University, Zibo, Shandong 255036, P.R. China
| | - Guihua Hou
- Biomedical Isotope Research Center, School of Medicine, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Huaiquan Wang
- Nuclear Medicine Department, Central Hospital of Zibo, Shandong University, Zibo, Shandong 255036, P.R. China
| |
Collapse
|
13
|
Grabner A, Kentrup D, Pawelski H, Mühlmeister M, Biermann C, Edemir B, Heitplatz B, Van Marck V, Bettinger T, Pavenstädt H, Schlatter E, Stypmann J, Tiemann K, Reuter S. Renal Contrast-Enhanced Sonography Findings in a Model of Acute Cellular Allograft Rejection. Am J Transplant 2016; 16:1612-9. [PMID: 26613381 DOI: 10.1111/ajt.13648] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 11/22/2015] [Indexed: 01/25/2023]
Abstract
Noninvasive methods to diagnose and differentiate acute cellular rejection from acute tubular necrosis or acute calcineurin inhibitor toxicity are still missing. Because T lymphocytes play a decisive role in early states of rejection, we investigated the suitability and feasibility of antibody-mediated contrast-enhanced ultrasound by using microbubbles targeted to CD3(+) , CD4(+) , or CD8(+) T cells in different models of renal disease. In an established rat renal transplantation model, CD3-mediated ultrasound allows the detection of acute rejection as early as on postoperative day 2. Ultrasound signal intensities increased with the severity of inflammation. Further, an early response to therapy could be monitored by using contrast-enhanced sonography. Notably, acute tubular necrosis occurring after ischemia-reperfusion injury as well as acute calcineurin inhibitor toxicity could easily be differentiated. Finally, the quantified ultrasound signal correlated significantly with the number of infiltrating T cells obtained by histology and with CD3 mRNA levels, as well as with chemokine CXCL9, CXCL11, and CCL19 mRNA but not with KIM-1 mRNA expression, thereby representing the severity of graft inflammation but not the degree of kidney injury. In summary, we demonstrate that antibody-mediated contrast-enhanced ultrasound targeting T lymphocytes could be a promising tool for an easy and reproducible assessment of acute rejection after renal transplantation.
Collapse
Affiliation(s)
- A Grabner
- Department of Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - D Kentrup
- Department of Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - H Pawelski
- Department of Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - M Mühlmeister
- Department of Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - C Biermann
- Department of Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - B Edemir
- Department of Medicine, Hematology and Oncology, University of Halle, Halle, Germany
| | - B Heitplatz
- Department of Pathology, University of Münster, Münster, Germany
| | - V Van Marck
- Department of Pathology, University of Münster, Münster, Germany
| | | | - H Pavenstädt
- Department of Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - E Schlatter
- Department of Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - J Stypmann
- Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - K Tiemann
- Department of Cardiology, Otypka Heart Center and Department of Nuclear Medicine, Technical University Munich, Munich, Germany
| | - S Reuter
- Department of Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| |
Collapse
|
14
|
Thölking G, Schuette-Nuetgen K, Kentrup D, Pawelski H, Reuter S. Imaging-based diagnosis of acute renal allograft rejection. World J Transplant 2016; 6:174-182. [PMID: 27011915 PMCID: PMC4801793 DOI: 10.5500/wjt.v6.i1.174] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/28/2015] [Accepted: 12/02/2015] [Indexed: 02/05/2023] Open
Abstract
Kidney transplantation is the best available treatment for patients with end stage renal disease. Despite the introduction of effective immunosuppressant drugs, episodes of acute allograft rejection still endanger graft survival. Since efficient treatment of acute rejection is available, rapid diagnosis of this reversible graft injury is essential. For diagnosis of rejection, invasive core needle biopsy of the graft is the “gold-standard”. However, biopsy carries the risk of significant graft injury and is not immediately feasible in patients taking anticoagulants. Therefore, a non-invasive tool assessing the whole organ for specific and fast detection of acute allograft rejection is desirable. We herein review current imaging-based state of the art approaches for non-invasive diagnostics of acute renal transplant rejection. We especially focus on new positron emission tomography-based as well as targeted ultrasound-based methods.
