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Hu Y, Gordon N, Ogg K, Kraitchman DL, Durr NJ, Surtees B. Thermal Characterization and Preclinical Feasibility Verification of an Accessible, Carbon Dioxide-Based Cryotherapy System. Bioengineering (Basel) 2024; 11:391. [PMID: 38671812 PMCID: PMC11048087 DOI: 10.3390/bioengineering11040391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
To investigate the potential of an affordable cryotherapy device for the accessible treatment of breast cancer, the performance of a novel carbon dioxide-based device was evaluated through both benchtop testing and an in vivo canine model. This novel device was quantitatively compared to a commercial device that utilizes argon gas as the cryogen. The thermal behavior of each device was characterized through calorimetry and by measuring the temperature profiles of iceballs generated in tissue phantoms. A 45 min treatment in a tissue phantom from the carbon dioxide device produced a 1.67 ± 0.06 cm diameter lethal isotherm that was equivalent to a 7 min treatment from the commercial argon-based device, which produced a 1.53 ± 0.15 cm diameter lethal isotherm. An in vivo treatment was performed with the carbon dioxide-based device in one spontaneously occurring canine mammary mass with two standard 10 min freezes. Following cryotherapy, this mass was surgically resected and analyzed for necrosis margins via histopathology. The histopathology margin of necrosis from the in vivo treatment with the carbon dioxide device at 14 days post-cryoablation was 1.57 cm. While carbon dioxide gas has historically been considered an impractical cryogen due to its low working pressure and high boiling point, this study shows that carbon dioxide-based cryotherapy may be equivalent to conventional argon-based cryotherapy in size of the ablation zone in a standard treatment time. The feasibility of the carbon dioxide device demonstrated in this study is an important step towards bringing accessible breast cancer treatment to women in low-resource settings.
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Affiliation(s)
- Yixin Hu
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Naomi Gordon
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Katherine Ogg
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Dara L. Kraitchman
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Nicholas J. Durr
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA;
| | - Bailey Surtees
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
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Liatsou I, Fu Y, Li Z, Hasan M, Guo X, Yu J, Piccolo J, Cartee A, Wang H, Du Y, Bryan J, Gabrielson K, Kraitchman DL, Sgouros G. Therapeutic efficacy of an alpha-particle emitter labeled anti-GD2 humanized antibody against osteosarcoma-a proof of concept study. Eur J Nucl Med Mol Imaging 2024; 51:1409-1420. [PMID: 38108831 DOI: 10.1007/s00259-023-06528-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Current treatments for osteosarcoma (OS) have a poor prognosis, particularly for patients with metastasis and recurrence, underscoring an urgent need for new targeted therapies to improve survival. Targeted alpha-particle therapy selectively delivers cytotoxic payloads to tumors with radiolabeled molecules that recognize tumor-associated antigens. We have recently demonstrated the potential of an FDA approved, humanized anti-GD2 antibody, hu3F8, as a targeted delivery vector for radiopharmaceutical imaging of OS. The current study aims to advance this system for alpha-particle therapy of OS. METHODS The hu3F8 antibody was radiolabeled with actinium-225, and the safety and therapeutic efficacy of the [225Ac]Ac-DOTA-hu3F8 were evaluated in both orthotopic murine xenografts of OS and spontaneously occurring OS in canines. RESULTS Significant antitumor activity was proven in both cases, leading to improved overall survival. In the murine xenograft's case, tumor growth was delayed by 16-18 days compared to the untreated cohort as demonstrated by bioluminescence imaging. The results were further validated with magnetic resonance imaging at 33 days after treatment, and microcomputed tomography and planar microradiography post-mortem. Histological evaluations revealed radiation-induced renal toxicity, manifested as epithelial cell karyomegaly and suggestive polyploidy in the kidneys, suggesting rapid recovery of renal function after radiation damage. Treatment of the two canine patients delayed the progression of metastatic spread, with an overall survival time of 211 and 437 days and survival beyond documented metastasis of 111 and 84 days, respectively. CONCLUSION This study highlights the potential of hu3F8-based alpha-particle therapy as a promising treatment strategy for OS.
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Affiliation(s)
- Ioanna Liatsou
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Yingli Fu
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhi Li
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mahmud Hasan
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xin Guo
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jing Yu
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph Piccolo
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison Cartee
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hao Wang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yong Du
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Bryan
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Kathleen Gabrielson
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dara L Kraitchman
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George Sgouros
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Fu Y, Abiola G, Tunacao J, Vairavamurthy JP, Nwoke F, Dreher M, Shin EJ, Anders RA, Kraitchman DL, Weiss CR. Balancing Safety and Efficacy to Determine the Most Suitable Size of Imaging-Visible Embolic Microspheres for Bariatric Arterial Embolization in a Preclinical Model. J Vasc Interv Radiol 2023; 34:2224-2232.e3. [PMID: 37684003 DOI: 10.1016/j.jvir.2023.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/20/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES To identify the most suitable size of imaging-visible embolic agents with balanced safety and efficacy for bariatric arterial embolization (BAE) in a preclinical model. MATERIALS AND METHODS Twenty-seven pigs were divided into 3 cohorts. In Cohort I, 16 pigs were randomized to receive (n = 4 each) 40-100-μm microspheres in 1 or 2 fundal arteries, 70-340-μm radiopaque microspheres in 2 fundal arteries, or saline. In Cohort II, 3 pigs underwent renal arterial embolization with either custom-made 100-200-μm, 200-250-μm, 200-300-μm, or 300-400-μm radiopaque microspheres or Bead Block 300-500 μm with microsphere distribution assessed histologically. In Cohort III, 8 pigs underwent BAE in 2 fundal arteries with tailored 100-200-μm radiopaque microspheres (n = 5) or saline (n = 3). RESULTS In Cohort I, no significant differences in weight or ghrelin expression were observed between BAE and control animals. Moderate-to-severe gastric ulcerations were noted in all BAE animals. In Cohort II, renal embolization with 100-200-μm microspheres occluded vessels with a mean diameter of 139 μm ± 31, which is within the lower range of actual diameters of Bead Block 300-500 μm. In Cohort III, BAE with 100-200-μm microspheres resulted in significantly lower weight gain (42.3% ± 5.7% vs 51.6% ± 2.9% at 8 weeks; P = .04), fundal ghrelin cell density (16.1 ± 6.7 vs 23.6 ± 12.6; P = .045), and plasma ghrelin levels (1,709 pg/mL ± 172 vs 4,343 pg/mL ± 1,555; P < .01) compared with controls and superficial gastric ulcers (5/5). CONCLUSIONS In this preclinical model, tailored 100-200-μm microspheres were shown to be most suitable for BAE in terms of safety and efficacy.
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Affiliation(s)
- Yingli Fu
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Godwin Abiola
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessa Tunacao
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jenanan P Vairavamurthy
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Franklin Nwoke
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Dreher
- Peripheral Interventions Division, Boston Scientific Corporation, Marlborough, Massachusetts
| | - Eun Ji Shin
- Department of Gastroenterology and Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A Anders
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dara L Kraitchman
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Rivera D, Schupper AJ, Bouras A, Anastasiadou M, Kleinberg L, Kraitchman DL, Attaluri A, Ivkov R, Hadjipanayis CG. Neurosurgical Applications of Magnetic Hyperthermia Therapy. Neurosurg Clin N Am 2023; 34:269-283. [PMID: 36906333 PMCID: PMC10726205 DOI: 10.1016/j.nec.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Magnetic hyperthermia therapy (MHT) is a highly localized form of hyperthermia therapy (HT) that has been effective in treating various forms of cancer. Many clinical and preclinical studies have applied MHT to treat aggressive forms of brain cancer and assessed its role as a potential adjuvant to current therapies. Initial results show that MHT has a strong antitumor effect in animal studies and a positive association with overall survival in human glioma patients. Although MHT is a promising therapy with the potential to be incorporated into the future treatment of brain cancer, significant advancement of current MHT technology is required.
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Affiliation(s)
- Daniel Rivera
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, Suite F-158, Pittsburgh, PA 15213, USA; Brain Tumor Nanotechnology Laboratory, UPMC Hillman Cancer Center, 5117 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Alexander J Schupper
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Alexandros Bouras
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, Suite F-158, Pittsburgh, PA 15213, USA; Brain Tumor Nanotechnology Laboratory, UPMC Hillman Cancer Center, 5117 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Maria Anastasiadou
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Lawrence Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, 1550 Orleans Street, Baltimore, MD 21231-5678, USA
| | - Dara L Kraitchman
- Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Anilchandra Attaluri
- Department of Mechanical Engineering, The Pennsylvania State University, 777 West Harrisburg Pike Middletown, PA 17057, USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, 1550 Orleans Street, Baltimore, MD 21231-5678, USA; Department of Oncology, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD 21231-5678, USA; Department of Mechanical Engineering, Johns Hopkins University, Whiting School of Engineering, 3400 North Charles Street, Baltimore, MD 21218, USA; Department of Materials Science and Engineering, Johns Hopkins University, Whiting School of Engineering, 3400 North Charles Street, Baltimore, MD 21218, USA
| | - Constantinos G Hadjipanayis
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, Suite F-158, Pittsburgh, PA 15213, USA; Brain Tumor Nanotechnology Laboratory, UPMC Hillman Cancer Center, 5117 Centre Avenue, Pittsburgh, PA 15232, USA.
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Sharma A, Jangam A, Shen JLY, Ahmad A, Arepally N, Rodriguez B, Borrello J, Bouras A, Kleinberg L, Ding K, Hadjipanayis C, Kraitchman DL, Ivkov R, Attaluri A. Validation of a Temperature-Feedback Controlled Automated Magnetic Hyperthermia Therapy Device. Cancers (Basel) 2023; 15:327. [PMID: 36672278 PMCID: PMC9856953 DOI: 10.3390/cancers15020327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
We present in vivo validation of an automated magnetic hyperthermia therapy (MHT) device that uses real-time temperature input measured at the target to control tissue heating. MHT is a thermal therapy that uses heat generated by magnetic materials exposed to an alternating magnetic field. For temperature monitoring, we integrated a commercial fiber optic temperature probe containing four gallium arsenide (GaAs) temperature sensors. The controller device used temperature from the sensors as input to manage power to the magnetic field applicator. We developed a robust, multi-objective, proportional-integral-derivative (PID) algorithm to control the target thermal dose by modulating power delivered to the magnetic field applicator. The magnetic field applicator was a 20 cm diameter Maxwell-type induction coil powered by a 120 kW induction heating power supply operating at 160 kHz. Finite element (FE) simulations were performed to determine values of the PID gain factors prior to verification and validation trials. Ex vivo verification and validation were conducted in gel phantoms and sectioned bovine liver, respectively. In vivo validation of the controller was achieved in a canine research subject following infusion of magnetic nanoparticles (MNPs) into the brain. In all cases, performance matched controller design criteria, while also achieving a thermal dose measured as cumulative equivalent minutes at 43 °C (CEM43) 60 ± 5 min within 30 min.
