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Crystal structures of hen egg-white lysozyme complexes with gadolinium(III) and gadolinium(III)-N-acetyl-D-glucosamine.

Analysis at 0.25 nm resolution of the crystal structures of lysozyme-Gd(III) and lysozyme-Gd(III)-N-acetyl-D-glucosamine (GlcNac), prepared by diffusion methods, show that there are two main binding positions for Gd(III), one of which is close to glutamic acid-35 and the other close to aspartic acid-52. The two sites are 0.36 nm part. There is no evidence for the weak binding of Gd(III) to any of the eight other carboxy groups of lysozyme. In the presence of Gd(III), the binding of GlcNac is similar to that observed for the binding of the beta-anomer in subsite C. There are numerous small conformational changes in the protein on binding (Gd(III) and the sugar, and these have been quantified to a first approximation by real-space refinement. These changes are similar in both structures, and involve, among other small movements, shifts of one of the disulphide bridges by up to 0.05 nm. The movement of residues 70--74 observed in the binary complex of lysozyme-GlcNac [Perkins, Johnson, Machin & Phillips (1978) Biochem. J. 173-617] is not observed in the ternary complex of lysozyme-Gd(III)-GlcNac. The nature of the lysozyme-Gd(III) complex is discussed in the light of evidence from other crystallographic studies and n.m.r. solution studies. Preliminary findings for a lysozyme-Gd(III) complex prepared by co-crystallization methods are reported.

Acetylglucosamine

Neutron-capture therapy of murine ascites tumor with gadolinium-containing microcapsules.

Gadolinium-containing microcapsules were evaluated as an agent for gadolinium neutron-capture therapy. Mice were inoculated intraperitoneally with 10(7) Ehrlich ascites tumor cells and gadolinium microcapsules and exposed to thermal neutrons for 12 min (approximately 1.86 x 10(12) neutrons cm-2). Significantly more mice given gadolinium microcapsules than those given placebo microcapsules or control survived for 60 days and considerably longer (P < 0.0001), indicating that gadolinium neutron-capture reactions effectively suppressed the growth of ascites tumor cells in mice. The results suggest that these microcapsules are an effective gadolinium carrier for neutron-capture therapy.

Animals

Block of receptor response in the stretch receptor neuron of the crayfish by gadolinium.

The trivalent lanthanide gadolinium was found to block the mechanotransducer response in the stretch receptor neuron of the crayfish. At normal calcium concentration (13.5 mM) a 50 per cent block of the receptor current was found at 395 +/- 59 (mean +/- SD) microM gadolinium. At a calcium concentration of 1.35 mM a 50 per cent block of the receptor current was obtained at 103 +/- 14 (mean +/- SD) microM gadolinium. The potential activated potassium current was also affected by gadolinium. At 200 microM the amplitude of the peak outward current as a result of a 90 mV positive potential step was decreased by about 40 per cent. The fast inward sodium current was decreased less than 10 per cent by gadolinium. It is concluded that in the crayfish stretch receptor gadolinium blocks the receptor current, reflecting block of stretch-activated channels, but at higher concentrations than have been described for other stretch-activated channels. In addition the outward rectifier potassium current is also blocked reflecting a block of potassium channels.

Animals

Gadolinium-enhanced MR imaging of renal masses.

Preliminary reports indicate that gadolinium-enhanced magnetic resonance (MR) imaging is highly accurate for diagnosis of renal masses. The authors demonstrate the clinical utility of MR imaging for evaluating renal masses in 26 patients for whom contrast material-enhanced computed tomography (CT) was contraindicated or inadequate for diagnosis or staging. Nine patients had complex cysts, one had a perinephric hematoma, and 16 had a solid mass (three of which were benign). All patients underwent MR imaging before and after administration of gadopentetate dimeglumine. Multiple imaging techniques and sequences were used. All tumors and no cysts enhanced with gadolinium. Even though the three benign tumors enhanced, two were differentiated from renal carcinoma on the basis of other imaging features. Unenhanced MR imaging was accurate in staging of renal carcinomas, and use of gadolinium did not improve staging accuracy. Gadolinium-enhanced MR imaging is indicated when results of CT and sonography are indeterminate for malignancy and when contrast-enhanced CT is contraindicated because of renal failure or adverse reaction to iodinated contrast material. In this latter instance, MR imaging is useful for both diagnosis and staging.