Collapse
|
15
|
Sun H, Yang G, Liang T, Zhang C, Song J, Han J, Hou G. Non-invasive imaging of allogeneic transplanted skin graft by 131I-anti-TLR5 mAb. J Cell Mol Med 2014; 18:2437-44. [PMID: 25283154 PMCID: PMC4302649 DOI: 10.1111/jcmm.12423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/13/2014] [Indexed: 12/12/2022] Open
Abstract
Although 18F-fluorodeoxyglucose (18F-FDG) uptake can be used for the non-invasive detection and monitoring of allograft rejection by activated leucocytes, this non-specific accumulation is easily impaired by immunosuppressants. Our aim was to evaluate a 131I-radiolabelled anti-Toll-like receptor 5 (TLR5) mAb for non-invasive in vivo graft visualization and quantification in allogeneic transplantation mice model, compared with the non-specific radiotracer 18F-FDG under using of immunosuppressant. Labelling, binding, and stability studies were performed. BALB/c mice transplanted with C57BL/6 skin grafts, with or without rapamycin treatment (named as allo-treated group or allo-rejection group), were injected with 131I-anti-TLR5 mAb, 18F-FDG, or mouse isotype 131I-IgG, respectively. Whole-body phosphor-autoradiography and ex vivo biodistribution studies were obtained. Whole-body phosphor-autoradiography showed 131I-anti-TLR5 mAb uptake into organs that were well perfused with blood at 1 hr and showed clear graft images from 12 hrs onwards. The 131I-anti-TLR5 mAb had significantly higher graft uptake and target-to-non-target ratio in the allo-treated group, as determined by semi-quantification of phosphor-autoradiography images; these results were consistent with ex vivo biodistribution studies. However, high 18F-FDG uptake was not observed in the allo-treated group. The highest allograft-skin-to-native-skin ratio (A:N) of 131I-anti-TLR5 mAb uptake was significantly higher than the ratio for 18F-FDG (7.68 versus 1.16, respectively). 131I-anti-TLR5 mAb uptake in the grafts significantly correlated with TLR5 expression in the allograft area. The accumulation of 131I-IgG was comparable in both groups. We conclude that radiolabelled anti-TLR5 mAb is capable of detecting allograft with high target specificity after treatment with the immunosuppressive drug rapamycin.
Collapse
Affiliation(s)
- Hukui Sun
- Key Laboratory for Experimental Teratology of the Ministry of Education and Institute of Experimental Nuclear Medicine, School of Medicine, Shandong University, Ji'nan, Shandong, China
| | | | | | | | | | | | | |
Collapse
|
16
|
SPECT- and PET-based approaches for noninvasive diagnosis of acute renal allograft rejection. BIOMED RESEARCH INTERNATIONAL 2014; 2014:874785. [PMID: 24804257 PMCID: PMC3988725 DOI: 10.1155/2014/874785] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/04/2014] [Indexed: 11/18/2022]
Abstract
Molecular imaging techniques such as single
photon emission computed tomography (SPECT) or positron emission tomography are promising tools for noninvasive diagnosis of acute allograft rejection (AR). Given the importance of renal transplantation and the limitation of available donors, detailed analysis of factors that affect transplant survival is important. Episodes of acute allograft rejection are a negative prognostic factor for long-term graft survival. Invasive core needle biopsies are still the “goldstandard” in rejection diagnostics. Nevertheless, they are cumbersome to the patient and carry the risk of significant graft injury. Notably, they cannot be performed on patients taking anticoagulant drugs. Therefore, a noninvasive tool assessing the whole organ for specific and fast detection of acute allograft rejection is desirable. We herein review SPECT- and PET-based approaches for noninvasive molecular imaging-based diagnostics of acute transplant rejection.
Collapse
|
17
|
Chen DL, Wang X, Yamamoto S, Carpenter D, Engle JT, Li W, Lin X, Kreisel D, Krupnick AS, Huang HJ, Gelman AE. Increased T cell glucose uptake reflects acute rejection in lung grafts. Am J Transplant 2013; 13:2540-9. [PMID: 23927673 PMCID: PMC3956601 DOI: 10.1111/ajt.12389] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/30/2013] [Accepted: 06/15/2013] [Indexed: 01/25/2023]
Abstract
Although T cells are required for acute lung rejection, other graft-infiltrating cells such as neutrophils accumulate in allografts and are also high glucose utilizers. Positron emission tomography (PET) with the glucose probe [(18)F]fluorodeoxyglucose ([(18)F]FDG) has been employed to image solid organ acute rejection, but the sources of glucose utilization remain undefined. Using a mouse model of orthotopic lung transplantation, we analyzed glucose probe uptake in the grafts of syngeneic and allogeneic recipients with or without immunosuppression treatment. Pulmonary microPET scans demonstrated significantly higher [(18)F]FDG uptake in rejecting allografts when compared to transplanted lungs of either immunosuppressed or syngeneic recipients. [(18)F]FDG uptake was also markedly attenuated following T cell depletion therapy in lung recipients with ongoing acute rejection. Flow cytometric analysis using the fluorescent deoxyglucose analog 2-NBDG revealed that T cells, and in particular CD8(+) T cells, were the largest glucose utilizers in acutely rejecting lung grafts followed by neutrophils and antigen-presenting cells. These data indicate that imaging modalities tailored toward assessing T cell metabolism may be useful in identifying acute rejection in lung recipients.