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Affiliation(s)
- Anirudh Sharma
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Avesh Jangam
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University—Harrisburg, Harrisburg, PA 17057, USA
| | - Julian Low Yung Shen
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University—Harrisburg, Harrisburg, PA 17057, USA
| | - Aiman Ahmad
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University—Harrisburg, Harrisburg, PA 17057, USA
| | - Nageshwar Arepally
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University—Harrisburg, Harrisburg, PA 17057, USA
| | - Benjamin Rodriguez
- Sinai BioDesign, Mount Sinai Hospital, New York, NY 10029, USA
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Joseph Borrello
- Sinai BioDesign, Mount Sinai Hospital, New York, NY 10029, USA
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alexandros Bouras
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Lawrence Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Constantinos Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Dara L. Kraitchman
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Mechanical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Anilchandra Attaluri
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University—Harrisburg, Harrisburg, PA 17057, USA
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Fu Y, Yu J, Liatsou I, Du Y, Josefsson A, Nedrow JR, Rindt H, Bryan JN, Kraitchman DL, Sgouros G. Anti-GD2 antibody for radiopharmaceutical imaging of osteosarcoma. Eur J Nucl Med Mol Imaging 2022; 49:4382-4393. [PMID: 35809088 DOI: 10.1007/s00259-022-05888-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/19/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE Osteosarcoma (OS) is the most frequently diagnosed bone cancer in children with little improvement in overall survival in the past decades. The high surface expression of disialoganglioside GD2 on OS tumors and restricted expression in normal tissues makes it an ideal target for anti-OS radiopharmaceuticals. Since human and canine OS share many biological and molecular features, spontaneously occurring OS in canines has been an ideal model for testing new imaging and treatment modalities for human translation. In this study, we evaluated a humanized anti-GD2 antibody, hu3F8, as a potential delivery vector for targeted radiopharmaceutical imaging of human and canine OS. METHODS The cross-reactivity of hu3F8 with human and canine OS cells and tumors was examined by immunohistochemistry and flow cytometry. The hu3F8 was radiolabeled with indium-111, and the biodistribution of [111In]In-hu3F8 was assessed in tumor xenograft-bearing mice. The targeting ability of [111In]In-hu3F8 to metastatic OS was tested in spontaneous OS canines. RESULTS The hu3F8 cross reacts with human and canine OS cells and canine OS tumors with high binding affinity. Biodistribution studies revealed selective uptake of [111In]In-hu3F8 in tumor tissue. SPECT/CT imaging of spontaneous OS canines demonstrated avid uptake of [111In]In-hu3F8 in all metastatic lesions. Immunohistochemistry confirmed the extensive binding of radiolabeled hu3F8 within both osseous and soft lesions. CONCLUSION This study demonstrates the feasibility of targeting GD2 on OS cells and spontaneous OS canine tumors using hu3F8-based radiopharmaceutical imaging. Its ability to deliver an imaging payload in a targeted manner supports the utility of hu3F8 for precision imaging of OS and potential future use in radiopharmaceutical therapy.
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Affiliation(s)
- Yingli Fu
- Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, MD, Baltimore, USA
| | - Jing Yu
- Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, MD, Baltimore, USA
| | - Ioanna Liatsou
- Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, MD, Baltimore, USA
| | - Yong Du
- Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, MD, Baltimore, USA
| | - Anders Josefsson
- Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, MD, Baltimore, USA
| | - Jessie R Nedrow
- Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, MD, Baltimore, USA
| | - Hans Rindt
- Department of Veterinary Medicine & Surgery, the University of Missouri, Columbia, MO, USA
| | - Jeffrey N Bryan
- Department of Veterinary Medicine & Surgery, the University of Missouri, Columbia, MO, USA
| | - Dara L Kraitchman
- Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, MD, Baltimore, USA
| | - George Sgouros
- Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, MD, Baltimore, USA.
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Sharma A, Cressman E, Attaluri A, Kraitchman DL, Ivkov R. Current Challenges in Image-Guided Magnetic Hyperthermia Therapy for Liver Cancer. Nanomaterials (Basel) 2022; 12:2768. [PMID: 36014633 PMCID: PMC9414548 DOI: 10.3390/nano12162768] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 05/09/2023]
Abstract
For patients diagnosed with advanced and unresectable hepatocellular carcinoma (HCC), liver transplantation remains the best option to extend life. Challenges with organ supply often preclude liver transplantation, making palliative non-surgical options the default front-line treatments for many patients. Even with imaging guidance, success following treatment remains inconsistent and below expectations, so new approaches are needed. Imaging-guided thermal therapy interventions have emerged as attractive procedures that offer individualized tumor targeting with the potential for the selective targeting of tumor nodules without impairing liver function. Furthermore, imaging-guided thermal therapy with added standard-of-care chemotherapies targeted to the liver tumor can directly reduce the overall dose and limit toxicities commonly seen with systemic administration. Effectiveness of non-ablative thermal therapy (hyperthermia) depends on the achieved thermal dose, defined as time-at-temperature, and leads to molecular dysfunction, cellular disruption, and eventual tissue destruction with vascular collapse. Hyperthermia therapy requires controlled heat transfer to the target either by in situ generation of the energy or its on-target conversion from an external radiative source. Magnetic hyperthermia (MHT) is a nanotechnology-based thermal therapy that exploits energy dissipation (heat) from the forced magnetic hysteresis of a magnetic colloid. MHT with magnetic nanoparticles (MNPs) and alternating magnetic fields (AMFs) requires the targeted deposition of MNPs into the tumor, followed by exposure of the region to an AMF. Emerging modalities such as magnetic particle imaging (MPI) offer additional prospects to develop fully integrated (theranostic) systems that are capable of providing diagnostic imaging, treatment planning, therapy execution, and post-treatment follow-up on a single platform. In this review, we focus on recent advances in image-guided MHT applications specific to liver cancer.
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Affiliation(s)
- Anirudh Sharma
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Erik Cressman
- Department of Interventional Radiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Anilchandra Attaluri
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University, Middletown, PA 17057, USA
| | - Dara L. Kraitchman
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
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8
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Vairavamurthy J, Yuan F, Anders RA, Kraitchman DL, Weiss CR. Identifying the Ideal Target Vessel Size for Bariatric Embolization: Histologic Analysis of Swine and Human Gastric Fundi. J Vasc Interv Radiol 2022; 33:28-32. [PMID: 34980451 PMCID: PMC8740629 DOI: 10.1016/j.jvir.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 01/03/2023] Open
Abstract
This study aimed to identify the ideal arteriole size to target in bariatric embolization, with the goal of maximizing weight loss efficacy while maintaining patient safety. Although all published clinical trials of bariatric embolization have used embolic microspheres that were at least 300 μm in diameter, optimal weight loss outcomes have been achieved safely in swine using 50-μm embolics. Human fundal remnants from bariatric surgery were compared with swine fundal sections after bariatric embolization with 50-μm embolic microspheres to assess the ideal fundal vessel size for bariatric embolization. In swine, the 50-μm embolic microspheres deposited in the luminal half of the submucosa with a mean arteriole size of 49 μm ± 30. The mean arteriole diameter in the corresponding submucosal layer of the human gastric fundi was 40 μm ± 30. These measurements may inform future clinical trials and direct the development of embolic agents for bariatric embolization.
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Affiliation(s)
- Jenanan Vairavamurthy
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Frank Yuan
- Vascular and Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, MD
| | - Robert A. Anders
- Department of Pathology, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, MD
| | - Dara L. Kraitchman
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD
| | - Clifford R. Weiss
- Vascular and Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, MD;,Address for correspondence: Clifford R. Weiss, MD, FSIR, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD 21287 (; Telephone: 410-614-1046; Fax: 410-614-1977)
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Yuan F, Latif MA, Shafaat O, Prologo JD, Hill JO, Gudzune KA, Marrone AK, Kraitchman DL, Rogers AM, Khaitan L, Oklu R, Pereira K, Steele K, White SB, Weiss CR. Interventional Radiology Obesity Therapeutics: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel. J Vasc Interv Radiol 2021; 32:1388.e1-1388.e14. [PMID: 34462083 DOI: 10.1016/j.jvir.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 02/06/2023] Open
Abstract
The Society of Interventional Radiology Foundation commissioned a Research Consensus Panel to establish a research agenda on "Obesity Therapeutics" in interventional radiology (IR). The meeting convened a multidisciplinary group of physicians and scientists with expertise in obesity therapeutics. The meeting was intended to review current evidence on obesity therapies, familiarize attendees with the regulatory evaluation process, and identify research deficiencies in IR bariatric interventions, with the goal of prioritizing future high-quality research that would move the field forward. The panelists agreed that a weight loss of >8%-10% from baseline at 6-12 months is a desirable therapeutic endpoint for future IR weight loss therapies. The final consensus on the highest priority research was to design a blinded randomized controlled trial of IR weight loss interventions versus sham control arms, with patients receiving behavioral therapy.
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Affiliation(s)
- Frank Yuan
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Muhammad A Latif
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Omid Shafaat
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J David Prologo
- Department of Radiology, Division of Vascular and Interventional Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - James O Hill
- Department of Nutrition Sciences, School of Health Professions, Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kimberly A Gudzune
- Department of Obesity Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - April K Marrone
- Division of Renal, Gastrointestinal, Obesity and Transplant Devices, Office of GastroRenal, ObGyn, General Hospital and Urology Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Dara L Kraitchman
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ann M Rogers
- Department of Surgery, Penn State Health Surgical Specialties, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Leena Khaitan
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Rahmi Oklu
- Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic, Scottsdale, Arizona
| | - Keith Pereira
- Department of Radiology, Division of Interventional Radiology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Kimberley Steele
- Department of General Surgery, Bariatric Surgery Program, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah B White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Clifford R Weiss
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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10
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Fu Y, Yu J, Liatsou I, Josefsson A, Du Y, Bryan J, Kraitchman DL, Sgouros G. Abstract 1395: Humanized GD2 antibody for targeted radiopharmaceutical therapy of human and canine osteosarcoma. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Osteosarcoma (OS) is the most frequently diagnosed bone tumor in children in the United States. The prognosis for metastatic or recurrent OS has remained poor (5-year survival<30%) with no new effective therapies developed during the past 30 years. The high expression of tumor antigen, ganglioside GD2, on a variety of tumors, including OS, with its restricted expression on normal tissue makes GD2 an ideal target for anti-OS radiopharmaceutical therapy. Since human and canine OS shares many biological and molecular features and the prevalence of OS in dogs is 27 times higher than that in humans, spontaneously occurring OS in dogs has been shown to be an ideal model for testing new treatments for human translation. In this study, we evaluated a humanized GD2 antibody, hu3F8, that was developed for neuroblastoma therapy, as a potential delivery vector for targeted radiopharmaceutical therapy of human and canine OS.The cross immunoreactivity of hu3F8 with canine OS cells (OSCA78) and tissue, and human OS cells was confirmed by immunohistochemistry staining and flow cytometry. The binding affinity of hu3F8 to GD2 was assessed in vitro in OSCA78 and IMR32 (a human neuroblastoma cell line known expressing GD2) cell lines using 111In-DTPA-hu3F8. The dissociation constant Kd was 7.4 ± 1.0 nM for OSCA78, and 6.2 ± 1.9 nM for IMR32. Biodistribution study was performed in Nu/Nu mice bearing either OSCA78 tumor or IMR32 tumor. At 24 h after 111In-DTPA-hu3F8 injection, the highest uptake was observed in the tumor, followed by the blood, spleen, lung, and kidneys. The mean tumor uptake was 12.0% ID/g for OSCA78 tumors and 15.0% ID/g for IMR32 tumors, with a tumor-to-muscle ratio of 10.6 and 21.1, and a tumor-to-blood ratio of 1.1 and 2.4, for OSCA78 and IMR32 tumors, respectively. The 72 h biodistribution study revealed the highest uptake of 111In-DTPA-hu3F8 in both OSCA78 (28.0% ID/g) and IMR32 (51.6% ID/g ) tumors, with a tumor-to-muscle ratio of 93.3 and 206.6, and a tumor-to-blood ratio of 6.7 and 8.4, for OSCA78 tumors and IMR32 tumors, respectively. The improved uptake of 111In-DTPA-hu3F8 in tumors at 72 h was indicative of selective binding of 111In-DTPA-hu3F8 to GD2 expressing tumors. SPECT imaging showed that both OSCA78 and IMR32 tumors with 111In-DTPA-hu3F8 had superior contrast to the background, while 111In-DTPA-Rituximab (an irrelevant antibody) injected OSCA78-bearing mouse only showed moderate contrast to the background in the kidney.The cross immunoreactivity and high binding affinity of hu3F8 to canine OS cells/tissue and its ability to deliver an imaging payload (111In) suggest that conjugating hu3F8 with a radionuclide, such as alpha-emitter, 225Ac, may provide a potent radiopharmaceutical therapy for human and canine OS.