Carcinoma, Renal Cell

Evaluation of two new gadolinium chelates as contrast agents for MRI.

Two new gadolinium chelates were investigated for potential use as tissue-specific contrast agents for magnetic resonance imaging. In vitro measurements of stability constants, octanol/water partition coefficients and relaxation times in solutions of water and human serum albumin (HSA) were performed with each new chelate and compared with gadolinium-diethylenetriamine pentaacetic acid, Gd(DTPA). Biodistribution studies and magnetic resonance imaging in rats were used to evaluate the new chelates in vivo. The stability constants (log K) of gadolinium-N,N''-bis(3-hydroxy-6-methyl-2- pyridylmethyl)diethylenetriamine-N,N',N''-triacetic acid, Gd(DTTA-HP), and gadolinium-1,7,13-triaza-4,10,16-trioxacyclooctadecane-N,N', N''-triacetic acid, Gd(TTCT), were determined to be 23.65 and 18.07, respectively. These can be compared to a literature value of 22.46 for Gd(DTPA). Octanol/water partition coefficients for both complexes showed they were more lipophilic than Gd(DTPA). Gd(DTTA-HP) exhibited a smaller relaxivity in water but a larger relaxivity in 4% HSA than Gd(DTPA). Gd(TTCT) exhibited a lower relaxivity than Gd(DTPA) in both water and 4% HSA. Both complexes showed similar biodistributions to Gd(DTPA) no carrier-added concentrations. Gd(DTTA-HP) had a greater percent change in signal intensity than Gd(DTPA) on T1-weighted spin-echo images in the heart, liver, and kidney. Percent change in signal intensity for Gd(TTCT) was lower than Gd(DTPA) in heart, liver, and kidney.

Acetates

Bladder tumor staging: comparison of conventional and gadolinium-enhanced dynamic MR imaging and CT.

With computed tomography (CT) and unenhanced magnetic resonance (MR) imaging, stage pT3b extravesical extension and beyond can be diagnosed, but tumors confined to the bladder wall (stages pT1-pT3a) are poorly delineated. To determine whether visualization of such tumors could be improved with gadolinium-enhanced MR imaging, dynamic breath-hold T1-weighted MR images were obtained after intravenous infusion of 0.1 mmol/kg gadopentetate dimeglumine in 79 patients (86 tumors). Conventional MR images, CT scans, and histologic correlation were available in all cases. With dynamic gadolinium-enhanced MR imaging, the mucosa could be distinguished from the muscular layers of the bladder wall. Staging accuracy with this technique was 85% (73 of 86), which was significantly better than with CT (55%; 47 of 86) (P < .005) or conventional MR imaging (58%; 50 of 86) (P < .05). The accuracy of staging the intramural extent (pT1-pT3a) of bladder tumors was thus improved with gadolinium-enhanced dynamic MR imaging.

Adult

Indications for gadolinium-DTPA in magnetic resonance evaluation of extracranial head and neck mass lesions: review of experience with 27 patients examined with a 2 tesla imager.

The authors review their experience with 27 patients who underwent gadolinium-enhanced magnetic resonance imaging (MRI) at 2 tesla. The contribution of the contrast agent was evaluated with respect to three properties--lesion conspicuity, margins and characterization. Gadolinium enhancement contributed most to the characterization of the lesion and helped to better define lesion margins in relationship to nonfatty tissues. It is concluded that gadolinium-enhanced MR images frequently give significant additional information in the evaluation of head and neck mass lesions.

Contrast Media

Gadolinium-pentetic acid magnetic resonance imaging in patients with relapsing remitting multiple sclerosis.