Collapse
Affiliation(s)
- Delphine L. Chen
- Department of Radiology, Washington University School of Medicine,
St. Louis, MO 63110 USA,Address correspondence to either: Delphine L. Chen, Division of
Radiological Sciences and Nuclear Medicine, Washington University School of
Medicine, Box 8223, 510 S. Kingshighway Blvd., St. Louis, MO 63110
or Andrew E. Gelman, Division of
Cardiothoracic Surgery, Washington University School of Medicine, Box 8234, 660
S. Euclid Ave., St. Louis, MO 63110
| | - Xingan Wang
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA
| | - Sumiharu Yamamoto
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA
| | - Danielle Carpenter
- Department of Pathology & Immunology, Washington University
School of Medicine, St. Louis, MO 63110 USA
| | - Jacquelyn T. Engle
- Department of Radiology, Washington University School of Medicine,
St. Louis, MO 63110 USA
| | - Wenjun Li
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA
| | - Xue Lin
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA
| | - Daniel Kreisel
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA,Department of Pathology & Immunology, Washington University
School of Medicine, St. Louis, MO 63110 USA
| | - Alexander S. Krupnick
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA
| | - Howard J. Huang
- Department of Medicine, Washington University School of Medicine,
St. Louis, MO 63110 USA
| | - Andrew E. Gelman
- Department of Surgery, Washington University School of Medicine, St.
Louis, MO 63110 USA,Department of Pathology & Immunology, Washington University
School of Medicine, St. Louis, MO 63110 USA,Address correspondence to either: Delphine L. Chen, Division of
Radiological Sciences and Nuclear Medicine, Washington University School of
Medicine, Box 8223, 510 S. Kingshighway Blvd., St. Louis, MO 63110
or Andrew E. Gelman, Division of
Cardiothoracic Surgery, Washington University School of Medicine, Box 8234, 660
S. Euclid Ave., St. Louis, MO 63110
| |
Collapse
|
18
|
Grabner A, Kentrup D, Edemir B, Sirin Y, Pavenstädt H, Schlatter E, Schober O, Schäfers M, Schnöckel U, Reuter S. PET with 18F-FDG-labeled T lymphocytes for diagnosis of acute rat renal allograft rejection. J Nucl Med 2013; 54:1147-53. [PMID: 23670903 DOI: 10.2967/jnumed.112.109231] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
UNLABELLED We proposed small-animal PET with (18)F-FDG-labeled T lymphocytes as a new method for image-based diagnosis of acute allogeneic renal transplant rejection (AR) established in a rat model. METHODS One and 2 h after tail vein injection of 30 × 10(6) ex vivo (18)F-FDG-labeled human T cells into male 10-wk-old uninephrectomized, allogeneically transplanted rats (aTX; Lewis-brown Norway [LBN] to Lewis), whole-body radioactivity distribution was assessed in vivo by small-animal PET (postoperative day 4), and percentage injected dose (%ID) as a parameter of T-cell infiltration was assessed and compared between graft and native kidney. In vivo results were confirmed by autoradiography and staining of human CD3 after postmortem dissection. Syngeneically transplanted rats (sTX) (LBN to LBN), rats with ischemia-reperfusion injury (IRI) (45-min warm ischemia), and rats subjected to acute cyclosporine A (CSA) toxicity (50 mg/kg for 2 d intraperitoneally) served as controls. RESULTS The accumulation of labeled cells was significantly elevated in allografts with AR (1.07 ± 0.28 %ID), compared with native control kidneys (0.49 ± 0.18 %ID) (P < 0.0001). No differences were found among native controls, sTX, CSA toxicity, and kidneys with IRI. In vivo uptake of (18)F-FDG cells measured in the PET scanner correlated with results obtained by autoradiography, histologic evaluation, and polymerase chain reaction. CONCLUSION We proposed graft PET imaging using (18)F-FDG-labeled T cells as a new option to detect rat renal AR with a low dose of (18)F-FDG in a noninvasive, fast, and specific manner in rats.