Citation Format: Yingli Fu, Jing Yu, Ioanna Liatsou, Anders Josefsson, Yong Du, Jeffrey Bryan, Dara L. Kraitchman, George Sgouros. Humanized GD2 antibody for targeted radiopharmaceutical therapy of human and canine osteosarcoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1395.
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Affiliation(s)
- Yingli Fu
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jing Yu
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ioanna Liatsou
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Yong Du
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - George Sgouros
- 1Johns Hopkins University School of Medicine, Baltimore, MD
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11
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Liu X, Karmarkar P, Voit D, Frahm J, Weiss CR, Kraitchman DL, Bottomley PA. Real-Time High-Resolution MRI Endoscopy at up to 10 Frames per Second. BME Front 2021; 2021:6185616. [PMID: 37849906 PMCID: PMC10521714 DOI: 10.34133/2021/6185616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/02/2021] [Indexed: 10/19/2023] Open
Abstract
Objective. Atherosclerosis is a leading cause of mortality and morbidity. Optical endoscopy, ultrasound, and X-ray offer minimally invasive imaging assessments but have limited sensitivity for characterizing disease and therapeutic response. Magnetic resonance imaging (MRI) endoscopy is a newer idea employing tiny catheter-mounted detectors connected to the MRI scanner. It can see through vessel walls and provide soft-tissue sensitivity, but its slow imaging speed limits practical applications. Our goal is high-resolution MRI endoscopy with real-time imaging speeds comparable to existing modalities. Methods. Intravascular (3 mm) transmit-receive MRI endoscopes were fabricated for highly undersampled radial-projection MRI in a clinical 3-tesla MRI scanner. Iterative nonlinear reconstruction was accelerated using graphics processor units connected via a single ethernet cable to achieve true real-time endoscopy visualization at the scanner. MRI endoscopy was performed at 6-10 frames/sec and 200-300 μm resolution in human arterial specimens and porcine vessels ex vivo and in vivo and compared with fully sampled 0.3 frames/sec and three-dimensional reference scans using mutual information (MI) and structural similarity (3-SSIM) indices. Results. High-speed MRI endoscopy at 6-10 frames/sec was consistent with fully sampled MRI endoscopy and histology, with feasibility demonstrated in vivo in a large animal model. A 20-30-fold speed-up vs. 0.3 frames/sec reference scans came at a cost of ~7% in MI and ~45% in 3-SSIM, with reduced motion sensitivity. Conclusion. High-resolution MRI endoscopy can now be performed at frame rates comparable to those of X-ray and optical endoscopy and could provide an alternative to existing modalities, with MRI's advantages of soft-tissue sensitivity and lack of ionizing radiation.
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Affiliation(s)
- Xiaoyang Liu
- Department of Electrical and Computer Engineering, Johns Hopkins University, USA
- The Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Parag Karmarkar
- The Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dirk Voit
- Biomedizinishe NMR, Max-Plank-Institut fur Biophysikalische Chemie, Gottingen, Germany
| | - Jens Frahm
- Biomedizinishe NMR, Max-Plank-Institut fur Biophysikalische Chemie, Gottingen, Germany
| | - Clifford R. Weiss
- The Division of Interventional Radiology, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dara L. Kraitchman
- The Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Paul A. Bottomley
- Department of Electrical and Computer Engineering, Johns Hopkins University, USA
- The Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
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12
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Beh CW, Fu Y, Weiss CR, Hu C, Arepally A, Mao HQ, Wang TH, Kraitchman DL. Microfluidic-prepared, monodisperse, X-ray-visible, embolic microspheres for non-oncological embolization applications. Lab Chip 2020; 20:3591-3600. [PMID: 32869821 PMCID: PMC7531348 DOI: 10.1039/d0lc00098a] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Embolotherapy using particle embolics is normally performed with exogenous contrast to assist in visualization. However, the exact location of the embolics cannot be identified after contrast washout. We developed a novel, pseudo-check valve-integrated microfluidic device, that partitions barium- impregnated alginate from crosslinking solution, thereby preventing nozzle failure. This enables rapid and continuous generation of inherently X-ray-visible embolic microspheres (XEMs) with uniform size. The XEMs are visible under clinical X-ray and cone beam CT both in vitro and in vivo. In particular, we demonstrated the embolization properties of these XEMs in large animals, performing direct intra- and post-procedural assessment of embolic delivery. The persistent radiopacity of these XEMs enables real-time evaluation of embolization precision and offers great promise for non-invasive follow-up examination without exogenous contrast. We also demonstrated that bariatric arterial embolization with XEMs significantly suppresses weight gain in swine, as an example of a non-oncological application of embolotherapy.
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Affiliation(s)
- Cyrus W Beh
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N, Charles St, Baltimore, MD 21218, USA.
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13
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Pasciak AS, Manupipatpong S, Hui FK, Gainsburg L, Krimins R, Zink MC, Brayton CF, Morris M, Sage J, Donahue DR, Dreher MR, Kraitchman DL, Weiss CR. Yttrium-90 radioembolization as a possible new treatment for brain cancer: proof of concept and safety analysis in a canine model. EJNMMI Res 2020; 10:96. [PMID: 32804262 PMCID: PMC7431501 DOI: 10.1186/s13550-020-00679-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/28/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose To evaluate the safety, feasibility, and preliminary efficacy of yttrium-90 (90Y) radioembolization (RE) as a minimally invasive treatment in a canine model with presumed spontaneous brain cancers. Materials Three healthy research dogs (R1–R3) and five patient dogs with spontaneous intra-axial brain masses (P1–P5) underwent cerebral artery RE with 90Y glass microspheres (TheraSphere). 90Y-RE was performed on research dogs from the unilateral internal carotid artery (ICA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) while animals with brain masses were treated from the ICA. Post-treatment 90Y PET/CT was performed along with serial neurological exams by a veterinary neurologist. One month after treatment, research dogs were euthanized and the brains were extracted and sent for microdosimetric and histopathologic analyses. Patient dogs received post-treatment MRI at 1-, 3-, and 6-month intervals with long-term veterinary follow-up. Results The average absorbed dose to treated tissue in R1–R3 was 14.0, 30.9, and 73.2 Gy, respectively, with maximum doses exceeding 1000 Gy. One month after treatment, research dog pathologic analysis revealed no evidence of cortical atrophy and rare foci consistent with chronic infarcts, e.g., < 2-mm diameter. Absorbed doses to masses in P1–P5 were 45.5, 57.6, 58.1, 45.4, and 64.1 Gy while the dose to uninvolved brain tissue was 15.4, 27.6, 19.2, 16.7, and 33.3 G, respectively. Among both research and patient animals, 6 developed acute neurologic deficits following treatment. However, in all surviving dogs, the deficits were transient resolving between 7 and 33 days post-therapy. At 1 month post-therapy, patient animals showed a 24–94% reduction in mass volume with partial response in P1, P3, and P4 at 6 months post-treatment. While P2 initially showed a response, by 5 months, the mass had advanced beyond pre-treatment size, and the dog was euthanized. Conclusion This proof of concept demonstrates the technical feasibility and safety of 90Y-RE in dogs, while preliminary, initial data on the efficacy of 90Y-RE as a potential treatment for brain cancer is encouraging.
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Affiliation(s)
- Alexander S Pasciak
- School of Medicine, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA.
| | - Sasicha Manupipatpong
- School of Medicine, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Ferdinand K Hui
- Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Larry Gainsburg
- Mid-Atlantic Veterinary Neurology and Neurosurgery, Baltimore, MD, USA
| | - Rebecca Krimins
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University, Baltimore, MD, USA.,Department of Radiology and Radiological Science, Express Radiology Research Lab, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiology and Radiological Science, Veterinary Clinical Trials Network, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M Christine Zink
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University, Baltimore, MD, USA
| | - Cory F Brayton
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University, Baltimore, MD, USA
| | - Meaghan Morris
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Danielle R Donahue
- Mouse Imaging Facility, National Institutes of Health, Bethesda, MD, USA
| | - Matthew R Dreher
- Biocompatibles UK Ltd., a BTG International group company, Farnham, Surrey, UK
| | - Dara L Kraitchman
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University, Baltimore, MD, USA.,Department of Radiology and Radiological Science, Center for Image-Guided Animal Therapy, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clifford R Weiss
- Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department Biomedical Engineering, The Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
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14
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Abstract
The prevalence of obesity is increasing globally, leading to significantly increased morbidity, mortality, and health care costs. However, there is a lack of effective treatment options that can treat patients with obesity less invasively than with bariatric surgery. Bariatric arterial embolization (BAE) is an image-guided, minimally invasive, percutaneous procedure that is currently being investigated in preclinical animal models and early clinical trials. If successful, BAE may represent a viable interventional approach for obesity treatment. The purpose of this article is to introduce the physiological and anatomical rationale for BAE, review techniques involved in performing BAE for weight modulation, and provide up-to-date preclinical evidence that supports the translation of BAE into patients.