Ten patients with relapsing-remitting multiple sclerosis have been studied by serial gadolinium-pentetic acid magnetic resonance imaging (MRI) every 14 days for 3 months. At the end of the follow-up, seven relapses occurred in six patients; no therapy was administered during the study. Ninety-three enhancing lesions were collected in eight patients. With regard to the duration of the enhancement, 32 lesions were detected in only one MRI scan and 32 were found in more MRI scans (most of the lesions occurring in two serial examinations). Four old lesions increased their size with delayed enhancement. Correlation was found between the relapses and the gadolinium-pentetic acid-enhancing areas only for one brain-stem and two cervical spinal cord lesions. Gadolinium-pentetic acid MRI provides useful information about activity of the disease that cannot be obtained clinically even if the dynamic of the lesions may be undervalued in old plaques.

Adult

The effects of high-dose methylprednisolone on gadolinium-enhanced magnetic resonance imaging and cerebrospinal fluid measurements in multiple sclerosis.

Blood-brain barrier (BBB) disruption is probably the first event in the lesion development in multiple sclerosis (MS). This stage can be visualized by gadolinium-enhanced magnetic resonance (MR) imaging of the brain. Serial MR imaging studies have indicated a continuous spectrum of disease activity with waxing and waning of acute lesions, even in clinically stable MS patients. High-dose intravenous methylprednisolone (MP) has a beneficial clinical effect; reduces gadolinium enhancement, indicating improvement of BBB integrity; and, in MS patients, decreases intrathecal immunoglobulin synthesis with reduction of cerebrospinal fluid (CSF) myelin basic protein (MBP). A correlative triad is noted between gadolinium enhancement, clinical improvement, and decrease of CSF MBP following MP treatment, indicating a relationship between restoration of BBB integrity, clinical improvement and decrease of myelin breakdown. It is not clear whether MP interferes primarily with the process of demyelination or reacts non-specifically with its mediators.

Gadolinium

Open channel block by gadolinium ion of the stretch-inactivated ion channel in mdx myotubes.

Currents flowing through single stretch-inactivated ion channels were recorded from cell-attached patches on myotubes from mdx mice. Adding micromolar concentrations of gadolinium to patch electrodes containing normal saline produced rapid transitions in the single-channel current between the fully open and closed states. The kinetics of the current fluctuations followed the predictions of a simple model of open channel block in which the transitions in the current arise from the entry and exit of Gd from the channel pore: histograms of the open and closed times were well fit with single exponentials, the blocking rate depended linearly on the concentration of gadolinium in the patch electrode, and the unblocking rate was independent of the concentration of gadolinium. Hyperpolarizing the patch increased the rate of unblocking (approximately e-fold per 85 mV), suggesting the charged blocking particle can exit the channel into the cell under the influence of the applied membrane field. The rate of blocking was rapid and was independent of the patch potential, consistent with the rate of ion entry into the pore being determined by its rate of diffusion in solution. When channel open probability was reduced by applying suction to the electrode, the blocking kinetics were independent of the extent of inactivation, suggesting that mechanosensitive gating does not modify the structure of the channel pore.

Animals

[Pharmacokinetics of gadolinium-DTPA in chronic renal insufficiency requiring dialysis].

MRT with gadolinium-DTPA (0.1 mmol/kg body weight) was performed in 10 patients with renal insufficiency requiring dialysis and the clearance of gadolinium-DTPA was studied. After 3 dialysis on 3 successive days more than 97% of the initial concentration of gadolinium-DTPA had been eliminated. Average half-life was 1.87 hours. There were no side effects in any of the patients. Close laboratory observation of liver function showed no significant changes during the period of study. No contra-indication for the use of this contrast medium in patients with renal insufficiency requiring dialysis was found during this study.

Adult

Transport calculations of depth-dose distributions for gadolinium neutron capture therapy.