Collapse
Affiliation(s)
- Alexander Grabner
- Department of Internal Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Grabner A, Kentrup D, Schnöckel U, Gabriëls G, Schröter R, Pavenstädt H, Schober O, Schlatter E, Schäfers M, Reuter S. Non-invasive imaging of acute allograft rejection after rat renal transplantation using 18F-FDG PET. J Vis Exp 2013:e4240. [PMID: 23644348 DOI: 10.3791/4240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The number of patients with end-stage renal disease, and the number of kidney allograft recipients continuously increases. Episodes of acute cellular allograft rejection (AR) are a negative prognostic factor for long-term allograft survival, and its timely diagnosis is crucial for allograft function (1). At present, AR can only be definitely diagnosed by core-needle biopsy, which, as an invasive method, bares significant risk of graft injury or even loss. Moreover, biopsies are not feasible in patients taking anticoagulant drugs and the limited sampling site of this technique may result in false negative results if the AR is focal or patchy. As a consequence, this gave rise to an ongoing search for new AR detection methods, which often has to be done in animals including the use of various transplantation models. Since the early 60s rat renal transplantation is a well-established experimental method for the examination and analysis of AR (2). We herein present in addition small animal positron emission tomography (PET) using (18)F-fluorodeoxyglucose (FDG) to assess AR in an allogeneic uninephrectomized rat renal transplantation model and propose graft FDG-PET imaging as a new option for a non-invasive, specific and early diagnosis of AR also for the human situation (3). Further, this method can be applied for follow-up to improve monitoring of transplant rejection (4).
Collapse
Affiliation(s)
- Alexander Grabner
- Department of Internal Medicine D, Experimental Nephrology, University of Münster.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Hao G, Du Y, Zhou XJ, Guo J, Sun X, Mohan C, Öz OK. Serial non-invasive assessment of antibody induced nephritis in mice using positron emission tomography. PLoS One 2013; 8:e57418. [PMID: 23460853 PMCID: PMC3584026 DOI: 10.1371/journal.pone.0057418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/21/2013] [Indexed: 02/03/2023] Open
Abstract
Mouse models of experimental anti-glomerular basement membrane (anti-GBM) nephritis provide an analytical tool for studying spontaneous lupus nephritis. The potential of Positron Emission Tomography (PET) was evaluated using 2-deoxy-2-[18F]fluoro-d-glucose (FDG) as a probe to monitor the progression of anti-GBM induced nephritis in a mouse model. The imaging results were compared to conventional measures of renal function and pathological changes. Serum and urinary vascular cell adhesion molecule-1 (VCAM-1) levels were used as measures of endothelial cell activation and inflammation. Following a challenge with anti-glomerular antibodies, mice exhibited peak changes in serum creatinine, proteinuria, and glomerulonephritis score at 14 days post-challenge (p.c.). In contrast, VCAM levels peaked at day 7 p.c. On dynamic PET images (0–60 min) of day 7, kidneys of the anti-GBM nephritis mice demonstrated a unique pattern of FDG uptake. Compared to the time activity curve (TAC) prior to challenge, a rightward shift was observed after the challenge. By day 10 p.c., kidney FDG uptake was lower than baseline and remained so until the study ended at 21 days p.c. During this time frame measures of renal dysfunction remained high but VCAM-1 levels declined. These changes were accompanied by an increase in kidney volume as measured by Computed Tomography (CT) and intra-abdominal fluid collection. Our results suggest that FDG-PET-CT can be used as a non-invasive imaging tool to longitudinally monitor the progression of renal disease activity in antibody mediated nephritis and the magnitude of renal FDG retention correlates better with early markers of renal inflammation than renal dysfunction.