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Affiliation(s)
- Yingli Fu
- Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD.
| | - Dara L Kraitchman
- Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD
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15
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Weiss CR, Abiola GO, Fischman AM, Cheskin LJ, Vairavamurthy J, Holly BP, Akinwande O, Nwoke F, Paudel K, Belmustakov S, Hong K, Patel RS, Shin EJ, Steele KE, Moran TH, Thompson RE, Dunklin T, Ziessman H, Kraitchman DL, Arepally A. Bariatric Embolization of Arteries for the Treatment of Obesity (BEAT Obesity) Trial: Results at 1 Year. Radiology 2019; 291:792-800. [PMID: 30938624 DOI: 10.1148/radiol.2019182354] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Bariatric embolization is a new endovascular procedure to treat patients with obesity. However, the safety and efficacy of bariatric embolization are unknown. Purpose To evaluate the safety and efficacy of bariatric embolization in severely obese adults at up to 12 months after the procedure. Materials and Methods For this prospective study (NCT0216512 on ClinicalTrials.gov ), 20 participants (16 women) aged 27-68 years (mean ± standard deviation, 44 years ± 11) with mean body mass index of 45 ± 4.1 were enrolled at two institutions from June 2014 to February 2018. Transarterial embolization of the gastric fundus was performed using 300- to 500-µm embolic microspheres. Primary end points were 30-day adverse events and weight loss at up to 12 months. Secondary end points at up to 12 months included technical feasibility, health-related quality of life (Short Form-36 Health Survey ([SF-36]), impact of weight on quality of life (IWQOL-Lite), and hunger or appetite using a visual assessment scale. Analysis of outcomes was performed by using one-sample t tests and other exploratory statistics. Results Bariatric embolization was performed successfully for all participants with no major adverse events. Eight participants had a total of 11 minor adverse events. Mean excess weight loss was 8.2% (95% confidence interval [CI]: 6.3%, 10%; P < .001) at 1 month, 11.5% (95% CI: 8.7%, 14%; P < .001) at 3 months, 12.8% (95% CI: 8.3%, 17%; P < .001) at 6 months, and 11.5% (95% CI: 6.8%, 16%; P < .001) at 12 months. From baseline to 12 months, mean SF-36 scores increased (mental component summary, from 46 ± 11 to 50 ± 10, P = .44; physical component summary, from 46 ± 8.0 to 50 ± 9.3, P = .15) and mean IWQOL-Lite scores increased from 57 ± 18 to 77 ± 18 (P < .001). Hunger or appetite decreased for 4 weeks after embolization and increased thereafter, without reaching pre-embolization levels. Conclusion Bariatric embolization is well tolerated in severely obese adults, inducing appetite suppression and weight loss for up to 12 months. Published under a CC BY-NC-ND 4.0 license. Online supplemental material is available for this article.
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Affiliation(s)
- Clifford R Weiss
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Godwin O Abiola
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Aaron M Fischman
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Lawrence J Cheskin
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Jay Vairavamurthy
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Brian P Holly
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Olaguoke Akinwande
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Franklin Nwoke
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Kalyan Paudel
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Stephen Belmustakov
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Kelvin Hong
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Rahul S Patel
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Eun J Shin
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Kimberley E Steele
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Timothy H Moran
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Richard E Thompson
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Taylor Dunklin
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Harvey Ziessman
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Dara L Kraitchman
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
| | - Aravind Arepally
- From the Russell H. Morgan Department of Radiology and Radiological Science (C.R.W., J.V., B.P.H., O.A., F.N., K.P., K.H., T.D., H.Z., D.L.K.), Department of Medicine (E.J.S.), Department of Surgery (K.E.S.), and Department of Psychiatry and Behavioral Sciences (T.H.M.), The Johns Hopkins University School of Medicine, Baltimore, MD 21287; Department of Health, Behavior, and Society (L.J.C.) and Department of Biostatistics (R.E.T.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The Johns Hopkins University School of Medicine, Baltimore, MD (G.O.A., S.B.); Department of Radiology, Mount Sinai Hospital, New York, NY (A.M.F., R.S.P.); and Department of Radiology, Piedmont Healthcare, Atlanta, GA (A.A.)
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Fu Y, Weiss CR, Paudel K, Shin EJ, Kedziorek D, Arepally A, Anders RA, Kraitchman DL. Bariatric Arterial Embolization: Effect of Microsphere Size on the Suppression of Fundal Ghrelin Expression and Weight Change in a Swine Model. Radiology 2018; 289:83-89. [PMID: 29989526 DOI: 10.1148/radiol.2018172874] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To determine whether microsphere size effects ghrelin expression and weight gain after selective bariatric arterial embolization (BAE) in swine. Materials and Methods BAE was performed in 10 swine by using smaller (100-300 μm; n = 5) or larger (300-500 μm; n = 5) calibrated microspheres into gastric arteries. Nine control pigs underwent a sham procedure. Weight and fasting plasma ghrelin levels were measured at baseline and weekly for 16 weeks. Ghrelin-expressing cells (GECs) in the stomach were assessed by using immunohistochemical staining and analyzed by using the Wilcoxon rank-sum test. Results In pigs treated with smaller microspheres, mean weight gain at 16 weeks (106.9% ± 15.0) was less than in control pigs (131.9% ± 11.6) (P < .001). Mean GEC density was lower in the gastric fundus (14.8 ± 6.3 vs 25.0 ± 6.9, P < .001) and body (27.5 ± 12.3 vs 37.9 ± 11.8, P = .004) but was not significantly different in the gastric antrum (28.2 ± 16.3 vs 24.3 ± 11.6, P = .84) and duodenum (9.2 ± 3.8 vs 8.7 ± 2.9, P = .66) versus in control pigs. BAE with larger microspheres failed to suppress weight gain or GECs in any stomach part compared with results in control swine. Plasma ghrelin levels were similar between BAE pigs and control pigs, regardless of microsphere size. Week 1 endoscopic evaluation for gastric ulcers revealed none in control pigs, five ulcers in five pigs embolized by using smaller microspheres, and three ulcers in five pigs embolized by using larger microspheres. Conclusion In bariatric arterial embolization, smaller microspheres rather than larger microspheres showed greater weight gain suppression and fundal ghrelin expression with more gastric ulceration in a swine model. © RSNA, 2018.
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Affiliation(s)
- Yingli Fu
- From the Russell H. Morgan Department of Radiology and Radiological Science (Y.F., C.R.W., K.P., D.K., D.L.K.), Department of Gastroenterology (E.J.S.), and Department of Pathology (R.A.A.), the Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed Tower 7203, Baltimore, MD 21287; and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Clifford R Weiss
- From the Russell H. Morgan Department of Radiology and Radiological Science (Y.F., C.R.W., K.P., D.K., D.L.K.), Department of Gastroenterology (E.J.S.), and Department of Pathology (R.A.A.), the Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed Tower 7203, Baltimore, MD 21287; and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Kalyan Paudel
- From the Russell H. Morgan Department of Radiology and Radiological Science (Y.F., C.R.W., K.P., D.K., D.L.K.), Department of Gastroenterology (E.J.S.), and Department of Pathology (R.A.A.), the Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed Tower 7203, Baltimore, MD 21287; and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Eun-Ji Shin
- From the Russell H. Morgan Department of Radiology and Radiological Science (Y.F., C.R.W., K.P., D.K., D.L.K.), Department of Gastroenterology (E.J.S.), and Department of Pathology (R.A.A.), the Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed Tower 7203, Baltimore, MD 21287; and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Dorota Kedziorek
- From the Russell H. Morgan Department of Radiology and Radiological Science (Y.F., C.R.W., K.P., D.K., D.L.K.), Department of Gastroenterology (E.J.S.), and Department of Pathology (R.A.A.), the Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed Tower 7203, Baltimore, MD 21287; and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Aravind Arepally
- From the Russell H. Morgan Department of Radiology and Radiological Science (Y.F., C.R.W., K.P., D.K., D.L.K.), Department of Gastroenterology (E.J.S.), and Department of Pathology (R.A.A.), the Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed Tower 7203, Baltimore, MD 21287; and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Robert A Anders
- From the Russell H. Morgan Department of Radiology and Radiological Science (Y.F., C.R.W., K.P., D.K., D.L.K.), Department of Gastroenterology (E.J.S.), and Department of Pathology (R.A.A.), the Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed Tower 7203, Baltimore, MD 21287; and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Dara L Kraitchman
- From the Russell H. Morgan Department of Radiology and Radiological Science (Y.F., C.R.W., K.P., D.K., D.L.K.), Department of Gastroenterology (E.J.S.), and Department of Pathology (R.A.A.), the Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed Tower 7203, Baltimore, MD 21287; and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
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Zlabinger K, Lukovic D, Hemetsberger R, Gugerell A, Winkler J, Mandic L, Traxler D, Spannbauer A, Wolbank S, Zanoni G, Kaun C, Posa A, Gyenes A, Petrasi Z, Petnehazy Ö, Repa I, Hofer-Warbinek R, de Martin R, Gruber F, Charwat S, Huber K, Pavo N, Pavo IJ, Nyolczas N, Kraitchman DL, Gyöngyösi M. Matrix Metalloproteinase-2 Impairs Homing of Intracoronary Delivered Mesenchymal Stem Cells in a Porcine Reperfused Myocardial Infarction: Comparison With Intramyocardial Cell Delivery. Front Bioeng Biotechnol 2018; 6:35. [PMID: 29670878 PMCID: PMC5893806 DOI: 10.3389/fbioe.2018.00035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/15/2018] [Indexed: 12/16/2022] Open
Abstract
Background Intracoronary (IC) injection of mesenchymal stem cells (MSCs) results in a prompt decrease of absolute myocardial blood flow (AMF) with late and incomplete recovery of myocardial tissue perfusion. Here, we investigated the effect of decreased AMF on oxidative stress marker matrix metalloproteinase-2 (MMP-2) and its influence on the fate and homing and paracrine character of MSCs after IC or intramyocardial cell delivery in a closed-chest reperfused myocardial infarction (MI) model in pigs. Methods Porcine MSCs were transiently transfected with Ad-Luc and Ad-green fluorescent protein (GFP). One week after MI, the GFP-Luc-MSCs were injected either IC (group IC, 11.00 ± 1.07 × 106) or intramyocardially (group IM, 9.88 ± 1.44 × 106). AMF was measured before, immediately after, and 24 h post GFP-Luc-MSC delivery. In vitro bioluminescence signal was used to identify tissue samples containing GFP-Luc-MSCs. Myocardial tissue MMP-2 and CXCR4 receptor expression (index of homing signal) were measured in bioluminescence positive and negative infarcted and border, and non-ischemic myocardial areas 1-day post cell transfer. At 7-day follow-up, myocardial homing (cadherin, CXCR4, and stromal derived factor-1alpha) and angiogenic [fibroblast growth factor 2 (FGF2) and VEGF] were quantified by ELISA of homogenized myocardial tissues from the bioluminescence positive and negative infarcted and border, and non-ischemic myocardium. Biodistribution of the implanted cells was quantified by using Luciferase assay and confirmed by fluorescence immunochemistry. Global left ventricular ejection fraction (LVEF) was measured at baseline and 1-month post cell therapy using magnet resonance image. Results AMF decreased immediately after IC cell delivery, while no change in tissue perfusion was found in the IM group (42.6 ± 11.7 vs. 56.9 ± 16.7 ml/min, p = 0.018). IC delivery led to a significant increase in myocardial MMP-2 64 kD expression (448 ± 88 vs. 315 ± 54 intensity × mm2, p = 0.021), and decreased expression of CXCR4 (592 ± 50 vs. 714 ± 54 pg/tissue/ml, p = 0.006), with significant exponential decay between MMP-2 and CXCR4 (r = 0.679, p < 0.001). FGF2 and VEGF of the bioluminescence infarcted and border zone of homogenized tissues were significantly elevated in the IM goups as compared to IC group. LVEF increase was significantly higher in IM group (0.8 ± 8.4 vs 5.3 ± 5.2%, p = 0.046) at the 1-month follow up. Conclusion Intracoronary stem cell delivery decreased AMF, with consequent increase in myocardial expression of MMP-2 and reduced CXCR4 expression with lower level of myocardial homing and angiogenic factor release as compared to IM cell delivery.