Depth-dose distributions were calculated for thermal and epithermal neutron fluence and capture gamma ray dose rates using a two-dimensional neutron-coupled gamma-ray transport code (DOT 3.5) for gadolinium neutron capture therapy. The results show that (i) a capture gamma-ray dose rate of 10 Gy h-1 was obtained with a thermal neutron fluence rate of 1.5 x 10(9) cm-2 s-1 in a simulated tumour containing 5000 PPM gadolinium placed near the surface of a water phantom, (ii) deep-seated tumours may be treated with epithermal neutrons, and (iii) gadolinium neutron capture therapy appears to achieve comparable dose distributions to those of boron neutron capture therapy.

Gadolinium

The effect of intravenous gadolinium on the magnetic resonance appearance of cerebrospinal fluid.

The authors determined whether a sufficient amount of intravenously administered gadolinium enters the cerebrospinal fluid (CSF) to visibly shorten the T1 relaxation time. Transfer of intravenously administered contrast media into the CSF has been previously documented for iodinated contrast materials; however, the change in computed tomography density is not sufficient to have a clinically useful myelographic effect. Visible shortening of the T1 of CSF on gadolinium-enhanced magnetic resonance imaging of the spine may have clinical use. Twelve dogs were given gadolinium, and CSF was sampled at intervals over a 6-hour period. The T1 values of the CSF samples were quantitated and plotted against time. The average decrease in T1 was 23% at 60 minutes, which is nearly the peak effect. The increased signal intensity was visible at clinical window settings at 60 minutes. It is possible that this may be clinically useful for certain types of examinations. Importantly, this should be recognized as a normal appearance, and not necessarily a sign of pathology.

Animals

AUR Memorial Award 1991. Immunogenicity of gadolinium-based contrast agents for magnetic resonance imaging. Induction and characterization of antibodies in animals.

To evaluate the immunogenic potential of gadolinium-based magnetic resonance imaging (MRI) contrast agents, Sprague-Dawley rats were sensitized with gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) dimeglumine and with Gd-DTPA covalently linked to either human serum albumin, dextran, or polylysine. IgG antibodies directed against Gd-DTPA were detected in immune sera by an enzyme-linked immunosorbent assay (ELISA), and were confirmed by competitive inhibition of antibody binding using free Gd-DTPA dimeglumine. Antiserum induced by immunization with human serum albumin-(Gd-DTPA) was characterized by a monophasic competition curve with 50% inhibition (IC50) = 5.5 x 10(-4) M when Gd-DTPA dimeglumine was used as both the well-coating and the displacing agent in a competition ELISA. Antiserum induced by Gd-DTPA dimeglumine alone was characterized by a biphasic competition curve with IC50 = 6.5 x 10(-7) M and 7.9 x 10(-4) M. Antisera obtained after exposure to either dextran-(Gd-DTPA) or polylysine-(Gd-DTPA) were of insufficient titer for characterization. The detection of antibodies specific for Gd-DTPA suggests in vivo protein binding with formation of hapten-carrier conjugates. This hypothesis is supported by increased relaxivity values observed when Gd-DTPA dimeglumine is incubated in serum rather than in water. Gd-DTPA dimeglumine and albumin-(Gd-DTPA) are immunogenic in rats under idealized experimental conditions. Additional studies will be necessary to determine the potential for immunologic response in humans to gadolinium chelates under conditions of exposure inherent in clinical use.

Animals

Gadolinium neutron capture therapy for brain tumors: a computer study.

A Monte Carlo computer study of the total dose distribution from neutrons and prompt gamma emissions (but excluding the contribution from conversion and Auger electrons) for gadolinium neutron capture therapy of brain tumors has been carried out in order to test the theoretic feasibility of this modality using commercially available magnetic resonance contrast media. The three-dimensional dose distribution calculations were performed in a spherical head phantom with a spherical tumor at the center. Potentially achievable gadolinium concentrations of 150 micrograms/g of tissue in tumor and 3 micrograms/g in normal tissue were assumed with enrichment to 79.9% gadolinium-157, as supplied by Oak Ridge National Laboratory. Irradiation was assumed to be with a 2-keV monoenergetic cylindrical epithermal neutron beam having a radius of 4 cm. The three-dimensional thermal neutron fluence resulting from the 2-keV beam propagation through the tissue was modeled. For a single neutron beam, the maximum dose is delivered within the tumor but the dose is very inhomogeneous across the tumor volume due to rapid decrease of thermal neutron fluence with depth. Two parallel opposed neutron beams deliver to the interface of normal and malignant tissue 70%-80% of the maximum dose received at the center of the tumor. To deliver an average tumor dose of 500 cGy in 10 min would require a 2-keV source neutrons number of 8.0 x 10(11) per s within the geometry of the beam.