Collapse
Affiliation(s)
- Guiyang Hao
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Yong Du
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Xin J. Zhou
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Jianfei Guo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Xiankai Sun
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail: (OKO); (CM); (XS)
| | - Chandra Mohan
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail: (OKO); (CM); (XS)
| | - Orhan K. Öz
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail: (OKO); (CM); (XS)
| |
Collapse
|
21
|
De Mauri A, Brambilla M, Izzo C, Matheoud R, Chiarinotti D, Carriero A, Stratta P, De Leo M. Cumulative radiation dose from medical imaging in kidney transplant patients. Nephrol Dial Transplant 2012; 27:3645-51. [PMID: 22619314 DOI: 10.1093/ndt/gfs145] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although many patients undergoing kidney transplant are exposed to multiple examinations that increase cumulative effective doses (CEDs) of ionizing radiation, no data are available characterizing their total longitudinal radiation burden and relating radiation burden with risk factors for more exposure. METHODS We did a retrospective cohort study of 92 patients (mean age 52 years; range: 20-75 years) who underwent kidney transplant at University Hospital, Novara, Italy, that evaluated all following medical imaging procedures involving ionizing radiation undergone beginning June 2007, and all subsequent procedures through August 2011, at the centre. RESULTS The mean and median annual CED were 17.2 and 4.9 millisieverts (mSv) per patient-year. The mean and median total CED per patient over the study period were 46.1 and 17.3 mSv, respectively. Twenty-eight and 12% of patients had total CED >50 and 100 mSv, values which are associated with a good or strong evidence of an increased cancer mortality risk, respectively. Computed tomography scanning accounted for 73% of the total CED. The annual CED was significantly higher in incident patients and in patients with ischaemic heart disease and cancer. CONCLUSION In this institution, multiple testing of kidney transplant patients was common in many patients associated with high cumulative estimated doses of ionizing radiation.
Collapse
Affiliation(s)
- Andreana De Mauri
- Nephrology Department, University Hospital Maggiore della Carità, Novara, Italy
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Kentrup D, Reuter S, Schnöckel U, Grabner A, Edemir B, Pavenstädt H, Schober O, Schäfers M, Schlatter E, Büssemaker E. Hydroxyfasudil-mediated inhibition of ROCK1 and ROCK2 improves kidney function in rat renal acute ischemia-reperfusion injury. PLoS One 2011; 6:e26419. [PMID: 22031832 PMCID: PMC3198766 DOI: 10.1371/journal.pone.0026419] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 09/26/2011] [Indexed: 11/18/2022] Open
Abstract
Renal ischemia-reperfusion (IR) injury (IRI) is a common and important trigger of acute renal injury (AKI). It is inevitably linked to transplantation. Involving both, the innate and the adaptive immune response, IRI causes subsequent sterile inflammation. Attraction to and transmigration of immune cells into the interstitium is associated with increased vascular permeability and loss of endothelial and tubular epithelial cell integrity. Considering the important role of cytoskeletal reorganization, mainly regulated by RhoGTPases, in the development of IRI we hypothesized that a preventive, selective inhibition of the Rho effector Rho-associated coiled coil containing protein kinase (ROCK) by hydroxyfasudil may improve renal IRI outcome. Using an IRI-based animal model of AKI in male Sprague Dawley rats, animals treated with hydroxyfasudil showed reduced proteinuria and polyuria as well as increased urine osmolarity when compared with sham-treated animals. In addition, renal perfusion (as assessed by 18F-fluoride Positron Emission Tomography (PET)), creatinine- and urea-clearances improved significantly. Moreover, endothelial leakage and renal inflammation was significantly reduced as determined by histology, 18F-fluordesoxyglucose-microautoradiography, Evans Blue, and real-time PCR analysis. We conclude from our study that ROCK-inhibition by hydroxyfasudil significantly improves kidney function in a rat model of acute renal IRI and is therefore a potential new therapeutic option in humans.