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Affiliation(s)
- Katrin Zlabinger
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Dominika Lukovic
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Alfred Gugerell
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Johannes Winkler
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Ljubica Mandic
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Denise Traxler
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Susanne Wolbank
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology/AUVA Research Center Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Gerald Zanoni
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology/AUVA Research Center Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christoph Kaun
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Aniko Posa
- Institute of Biophysics, Biological Research Center, Szeged, Hungary
| | - Andrea Gyenes
- Institute of Biophysics, Biological Research Center, Szeged, Hungary
| | - Zsolt Petrasi
- Institute of Diagnostics and Radiation Oncology, University of Kaposvar, Kaposvar, Hungary
| | - Örs Petnehazy
- Institute of Diagnostics and Radiation Oncology, University of Kaposvar, Kaposvar, Hungary
| | - Imre Repa
- Institute of Diagnostics and Radiation Oncology, University of Kaposvar, Kaposvar, Hungary
| | - Renate Hofer-Warbinek
- Department of Biomolecular Medicine and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Rainer de Martin
- Department of Biomolecular Medicine and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | - Florian Gruber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Silvia Charwat
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Kurt Huber
- 3rd Department of Medicine (Cardiology and Emergency Medicine), Wilhelminenhospital, Vienna, Austria
| | - Noemi Pavo
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Imre J Pavo
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Noemi Nyolczas
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Dara L Kraitchman
- Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
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Krimins RA, Fritz J, Gainsburg LA, Gavin PR, Ihms EA, Huso DL, Kraitchman DL. Use of magnetic resonance imaging-guided biopsy of a vertebral body mass to diagnose osteosarcoma in a Rottweiler. J Am Vet Med Assoc 2017; 250:779-784. [PMID: 28306496 DOI: 10.2460/javma.250.7.779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 9-year-old spayed female Rottweiler with hind limb ataxia was examined because of anorexia and an acute onset of hind limb paresis. CLINICAL FINDINGS Neurologic evaluation revealed hind limb ataxia and symmetric paraparesis with bilaterally abnormal hind limb postural reactions including hopping, hemiwalking, hemistanding, and delayed proprioception, which were suggestive of a lesion somewhere in the T3-L3 segment of the spinal cord. Thoracolumbar radiography revealed an abnormal radiopacity suggestive of a mass at T11. Two 3.5-cm-long osseous core biopsy specimens of the mass were obtained by MRI guidance. Histologic appearance of the specimens was consistent with osteosarcoma. TREATMENT AND OUTCOME The owners of the dog declined further treatment owing to a poor prognosis. The dog was euthanized within 12 months after diagnosis because of a declining quality of life. CLINICAL RELEVANCE The acquisition of biopsy specimens by MRI guidance is an emerging technique in veterinary medicine. As evidenced by the dog of this report, MRI-guided biopsy can be used to safely obtain diagnostic biopsy specimens from tissues at anatomic locations that are difficult to access. This technique can potentially be used to facilitate early diagnosis and treatment of disease, which could improve patient outcome. The MRI guidance technique described may also be useful for local administration of chemotherapeutics or radiofrequency ablation or cryoablation of various neoplasms of the vertebral column.
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Weiss CR, Akinwande O, Paudel K, Cheskin LJ, Holly B, Hong K, Fischman AM, Patel RS, Shin EJ, Steele KE, Moran TH, Kaiser K, Park A, Shade DM, Kraitchman DL, Arepally A. Clinical Safety of Bariatric Arterial Embolization: Preliminary Results of the BEAT Obesity Trial. Radiology 2017; 283:598-608. [PMID: 28195823 DOI: 10.1148/radiol.2016160914] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose To conduct a pilot prospective clinical trial to evaluate the feasibility, safety, and short-term efficacy of bariatric embolization, a recently developed endovascular procedure for the treatment of obesity, in patients with severe obesity. Materials and Methods This is an institutional review board- and U.S. Food and Drug Administration-approved prospective physician-initiated investigational device exemption study. This phase of the study ran from June 2, 2014, to August 4, 2015. Five severely obese patients (four women, one man) who were 31-49 years of age and who had a mean body mass index of 43.8 kg/m2 ± 2.9 with no clinically important comorbidities were enrolled in this study. Transarterial embolization of the gastric fundus with fluoroscopic guidance was performed with 300-500-μm Embosphere microspheres. The primary end point was 30-day adverse events (AEs). The secondary end points included short-term weight loss, serum obesity-related hormone levels, hunger and satiety assessments, and quality of life (QOL) surveys, reported up to 3 months. Simple statistics of central tendencies and variability were calculated. No hypothesis testing was performed. Results The left gastric artery, with or without the gastroepiploic artery, was embolized in five patients, with a technical success rate of 100%. There were no major AEs. There were two minor AEs-subclinical pancreatitis and a mucosal ulcer that had healed by the time of 3-month endoscopy. A hospital stay of less than 48 hours for routine supportive care was provided for three patients. Mean excess weight loss of 5.9% ± 2.4 and 9.0% ± 4.1 was noted at 1 month and at 3 months, respectively. Mean change in serum ghrelin was 8.7% ± 34.7 and -17.5% ± 29 at 1 month and 3 months, respectively. Mean changes in serum glucagon-like peptide 1 and peptide YY were 106.6% ± 208.5 and 17.8% ± 54.8 at 1 month. There was a trend toward improvement in QOL parameters. Hunger/appetite scores decreased in the first 2 weeks after the procedure and then rose without reaching preprocedure levels. Conclusion Bariatric embolization is feasible and appears to be well tolerated in severely obese patients. In this small patient cohort, it appears to induce appetite suppression and may induce weight loss. Further expansion of this study will provide more insight into the long-term safety and efficacy of bariatric embolization. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Clifford R Weiss
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Olaguoke Akinwande
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Kaylan Paudel
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Lawrence J Cheskin
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Brian Holly
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Kelvin Hong
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Aaron M Fischman
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Rahul S Patel
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Eun J Shin
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Kimberley E Steele
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Timothy H Moran
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Kristen Kaiser
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Amie Park
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - David M Shade
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Dara L Kraitchman
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
| | - Aravind Arepally
- From the Departments of Radiology (C.R.W., O.A., K.P., B.H., K.H., D.L.K.), Gastroenterology and Hepatology (E.J.S.), Surgery (K.E.S.), and Psychiatry (T.H.M.), Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD 21287; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (L.J.C.); Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.M.F., R.S.P.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (K.K., A.P., D.M.S.); and Department of Radiology, Piedmont Healthcare, Atlanta, Ga (A.A.)
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Rose LC, Kadayakkara DK, Wang G, Bar-Shir A, Helfer BM, O'Hanlon CF, Kraitchman DL, Rodriguez RL, Bulte JWM. Fluorine-19 Labeling of Stromal Vascular Fraction Cells for Clinical Imaging Applications. Stem Cells Transl Med 2015; 4:1472-81. [PMID: 26511652 DOI: 10.5966/sctm.2015-0113] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/31/2015] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED Stromal vascular fraction (SVF) cells are used clinically for various therapeutic targets. The location and persistence of engrafted SVF cells are important parameters for determining treatment failure versus success. We used the GID SVF-1 platform and a clinical protocol to harvest and label SVF cells with the fluorinated ((19)F) agent CS-1000 as part of a first-in-human phase I trial (clinicaltrials.gov identifier NCT02035085) to track SVF cells with magnetic resonance imaging during treatment of radiation-induced fibrosis in breast cancer patients. Flow cytometry revealed that SVF cells consisted of 25.0% ± 15.8% CD45+, 24.6% ± 12.5% CD34+, and 7.5% ± 3.3% CD31+ cells, with 2.1 ± 0.7 × 10⁵ cells per cubic centimeter of adipose tissue obtained. Fluorescent CS-1000 (CS-ATM DM Green) labeled 87.0% ± 13.5% of CD34+ progenitor cells compared with 47.8% ± 18.5% of hematopoietic CD45+ cells, with an average of 2.8 ± 2.0 × 10¹² ¹⁹F atoms per cell, determined using nuclear magnetic resonance spectroscopy. The vast majority (92.7% ± 5.0%) of CD31+ cells were also labeled, although most coexpressed CD34. Only 16% ± 22.3% of CD45-/CD31-/CD34- (triple-negative) cells were labeled with CS-ATM DM Green. After induction of cell death by either apoptosis or necrosis, >95% of ¹⁹F was released from the cells, indicating that fluorine retention can be used as a surrogate marker for cell survival. Labeled-SVF cells engrafted in a silicone breast phantom could be visualized with a clinical 3-Tesla magnetic resonance imaging scanner at a sensitivity of approximately 2 × 10⁶ cells at a depth of 5 mm. The current protocol can be used to image transplanted SVF cells at clinically relevant cell concentrations in patients. SIGNIFICANCE Stromal vascular fraction (SVF) cells harvested from adipose tissue offer great promise in regenerative medicine, but methods to track such cell therapies are needed to ensure correct administration and monitor survival. A clinical protocol was developed to harvest and label SVF cells with the fluorinated (¹⁹F) agent CS-1000, allowing cells to be tracked with (19)F magnetic resonance imaging (MRI). Flow cytometry evaluation revealed heterogeneous ¹⁹F uptake in SVF cells, confirming the need for careful characterization. The proposed protocol resulted in sufficient ¹⁹F uptake to allow imaging using a clinical MRI scanner with point-of-care processing.
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Affiliation(s)
- Laura C Rose
- Division of Magnetic Resonance Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Deepak K Kadayakkara
- Division of Magnetic Resonance Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Guan Wang
- Department of Electrical and Computer Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amnon Bar-Shir
- Division of Magnetic Resonance Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Dara L Kraitchman
- Division of Magnetic Resonance Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Jeff W M Bulte
- Division of Magnetic Resonance Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Chemical & Biomolecular Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Weiss CR, Gunn AJ, Kim CY, Paxton BE, Kraitchman DL, Arepally A. Bariatric embolization of the gastric arteries for the treatment of obesity. J Vasc Interv Radiol 2015; 26:613-24. [PMID: 25777177 DOI: 10.1016/j.jvir.2015.01.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 12/31/2022] Open
Abstract
Obesity is a public health epidemic in the United States that results in significant morbidity, mortality, and cost to the health care system. Despite advancements in therapeutic options for patients receiving bariatric procedures, the number of overweight and obese individuals continues to increase. Therefore, complementary or alternative treatments to lifestyle changes and surgery are urgently needed. Embolization of the left gastric artery, or bariatric arterial embolization (BAE), has been shown to modulate body weight in animal models and early clinical studies. If successful, BAE represents a potential minimally invasive approach offered by interventional radiologists to treat obesity. The purpose of the present review is to introduce the interventional radiologist to BAE by presenting its physiologic and anatomic bases, reviewing the preclinical and clinical data, and discussing current and future investigations.
