Pathomechanisms of nephrogenic systemic fibrosis: new insights

Gupta, Ashish; Shamseddin, M. Khaled; Khaira, Ambar

doi:10.1111/j.1365-2230.2011.04136.x

Cited by 16 publications

(10 citation statements)

References 20 publications

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“…These may then bind with readily available phosphates, carbonates or citrates, and form insoluble molecules. Several authors mention histological findings of increased dermal collagen bundles, CD34+ fibroblast like cells, macrophages, mucin and transforming growth factor beta (TGFβ) in this cohort of patients [ 2 , 4 , 5 , 16 , 23 – 25 ]. Pre-existing renal disease has been the most prevalent patient characteristic.…”

Section: Introductionmentioning

confidence: 88%

“…Cofactors such as high dose erythropoietin treatment, pro-inflammatory state, high serum phosphate and calcium, and absence of ace inhibitor treatment, have also been linked to the appearance of NSF [ 27 – 30 ]. Chelated gadolinium such as gadodiamide and gadopentetate have been shown to directly stimulate macrophages and monocytes in vitro to release profibrotic cytokines and growth factors capable of initiating and supporting the characteristic tissue fibrosis [ 23 , 31 – 33 ].…”

Section: Introductionmentioning

confidence: 99%

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Revisiting the risks of MRI with Gadolinium based contrast agents—review of literature and guidelines

et al. 2015

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Gadolinium based contrast agents (GBCA) have been linked to the occurrence of nephrogenic systemic fibrosis (NSF) in renal impaired patients. The exact interaction between the various different available formulations and occurrence of NSF is not completely understood, but has been postulated. This association has triggered public health advisory bodies to issue guidelines and best practice recommendations on its use. As a result, the reported incidence of NSF, as well as the published use of GBCA-enhanced magnetic resonance imaging in renal impairment, has seen a decline. Understanding of the events that led to these recommendations can increase clinical awareness and the implications of their usage. We present a review of published literature and a brief overview of practice recommendations, guidelines and manuals on contrast safety to aide everyday imaging practice.Teaching Points• Low risk gadolinium based contrast agents should be the choice in renal insufficiency.• Higher doses have been linked to NSF development. Doses should be as low as possible.• Clear documentation of date,dose and type of formulation used should be noted.• Post-scan dialysis should be arranged as soon as possible and feasible.• Pre-existing inflammatory state is a risk factor;liver insufficiency is not a contraindication.

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Section: Introductionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Revisiting the risks of MRI with Gadolinium based contrast agents—review of literature and guidelines

et al. 2015

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“…Such testing is especially important when the agents contain heavy metals, which are extremely toxic if released from stabilizing chelates. For example, Gd chelates, commonly used as blood pool agents for MRI contrast, are now indicated as a risk factor for systemic nephrogenic fibrosis . Carbon nanotubes and silica nanoparticles, both of which show great promise as preclinical imaging agents, may also have issues owing to long retention times .…”

Section: Considerationsmentioning

confidence: 99%

Cell tracking using multimodal imaging

Srinivas

Melero

Kaempgen

et al. 2013

Contrast Media & Molecular

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In vivo imaging plays a key role in cell tracking, particularly for the optimization of cellular therapeutics. A recent trend is to use more than one imaging modality (multimodality imaging) for this purpose. There are several advantages to multimodal cell tracking, particularly the corroboration of data obtained using a new imaging agent or technique with an established one, and the ability to glean complementary information from a single experiment. In this review, we examine the different types of labels and imaging strategies used in the literature for multimodal cell tracking, and discuss the pros and cons of these approaches, with a focus on MRI. Despite many efforts and novel technologies, we still have to face situations where current imaging methods are simply not sensitive enough and new labeling strategies are hampered by the lack of approved reagents. Finally, we examine new in vitro and preclinical developments, which have the potential to tackle unresolved challenges in in vivo multimodal imaging.

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“…It is proposed that elevated levels of MT's in keratinocytes can lead to fibroblast proliferation (keloidogenesis) by inhibiting programmed cell death via zinc signaling cascades [55]. Metallothionein gene expression is modified in the secretome of fibroblast exposed to gadodiamide [56]. It is speculated that the gadolinium chelate may be directly inhibiting the metalloproteinase function as they have a zinc atom at the active site.…”

Section: Role Of Metallothioneinsmentioning

confidence: 99%

Understanding Nephrogenic Systemic Fibrosis

Chopra

Kandukurti

Shah

et al. 2012

International Journal of Nephrology

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Nephrogenic systemic fibrosis (NSF) is a rare and a debilitating disease noted uncommonly in patients with impaired renal function when exposed to low-stability gadolinium-based contrast agents (Gd-CAs). According to experimental studies, cytokines released by the stimulation of effector cells such as skin macrophages and peripheral blood monocytes activate circulating fibroblasts which play a major role in the development of NSF lesions. The presence of permissive factors, presumably, provides an environment conducive to facilitate the process of fibrosis. Multiple treatment modalities have been tried with variable success rates. More research is necessary to elucidate the underlying pathophysiological mechanisms which could potentially target the initial steps of fibrosis in these patients. This paper attempts to collate the inferences from the in vivo and in vitro experiments to the clinical observations to understand the pathogenesis of NSF. Schematic representations of receptor-mediated molecular pathways of activation of macrophages and fibroblasts by gadolinium and the final pathway to fibrosis are incorporated in the discussion.

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Pathomechanisms of nephrogenic systemic fibrosis: new insights

Cited by 16 publications

References 20 publications

Revisiting the risks of MRI with Gadolinium based contrast agents—review of literature and guidelines

Revisiting the risks of MRI with Gadolinium based contrast agents—review of literature and guidelines

Cell tracking using multimodal imaging

Understanding Nephrogenic Systemic Fibrosis

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