Collapse
Affiliation(s)
- Dominik Kentrup
- Department of Internal Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - Stefan Reuter
- Department of Internal Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - Uta Schnöckel
- Department of Nuclear Medicine, University of Münster, Münster, Germany
| | - Alexander Grabner
- Department of Internal Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - Bayram Edemir
- Department of Internal Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - Hermann Pavenstädt
- Department of Internal Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - Otmar Schober
- Department of Nuclear Medicine, University of Münster, Münster, Germany
| | - Michael Schäfers
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Eberhard Schlatter
- Department of Internal Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
| | - Eckhart Büssemaker
- Department of Internal Medicine D, Experimental Nephrology, University of Münster, Münster, Germany
- Dialysis Unit Hamm, Hamm, Germany
- * E-mail:
| |
Collapse
|
23
|
Lisanti MP, Martinez-Outschoorn UE, Lin Z, Pavlides S, Whitaker-Menezes D, Pestell RG, Howell A, Sotgia F. Hydrogen peroxide fuels aging, inflammation, cancer metabolism and metastasis: the seed and soil also needs "fertilizer". Cell Cycle 2011; 10:2440-9. [PMID: 21734470 PMCID: PMC3180186 DOI: 10.4161/cc.10.15.16870] [Citation(s) in RCA: 170] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/18/2011] [Indexed: 01/13/2023] Open
Abstract
In 1889, Dr. Stephen Paget proposed the "seed and soil" hypothesis, which states that cancer cells (the seeds) need the proper microenvironment (the soil) for them to grow, spread and metastasize systemically. In this hypothesis, Dr. Paget rightfully recognized that the tumor microenvironment has an important role to play in cancer progression and metastasis. In this regard, a series of recent studies have elegantly shown that the production of hydrogen peroxide, by both cancer cells and cancer-associated fibroblasts, may provide the necessary "fertilizer," by driving accelerated aging, DNA damage, inflammation and cancer metabolism, in the tumor microenvironment. By secreting hydrogen peroxide, cancer cells and fibroblasts are mimicking the behavior of immune cells (macrophages/neutrophils), driving local and systemic inflammation, via the innate immune response (NFκB). Thus, we should consider using various therapeutic strategies (such as catalase and/or other anti-oxidants) to neutralize the production of cancer-associated hydrogen peroxide, thereby preventing tumor-stroma co-evolution and metastasis. The implications of these findings for overcoming chemo-resistance in cancer cells are also discussed in the context of hydrogen peroxide production and cancer metabolism.
Collapse
Affiliation(s)
- Michael P Lisanti
- The Jefferson Stem Cell Biology and Regenerative Medicine Center, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Martinez-Outschoorn UE, Lin Z, Trimmer C, Flomenberg N, Wang C, Pavlides S, Pestell RG, Howell A, Sotgia F, Lisanti MP. Cancer cells metabolically "fertilize" the tumor microenvironment with hydrogen peroxide, driving the Warburg effect: implications for PET imaging of human tumors. Cell Cycle 2011; 10:2504-20. [PMID: 21778829 DOI: 10.4161/cc.10.15.16585] [Citation(s) in RCA: 238] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Previously, we proposed that cancer cells behave as metabolic parasites, as they use targeted oxidative stress as a "weapon" to extract recycled nutrients from adjacent stromal cells. Oxidative stress in cancer-associated fibroblasts triggers autophagy and mitophagy, resulting in compartmentalized cellular catabolism, loss of mitochondrial function, and the onset of aerobic glycolysis, in the tumor stroma. As such, cancer-associated fibroblasts produce high-energy nutrients (such as lactate and ketones) that fuel mitochondrial biogenesis, and oxidative metabolism in cancer cells. We have termed this new energy-transfer mechanism the "reverse Warburg effect." To further test the validity of this hypothesis, here we used an in vitro MCF7-fibroblast co-culture system, and quantitatively measured a variety of metabolic parameters by FACS analysis (analogous to laser-capture micro-dissection). Mitochondrial activity, glucose uptake, and ROS production were measured with highly-sensitive fluorescent probes (MitoTracker, NBD-2-deoxy-glucose, and DCF-DA). Interestingly, using this approach, we directly show that cancer cells initially secrete hydrogen peroxide that then triggers oxidative stress in neighboring fibroblasts. Thus, oxidative stress is contagious (spreads like a virus) and is propagated laterally and vectorially from cancer cells to adjacent fibroblasts. Experimentally, we show that oxidative stress in cancer-associated fibroblasts quantitatively reduces mitochondrial activity, and increases glucose uptake, as the fibroblasts become more dependent on aerobic glycolysis. Conversely, co-cultured cancer cells show significant increases in mitochondrial activity, and corresponding reductions in both glucose uptake and GLUT1 expression. Pre-treatment of co-cultures with extracellular catalase (an anti-oxidant enzyme that detoxifies hydrogen peroxide) blocks the onset of oxidative stress, and potently induces the death of cancer cells, likely via starvation. Given that cancer-associated fibroblasts show the largest increases in glucose uptake, we suggest that PET imaging of human tumors, with Fluoro-2-deoxy-D-glucose (F-2-DG), may be specifically detecting the tumor stroma, rather than epithelial cancer cells.
Collapse
Affiliation(s)
- Ubaldo E Martinez-Outschoorn
- The Jefferson Stem Cell Biology and Regenerative Medicine Center, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|