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Affiliation(s)
- Clifford R Weiss
- Vascular and Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, Maryland.
| | - Andrew J Gunn
- Vascular and Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, Maryland
| | - Charles Y Kim
- Department of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Ben E Paxton
- Department of Interventional Radiology, Yavapai Regional Medical Center, Prescott, Arizona
| | - Dara L Kraitchman
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, Maryland; Department of Molecular and Comparative Pathobiology, The Johns Hopkins University, Baltimore, Maryland
| | - Aravind Arepally
- Division of Interventional Radiology, Piedmont Radiology, Atlanta, Georgia
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Kraitchman DL, Hu C, Anders R, Moran T, Singh J, DiCamillo P, Shin E, Hai-Quan M, Wang TH, Aravind A, Weiss C. BARIATRIC ARTERIAL EMBOLIZATION AS TREATMENT FOR OBESITY: MECHANISMS USING HIGHLY CALIBRATED 50 MICRON EMBOLIC BEADS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61908-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fu Y, Azene N, Ehtiati T, Flammang A, Gilson WD, Gabrielson K, Weiss CR, Bulte JWM, Solaiyappan M, Johnston PV, Kraitchman DL. Fused X-ray and MR imaging guidance of intrapericardial delivery of microencapsulated human mesenchymal stem cells in immunocompetent swine. Radiology 2014; 272:427-37. [PMID: 24749713 DOI: 10.1148/radiol.14131424] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To assess intrapericardial delivery of microencapsulated, xenogeneic human mesenchymal stem cells (hMSCs) by using x-ray fused with magnetic resonance (MR) imaging (x-ray/MR imaging) guidance as a potential treatment for ischemic cardiovascular disease in an immunocompetent swine model. MATERIALS AND METHODS All animal experiments were approved by the institutional animal care and use committee. Stem cell microencapsulation was performed by using a modified alginate-poly-l-lysine-alginate encapsulation method to include 10% (wt/vol) barium sulfate to create barium-alginate microcapsules (BaCaps) that contained hMSCs. With x-ray/MR imaging guidance, eight female pigs (approximately 25 kg) were randomized to receive either BaCaps with hMSCs, empty BaCaps, naked hMSCs, or saline by using a percutaneous subxiphoid approach and were compared with animals that received empty BaCaps (n = 1) or BaCaps with hMSCs (n = 2) by using standard fluoroscopic delivery only. MR images and C-arm computed tomographic (CT) images were acquired before injection and 1 week after delivery. Animals were sacrificed immediately or at 1 week for histopathologic validation. Cardiac function between baseline and 1 week after delivery was evaluated by using a paired Student t test. RESULTS hMSCs remained highly viable (94.8% ± 6) 2 days after encapsulation in vitro. With x-ray/MR imaging, successful intrapericardial access and delivery were achieved in all animals. BaCaps were visible fluoroscopically and at C-arm CT immediately and 1 week after delivery. Whereas BaCaps were free floating immediately after delivery, they consolidated into a pseudoepicardial tissue patch at 1 week, with hMSCs remaining highly viable within BaCaps; naked hMSCs were poorly retained. Follow-up imaging 1 week after x-ray/MR imaging-guided intrapericardial delivery showed no evidence of pericardial adhesion and/or effusion or adverse effect on cardiac function. In contradistinction, BaCaps delivery with x-ray fluoroscopy without x-ray/MR imaging (n = 3) resulted in pericardial adhesions and poor hMSC viability after 1 week. CONCLUSION Intrapericardial delivery of BaCaps with hMSCs leads to high cell retention and survival. With x-ray/MR imaging guidance, intrapericardial delivery can be performed safely in the absence of preexisting pericardial effusion to provide a novel route for cardiac cellular regenerative therapy.
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Affiliation(s)
- Yingli Fu
- From the Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science (Y.F., C.R.W., J.W.M.B., M.S., D.L.K.), Department of Molecular and Comparative Pathobiology (N.A., K.G., D.L.K.), Institute for Cell Engineering (J.W.M.B.), and Division of Cardiology, Department of Internal Medicine (P.V.J.), The Johns Hopkins University School of Medicine, 600 N Wolfe St, 314 Park Bldg, Baltimore, MD 21087; and Department of Corporate Technology, Siemens Corporation, Baltimore, Md (T.E., A.F., W.D.G.)
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Paxton BE, Alley CL, Crow JH, Burchette J, Weiss CR, Kraitchman DL, Arepally A, Kim CY. Histopathologic and immunohistochemical sequelae of bariatric embolization in a porcine model. J Vasc Interv Radiol 2014; 25:455-61. [PMID: 24462005 DOI: 10.1016/j.jvir.2013.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the histopathologic sequelae of bariatric embolization on the gastric mucosa and to correlate with immunohistochemical evaluation of the gastric fundus, antrum, and duodenum. MATERIALS AND METHODS This study was performed on 12 swine stomach and duodenum specimens after necropsy. Of the 12 swine, 6 had previously undergone bariatric embolization of the gastric fundus, and the 6 control swine had undergone a sham procedure with saline. Gross pathologic, histopathologic, and immunohistochemical examinations of the stomach and duodenum were performed. Specifically, mucosal integrity, fibrosis, ghrelin-expressing cells, and gastrin-expressing cells were assessed. RESULTS Gross and histopathologic evaluation of treatment animals showed healing or healed mucosal ulcers in 50% of animals, with gastritis in 100% of treatment animals and in five of six control animals. The ghrelin-immunoreactive mean cell density was significantly lower in the gastric fundus in the treated animals compared with control animals (15.3 vs 22.0, P < .01) but similar in the gastric antrum (9.3 vs 14.3, P = .08) and duodenum (8.5 vs 8.6, P = .89). The gastrin-expressing cell density was significantly lower in the antrum of treated animals compared with control animals (82.2 vs 126.4, P = .03). A trend toward increased fibrosis was suggested in the gastric fundus of treated animals compared with controls (P = .07). CONCLUSIONS Bariatric embolization resulted in a significant reduction in ghrelin-expressing cells in the gastric fundus without evidence of upregulation of ghrelin-expressing cells in the duodenum. Healing ulcerations in half of treated animals underscores the need for additional refinement of this procedure.
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Affiliation(s)
- Ben E Paxton
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
| | - Christopher L Alley
- Department of Pathology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Jennifer H Crow
- Department of Pathology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - James Burchette
- Department of Pathology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Clifford R Weiss
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dara L Kraitchman
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
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Abstract
In the past ten years, the concept of injecting stem and progenitor cells to assist with rebuilding damaged blood vessels and myocardial tissue after injury in the heart and peripheral vasculature has moved from bench to bedside. Non-invasive imaging can not only provide a means to assess cardiac repair and, thereby, cellular therapy efficacy but also a means to confirm cell delivery and engraftment after administration. In this first of a two-part review, we will review the different types of cellular labeling techniques and the application of these techniques in cardiovascular magnetic resonance and ultrasound. In addition, we provide a synopsis of the cardiac cellular clinical trials that have been performed to-date.
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Affiliation(s)
- Nicole Azene
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD, USA
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University, Baltimore, MD, USA
| | - Yingli Fu
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD, USA
| | - Jeremy Maurer
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD, USA
| | - Dara L Kraitchman
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD, USA
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University, Baltimore, MD, USA
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, 314 Park Building, Baltimore, MD 21287, USA
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Kedziorek DA, Solaiyappan M, Walczak P, Ehtiati T, Fu Y, Bulte JWM, Shea SM, Brost A, Wacker FK, Kraitchman DL. Using C-arm x-ray imaging to guide local reporter probe delivery for tracking stem cell engraftment. Theranostics 2013; 3:916-26. [PMID: 24396502 PMCID: PMC3879108 DOI: 10.7150/thno.6943] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 11/28/2013] [Indexed: 11/05/2022] Open
Abstract
Poor cell survival and difficulties with visualization of cell delivery are major problems with current cell transplantation methods. To protect cells from early destruction, microencapsulation methods have been developed. The addition of a contrast agent to the microcapsule also could enable tracking by MR, ultrasound, and X-ray imaging. However, determining the cell viability within the microcapsule still remains an issue. Reporter gene imaging provides a way to determine cell viability, but delivery of the reporter probe by systemic injection may be hindered in ischemic diseases. In the present study, mesenchymal stem cells (MSCs) were transfected with triple fusion reporter gene containing red fluorescent protein, truncated thymidine kinase (SPECT/PET reporter) and firefly luciferase (bioluminescence reporter). Transfected cells were microencapsulated in either unlabeled or perfluorooctylbromide (PFOB) impregnated alginate. The addition of PFOB provided radiopacity to enable visualization of the microcapsules by X-ray imaging. Before intramuscular transplantation in rabbit thigh muscle, the microcapsules were incubated with D-luciferin, and bioluminescence imaging (BLI) was performed immediately. Twenty-four and forty-eight hours post transplantation, c-arm CT was used to target the luciferin to the X-ray-visible microcapsules for BLI cell viability assessment, rather than systemic reporter probe injections. Not only was the bioluminescent signal emission from the PFOB-encapsulated MSCs confirmed as compared to non-encapsulated, naked MSCs, but over 90% of injection sites of PFOB-encapsulated MSCs were visible on c-arm CT. The latter aided in successful targeting of the reporter probe to injection sites using conventional X-ray imaging to determine cell viability at 1-2 days post transplantation. Blind luciferin injections to the approximate location of unlabeled microcapsules resulted in successful BLI signal detection in only 18% of injections. In conclusion, reporter gene probes can be more precisely targeted using c-arm CT for in vivo transplant viability assessment, thereby avoiding large and costly systemic injections of a reporter probe.
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Affiliation(s)
- Dorota A Kedziorek
- 1. Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Meiyappan Solaiyappan
- 1. Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Piotr Walczak
- 1. Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States. ; 2. Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Tina Ehtiati
- 3. Center for Applied Medical Imaging, Corporate Technology, Siemens Corporation, Baltimore, Maryland, United States
| | - Yingli Fu
- 1. Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jeff W M Bulte
- 1. Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States. ; 2. Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Steven M Shea
- 1. Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States. ; 3. Center for Applied Medical Imaging, Corporate Technology, Siemens Corporation, Baltimore, Maryland, United States
| | - Alexander Brost
- 4. Pattern Recognition Lab, University of Erlangen, Erlangen, Germany
| | - Frank K Wacker
- 1. Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States. ; 5. Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Dara L Kraitchman
- 1. Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Arifin DR, Kedziorek DA, Fu Y, Chan KWY, McMahon MT, Weiss CR, Kraitchman DL, Bulte JWM. Microencapsulated cell tracking. NMR Biomed 2013; 26:850-859. [PMID: 23225358 PMCID: PMC3655121 DOI: 10.1002/nbm.2894] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/08/2012] [Accepted: 10/28/2012] [Indexed: 06/01/2023]
Abstract
Microencapsulation of therapeutic cells has been widely pursued to achieve cellular immunoprotection following transplantation. Initial clinical studies have shown the potential of microencapsulation using semi-permeable alginate layers, but much needs to be learned about the optimal delivery route, in vivo pattern of engraftment, and microcapsule stability over time. In parallel with noninvasive imaging techniques for 'naked' (i.e. unencapsulated) cell tracking, microcapsules have now been endowed with contrast agents that can be visualized by (1) H MRI, (19) F MRI, X-ray/computed tomography and ultrasound imaging. By placing the contrast agent formulation in the extracellular space of the hydrogel, large amounts of contrast agents can be incorporated with negligible toxicity. This has led to a new generation of imaging biomaterials that can render cells visible with multiple imaging modalities.