Brain Neoplasms

Normal abdominal enhancement patterns with dynamic gadolinium-enhanced MR imaging.

The objective of this study was to quantitatively and qualitatively determine contrast enhancement patterns of normal abdominal organs with dynamic gadolinium-enhanced magnetic resonance (MR) imaging. Dynamic gadolinium-enhanced, T1-weighted, spin-echo imaging was performed during a 23-second breath hold in 38 patients, with images acquired before, during, and at 1,2, and 5 minutes after bolus injection of gadopentetate dimeglumine. Enhancement patterns of normal liver, spleen, pancreas, adrenal gland, kidney, aorta, inferior vena cava, and fat were determined by visual evaluation and by performance of signal intensity measurements with an electronic cursor. Time-intensity curves demonstrated peak enhancement of all abdominal organs during or immediately after bolus injection of gadopentetate dimeglumine. MR enhancement patterns included visualization of renal cortical nephrogram and heterogeneous enhancement of the spleen during the bolus phase of contrast material administration. Peak enhancement of normal liver was 72%; spleen, 172%; pancreas, 82%; adrenal gland, 85%; and kidney, 291%. This study established reference data regarding abdominal organ enhancement that will be useful as dynamic gadolinium-enhanced MR imaging becomes clinically implemented.

Abdomen

[Gadolinium-MRI findings of two adrenoleukodystrophy cases treated with gamma-globulin].

Two cases of adrenoleukodystrophy were reported. We treated them with intravenous gamma-globulin infusion. MRI with gadolinium enhancement was performed before and after the therapy to evaluate the effect of gamma-globulin. Case 1 was a 19-year-old boy, who noticed left hemianopsia when he was 18 years old. Case 2 was a 36-year-old man, who developed ataxic gait and character change when he was 33 years old. Very long chain fatty acids in plasma and RBC membrane were elevated in both cases. On T2-weighted image of MRI, high signal lesions were seen in the white matter of occipital lobe in case 1, cerebellum, internal capsule, and around the corpus callosum in case 2. On T1-weighted image, the rim of every lesion was enhanced by gadolinium infusion. After the gamma-globulin therapy, gadolinium enhancement of the rim remarkably reduced in case 1. No reduction was observed in case 2. MRI findings of case 1 indicate the possibility that gamma-globulin may suppress the inflammation of the adrenoleukodystrophy.

Adrenoleukodystrophy

Preliminary clinical trial of gadodiamide injection: a new nonionic gadolinium contrast agent for MR imaging.

The safety and efficacy of a newly developed intravenous formulation of the nonionic contrast agent gadolinium diethylenetriaminepentaacetic acid-bis(methylamide), formulated as gadodiamide injection, was investigated. In 30 patients who underwent spin-echo magnetic resonance (MR) imaging before and after contrast agent enhancement, the enhanced images had characteristics judged similar to those of images enhanced by means of available gadolinium compounds. In 15 patients, contrast agent administration was of major diagnostic help, either revealing lesions not apparent without enhancement or providing important lesion characterization. In 12 patients, the lack of abnormal enhancement patterns was important in excluding the presence of disease. In three patients, the contrast agent did not provide information additional to that obtained with the unenhanced T1- and T2-weighted images. No clinically significant changes were observed in vital signs, neurologic status, or laboratory results. The authors conclude that, in this limited series, gadodiamide injection proved to be a safe and useful MR imaging contrast agent for evaluation of the central nervous system and surrounding structures.

Adult