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Affiliation(s)
- Dian R. Arifin
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorota A. Kedziorek
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yingli Fu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kannie W. Y. Chan
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael T. McMahon
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clifford R. Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dara L. Kraitchman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeff W. M. Bulte
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Meyer BC, Brost A, Kraitchman DL, Gilson WD, Strobel N, Hornegger J, Lewin JS, Wacker FK. Percutaneous punctures with MR imaging guidance: comparison between MR imaging-enhanced fluoroscopic guidance and real-time MR Imaging guidance. Radiology 2013; 266:912-9. [PMID: 23297324 DOI: 10.1148/radiol.12120117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate and compare the technical accuracy and feasibility of magnetic resonance (MR) imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance for percutaneous puncture procedures in phantoms and animals. MATERIALS AND METHODS The experimental protocol was approved by the institutional animal care and use committee. Punctures were performed in phantoms, aiming for markers (20 each for MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance), and pigs, aiming for anatomic landmarks (10 for MR imaging-enhanced fluoroscopic guidance and five for MR imaging guidance). To guide the punctures, T1-weighted three-dimensional (3D) MR images of the phantom or pig were acquired. Additional axial and coronal T2-weighted images were used to visualize the anatomy in the animals. For MR imaging-enhanced fluoroscopic guidance, phantoms and pigs were transferred to the fluoroscopic system after initial MR imaging and C-arm computed tomography (CT) was performed. C-arm CT and MR imaging data sets were coregistered. Prototype navigation software was used to plan a puncture path with use of MR images and to superimpose it on fluoroscopic images. For real-time MR imaging, an interventional MR imaging prototype for interactive real-time section position navigation was used. Punctures were performed within the magnet bore. After completion, 3D MR imaging was performed to evaluate the accuracy of insertions. Puncture durations were compared by using the log-rank test. The Mann-Whitney U test was applied to compare the spatial errors. RESULTS In phantoms, the mean total error was 8.6 mm ± 2.8 with MR imaging-enhanced fluoroscopic guidance and 4.0 mm ± 1.2 with real-time MR imaging guidance (P < .001). The mean puncture time was 2 minutes 10 seconds ± 44 seconds with MR imaging-enhanced fluoroscopic guidance and 37 seconds ± 14 with real-time MR imaging guidance (P < .001). In the animal study, a tolerable distance (<1 cm) between target and needle tip was observed for both MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance. The mean total error was 7.7 mm ± 2.4 with MR imaging-enhanced fluoroscopic guidance and 7.9 mm ± 4.9 with real-time MR imaging guidance (P = .77). The mean puncture time was 5 minutes 43 seconds ± 2 minutes 7 seconds with MR imaging-enhanced fluoroscopic guidance and 5 minutes 14 seconds ± 2 minutes 25 seconds with real-time MR imaging guidance (P = .68). CONCLUSION Both MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance demonstrated reasonable and similar accuracy in guiding needle placement to selected targets in phantoms and animals.
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Kedziorek DA, Hofmann LV, Fu Y, Gilson WD, Cosby KM, Kohl B, Barnett BP, Simons BW, Walczak P, Bulte JWM, Gabrielson K, Kraitchman DL. X-ray-visible microcapsules containing mesenchymal stem cells improve hind limb perfusion in a rabbit model of peripheral arterial disease. Stem Cells 2012; 30:1286-96. [PMID: 22438076 DOI: 10.1002/stem.1096] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The therapeutic goal in peripheral arterial disease (PAD) patients is to restore blood flow to ischemic tissue. Stem cell transplantation offers a new avenue to enhance arteriogenesis and angiogenesis. Two major problems with cell therapies are poor cell survival and the lack of visualization of cell delivery and distribution. To address these therapeutic barriers, allogeneic bone marrow-derived mesenchymal stem cells (MSCs) were encapsulated in alginate impregnated with a radiopaque contrast agent (MSC-Xcaps). In vitro MSC-Xcap viability by a fluorometric assay was high (96.9% ± 2.7% at 30 days postencapsulation) and as few as 10 Xcaps were visible on clinical x-ray fluoroscopic systems. Using an endovascular PAD model, rabbits (n = 21) were randomized to receive MSC-Xcaps (n = 6), empty Xcaps (n = 5), unencapsulated MSCs (n = 5), or sham intramuscular injections (n = 5) in the ischemic thigh 24 hours postocclusion. Immediately after MSC transplantation and 14 days later, digital radiographs acquired on a clinical angiographic system demonstrated persistent visualization of the Xcap injection sites with retained contrast-to-noise. Using a modified TIMI frame count, quantitative angiography demonstrated a 65% improvement in hind limb perfusion or arteriogenesis in MSC-Xcap-treated animals versus empty Xcaps. Post-mortem immunohistopathology of vessel density by anti-CD31 staining demonstrated an 87% enhancement in angiogenesis in Xcap-MSC-treated animals versus empty Xcaps. MSC-Xcaps represent the first x-ray-visible cellular therapeutic with enhanced efficacy for PAD treatment.
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Affiliation(s)
- Dorota A Kedziorek
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Lauer AM, El-Sharkawy AMM, Kraitchman DL, Edelstein WA. MRI acoustic noise can harm experimental and companion animals. J Magn Reson Imaging 2012; 36:743-7. [PMID: 22488793 DOI: 10.1002/jmri.23653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 03/05/2012] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To assess possible damage to the hearing of experimental and companion animal subjects of magnetic resonance imaging (MRI) scans. MATERIALS AND METHODS Using animal hearing threshold data and sound level measurements from typical MRI pulse sequences, we estimated "equivalent loudness" experienced by several experimental and companion animals commonly subjects of MRI scans. We compared the equivalent loudness and exam duration to safe noise standards set by the National Institute for Occupational Safety and Health (NIOSH). RESULTS Monkeys, dogs, cats, pigs, and rabbits are frequently exposed to equivalent loudness levels during MRI scans beyond what is considered safe for human exposure. The sensitive frequency ranges for rats and mice are shifted substantially upward and their equivalent loudness levels fall within the NIOSH safe zone. CONCLUSION MRI exposes many animals to levels of noise and duration that would exceed NIOSH human exposure limits. Researchers and veterinarians should use hearing protection for animals during MRI scans. Experimental research animals used in MRI studies are frequently kept and reimaged, and hearing loss could result in changed behavior. Damage to companion animals' hearing could make them less sensitive to commands and generally worsen interactions with family members. Much quieter MRI scanners would help decrease stress and potential harm to scanned animals, normalize physiology during MRI, and enable MRI of awake animals.
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Affiliation(s)
- Amanda M Lauer
- Otolaryngology-HNS, Johns Hopkins School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA
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Barnett BP, Ruiz-Cabello J, Hota P, Ouwerkerk R, Shamblott MJ, Lauzon C, Walczak P, Gilson WD, Chacko VP, Kraitchman DL, Arepally A, Bulte JWM. Use of perfluorocarbon nanoparticles for non-invasive multimodal cell tracking of human pancreatic islets. Contrast Media Mol Imaging 2012; 6:251-9. [PMID: 21861285 DOI: 10.1002/cmmi.424] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In vivo imaging of engraftment and immunorejection of transplanted islets is critical for further clinical development, with (1)H MR imaging of superparamagnetic iron oxide-labeled cells being the current premier modality. Using perfluorocarbon nanoparticles, we present here a strategy for non-invasive imaging of cells using other modalities. To this end, human cadaveric islets were labeled with rhodamine-perfluorooctylbromide (PFOB) nanoparticles, rhodamine-perfluoropolyether (PFPE) nanoparticles or Feridex as control and tested in vitro for cell viability and c-peptide secretion for 1 week. (19)F MRI, computed tomography (CT) and ultrasound (US) imaging was performed on labeled cell phantoms and on cells following transplantation beneath the kidney capsule of mice and rabbits. PFOB and PFPE-labeling did not reduce human islet viability or glucose responsiveness as compared with unlabeled cells or SPIO-labeled cells. PFOB- and PFPE-labeled islets were effectively fluorinated for visualization by (19)F MRI. PFOB-labeled islets were acoustically reflective for detection by US imaging and became sufficiently brominated to become radiopaque allowing visualization with CT. Thus, perfluorocarbon nanoparticles are multimodal cellular contrast agents that may find applications in real-time targeted delivery and imaging of transplanted human islets or other cells in a clinically applicable manner using MRI, US or CT imaging.
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Affiliation(s)
- Brad P Barnett
- Department of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Kraitchman DL, Qian D, Bottomley PA, Weiss CR. Unexpected Heating of MR-compatible Cyroablation Probes Using a Conventional 1.5T MR Scanner. Proc Int Soc Magn Reson Med Sci Meet Exhib Int Soc Magn Reson Med Sci Meet Exhib 2012; 20:2927. [PMID: 25346620 PMCID: PMC4207286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Dara L Kraitchman
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, United States ; Department of Molecular and Comparative Pathobiology, Johns Hopkins University, Baltimore, MD, United States
| | - Di Qian
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, United States ; Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Paul A Bottomley
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
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35
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Azene NM, Ehtiati T, Fu Y, Flammang A, Guehring J, Gilson WD, Kedziorek DD, Cook J, Johnston PV, Kraitchman DL. Intrapericardial delivery of visible microcapsules containing stem cells using xfm (x-ray fused with magnetic resonance imaging). J Cardiovasc Magn Reson 2011. [PMCID: PMC3106796 DOI: 10.1186/1532-429x-13-s1-p26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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36
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Xu Y, Fu Y, Kedziorek D, Azene N, Ehtiati T, Flamang A, Shea SM, Kraitchman DL. A comparison of time-of-flight mr angiography, contrast-enhanced mr angiography and ct angiography to evaluate vessel area in a rabbit peripheral arterial disease model. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106816 DOI: 10.1186/1532-429x-13-s1-p366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Link TW, Woodrum D, Gilson WD, Pan L, Qian D, Kraitchman DL, Bulte JWM, Arepally A, Weiss CR. MR-guided portal vein delivery and monitoring of magnetocapsules: assessment of physiologic effects on the liver. J Vasc Interv Radiol 2011; 22:1335-40. [PMID: 21816623 DOI: 10.1016/j.jvir.2011.03.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 03/11/2011] [Accepted: 03/15/2011] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The authors previously developed magnetic resonance (MR)-trackable magnetocapsules (MCs) that can simultaneously immunoprotect human islet cells and noninvasively monitor portal delivery and engraftment in real time with MR imaging. This study was designed to assess the physiologic effects of the delivery of a clinical dose of MCs (140,000 capsules) into the portal vein (PV) in swine over a 1-month period. MATERIALS AND METHODS MCs were formed by using clinical-grade alginate mixed with a clinically applicable dosage of ferumoxide. Percutaneous access into the PV was obtained by using a custom-built, MR-trackable needle, and 140,000 MCs were delivered under MR guidance in five swine. Portal pressures and liver function data were obtained over a 4-week period. RESULTS A transient increase in portal pressure occurred immediately after MC delivery that returned to normal levels by 4 weeks after MC delivery. Liver function test results were normal during the entire period, and the appearance of the MCs on MR imaging did not change. CONCLUSIONS A clinically applicable dose of 140,000 MCs has no adverse effects on portal pressures or liver function in this normal swine model during the first month after delivery.
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Affiliation(s)
- Thomas W Link
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Fu Y, Azene N, Xu Y, Kraitchman DL. Tracking stem cells for cardiovascular applications in vivo: focus on imaging techniques. ACTA ACUST UNITED AC 2011; 3:473-486. [PMID: 22287982 DOI: 10.2217/iim.11.33] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite rapid translation of stem cell therapy into clinical practice, the treatment of cardiovascular disease using embryonic stem cells, adult stem and progenitor cells or induced pluripotent stem cells has not yielded satisfactory results to date. Noninvasive stem cell imaging techniques could provide greater insight into not only the therapeutic benefit, but also the fundamental mechanisms underlying stem cell fate, migration, survival and engraftment in vivo. This information could also assist in the appropriate choice of stem cell type(s), delivery routes and dosing regimes in clinical cardiovascular stem cell trials. Multiple imaging modalities, such as MRI, PET, SPECT and CT, have emerged, offering the ability to localize, monitor and track stem cells in vivo. This article discusses stem cell labeling approaches and highlights the latest cardiac stem cell imaging techniques that may help clinicians, research scientists or other healthcare professionals select the best cellular therapeutics for cardiovascular disease management.
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Affiliation(s)
- Yingli Fu
- Russell H Morgan Department of Radiology & Radiological Science, Johns Hopkins University, Baltimore, MD, USA
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Patil RR, Yu J, Banerjee SR, Ren Y, Leong D, Jiang X, Pomper M, Tsui B, Kraitchman DL, Mao HQ. Probing in vivo trafficking of polymer/DNA micellar nanoparticles using SPECT/CT imaging. Mol Ther 2011; 19:1626-35. [PMID: 21750533 DOI: 10.1038/mt.2011.128] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Successful translation of nonviral gene delivery to therapeutic applications requires detailed understanding of in vivo trafficking of the vehicles. This report compares the pharmacokinetic and biodistribution profiles of polyethylene glycol-b-polyphosphoramidate (PEG-b-PPA)/DNA micellar nanoparticles after administration through intravenous infusion, intrabiliary infusion, and hydrodynamic injection using single photon emission computed tomography/computed tomography (SPECT/CT) imaging. Nanoparticles were labeled with (111)In using an optimized protocol to retain their favorable physicochemical properties. Quantitative imaging analysis revealed different in vivo trafficking kinetics for PEG-b-PPA/DNA nanoparticles after different routes of administration. The intrabiliary infusion resulted in the highest liver uptake of micelles compared with the other two routes. Analysis of intrabiliary infusion by the two-compartment pharmacokinetic modeling revealed efficient retention of micelles in the liver and minimal micelle leakage from the liver to the blood stream. This study demonstrates the utility of SPECT/CT as an effective noninvasive imaging modality for the characterization of nanoparticle trafficking in vivo and confirms that intrabiliary infusion is an effective route for liver-targeted delivery of DNA-containing nanoparticles.
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Affiliation(s)
- Rajesh R Patil
- Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
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Fu Y, Kedziorek D, Mease R, Chen Y, Huang G, Xu Y, Kraitchman DL. MULTI-MODALITY IMAGING-VISIBLE REPORTER GENE LABELED HUMAN MESENCHYMAL STEM CELLS FOR TREATING ISCHEMIC ARTERIAL DISEASES. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sathyanarayana S, Schär M, Kraitchman DL, Bottomley PA. Towards real-time intravascular endoscopic magnetic resonance imaging. JACC Cardiovasc Imaging 2011; 3:1158-65. [PMID: 21071004 DOI: 10.1016/j.jcmg.2010.08.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 08/06/2010] [Accepted: 08/23/2010] [Indexed: 02/07/2023]
Abstract
Fast, minimally invasive, high-resolution intravascular imaging is essential for identifying vascular pathological features and for developing novel diagnostic tools and treatments. Intravascular magnetic resonance imaging (MRI) with active internal probes offers high sensitivity to pathological features without ionizing radiation or the limited luminal views of conventional X-rays, but has been unable to provide a high-speed, high-resolution, endoscopic view. Herein, real-time MRI endoscopy is introduced for performing MRI from a viewpoint intrinsically locked to a miniature active, internal transmitter-receiver in a clinical 3.0-T MRI scanner. Real-time MRI endoscopy at up to 2 frames/s depicts vascular wall morphological features, atherosclerosis, and calcification at 80 to 300 μm resolution during probe advancement through diseased human iliac artery specimens and atherosclerotic rabbit aortas in vivo. MRI endoscopy offers the potential for fast, minimally invasive, transluminal, high-resolution imaging of vascular disease on a common clinical platform suitable for evaluating and targeting atherosclerosis in both experimental and clinical settings.
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Affiliation(s)
- Shashank Sathyanarayana
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
Recently, several protocols for labeling of stem cells with superparamagnetic iron oxides (SPIOs) have been developed, leading to an active and growing field aimed at visualizing stem cells using MRI (magnetic resonance imaging), including image-guided stem cell injections. This development occurred simultaneously with a significant rise in the number of cell therapy clinical trials for cardiovascular applications and their preceding pre-clinical studies in animal models. In this chapter, we will describe several labeling strategies that can be used to label cells with SPIO nanoparticles. This is followed by a discussion of current strategies for using MRI to visualize these cells in myocardial infarct.
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Affiliation(s)
- Dara L Kraitchman
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Kraitchman DL, Bulte JWM. Magnetic nanoparticles and neurotoxins for treating atrial fibrillation: a new way to get burned? Circulation 2010; 122:2642-4. [PMID: 21135362 DOI: 10.1161/circulationaha.110.000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kedziorek DA, Kraitchman DL. Superparamagnetic iron oxide labeling of stem cells for MRI tracking and delivery in cardiovascular disease. Methods Mol Biol 2010; 660:171-83. [PMID: 20680819 DOI: 10.1007/978-1-60761-705-1_11] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In the mid-1980s, iron oxide nanoparticles were developed as contrast agents for diagnostic imaging. In the last two decades, established methods to label cells with superparamagnetic iron oxides (SPIOs) have been developed to aid in targeted delivery and tracking of stem cell therapies. The surge in cellular therapy clinical trials for cardiovascular applications has seen a similar rise in the number of preclinical animal studies of SPIO-labeled stem cells in an effort to understand the mechanisms of cardiovascular regenerative therapy and stem cell biodistribution. The adoption of a limited number of methods of direct labeling of stem cells with SPIOs is due in large part to the desire to rapidly translate these techniques to clinical trials. In this review, we will outline the most commonly adopted methods for iron oxide labeling of stem cells for cardiovascular applications and describe strategies for magnetic resonance imaging (MRI) of magnetically labeled cells in the heart.
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Affiliation(s)
- Dorota A Kedziorek
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD, USA
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Abstract
Clinical and basic scientific studies of stem cell-based therapies have shown promising results for cardiovascular diseases. Despite a rapid transition from animal studies to clinical trials, the mechanisms by which stem cells improve heart function are yet to be fully elucidated. To optimize cell therapies in patients will require a noninvasive means to evaluate cell survival, biodistribution and fate in the same subject over time. Cell labeling offers the ability to image distinct cell lineages in vivo and investigate the efficacy of these therapies using standard noninvasive imaging techniques. In this article, we will discuss the most promising cell labeling techniques for translation to clinical cardiovascular applications.
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Affiliation(s)
- Yingli Fu
- The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, 600 N. Wolfe Street, 314 Park Building, Baltimore, MD 21287, USA
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Barnett BP, Ruiz-Cabello J, Hota P, Liddell R, Walczak P, Howland V, Chacko VP, Kraitchman DL, Arepally A, Bulte JWM. Fluorocapsules for improved function, immunoprotection, and visualization of cellular therapeutics with MR, US, and CT imaging. Radiology 2010; 258:182-91. [PMID: 20971778 DOI: 10.1148/radiol.10092339] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To develop novel immunoprotective alginate microcapsule formulations containing perfluorocarbons (PFCs) that may increase cell function, provide immunoprotection for xenografted cells, and simultaneously enable multimodality imaging. MATERIALS AND METHODS All animal experiments were approved by an Institutional Animal Care and Use Committee. Cadaveric human islet cells were encapsulated with alginate, poly-l-lysine, and perfluorooctyl bromide (PFOB) or perfluoropolyether (PFPE). In vitro viability and the glucose-stimulation index for insulin were determined over the course of 2 weeks and analyzed by using a cross-sectional time series regression model. The sensitivity of multimodality (computed tomography [CT], ultrasonography [US], and fluorine 19 [(19)F] magnetic resonance [MR] imaging) detection was determined for fluorocapsules embedded in gel phantoms. C57BL/6 mice intraperitoneally receiving 6000 PFOB-labeled (n = 6) or 6000 PFPE-labeled (n = 6) islet-containing fluorocapsules and control mice intraperitoneally receiving 6000 PFOB-labeled (n = 6) or 6000 PFPE-labeled (n = 6) fluorocapsules without islets were monitored for human C-peptide (insulin) secretion during a period of 55 days. Mice underwent (19)F MR imaging at 9.4 T and micro-CT. Swine (n = 2) receiving 9000 PFOB capsules through renal artery catheterization were imaged with a clinical multidetector CT scanner. Signal intensity was evaluated by using a paired t test. RESULTS Compared with nonfluorinated alginate microcapsules, PFOB fluorocapsules increased insulin secretion of encapsulated human islets, with values up to 18.5% (3.78 vs 3.19) at 8-mmol/L glucose concentration after 7 days in culture (P < .001). After placement of the immunoprotected encapsulated cells into mice, a sustained insulin release was achieved with human C-peptide levels of 19.1 pmol/L ± 0.9 (standard deviation) and 33.0 pmol/L ± 1.0 for PFPE and PFOB capsules, respectively. Fluorocapsules were readily visualized with (19)F MR imaging, US imaging, and CT with research- and clinical-grade imagers for all modalities. CONCLUSION Fluorocapsules enhance glucose responsiveness and insulin secretion in vitro, enable long-term insulin secretion by xenografted islet cells in vivo, and represent a novel contrast agent platform for multimodality imaging.
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Affiliation(s)
- Brad P Barnett
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, 720 Rutland Ave, 217 Traylor, Baltimore, MD 21205, USA
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Abstract
Molecular imaging is a new discipline that makes possible the noninvasive visualization of cellular and molecular processes in living subjects. In the field of cardiovascular regenerative therapy, imaging cell fate after transplantation is a high priority in both basic research and clinical translation. For cell-based therapy to truly succeed, we must be able to track the locations of delivered cells, the duration of cell survival, and any potential adverse effects. The insights gathered from basic research imaging studies will yield valuable insights into better designs for clinical trials. This review highlights the different types of stem cells used for cardiovascular repair, the development of various imaging modalities to track their fate in vivo, and the challenges of clinical translation of cardiac stem cell imaging in the future.
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Affiliation(s)
- Joseph C Wu
- Department of Medicine (Cardiology) and Radiology, Stanford University School of Medicine, Stanford, California, USA.
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Fu Y, Kedziorek D, Shea S, Ouwerkerk R, Huang G, Ehtiati T, Krieg R, Bulte JWM, Kraitchman DL. NOVEL 19F MRI AND CT TRACKABLE MICROENCAPSULATED MESENCHYMAL STEM CELLS FOR TREATING PERIPHERAL ARTERIAL DISEASE. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)62050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fu Y, Xie Y, Kedziorek DA, Shea SM, Ouwerkerk R, Ehtiati T, Huang G, Krieg R, Wacker F, Bulte JWM, Kraitchman DL. MRI and CT tracking of mesenchymal stem cells with novel perfluorinated alginate microcapsules. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-o14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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