Gadolinium contrast agents: dermal deposits and potential effects on epidermal small nerve fibers.

Autor: Krämer HH; Department of Neurology, Justus Liebig University of Giessen, 35392, Giessen, Germany., Bücker P; Institute of Inorganic and Analytical Chemistry, University of Münster, 48149, Münster, Germany., Jeibmann A; Institute of Neuropathology, University Hospital Münster, 48149, Münster, Germany., Richter H; Clinic for Diagnostic Imaging, Diagnostic Imaging Research Unit (DIRU),Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland., Rosenbohm A; Department of Neurology, University of Ulm, 89081, Ulm, Germany., Jeske J; Department of Neurology, Justus Liebig University of Giessen, 35392, Giessen, Germany., Baka P; Department of Neurology, University Medical Center, 55101, Mainz, Germany., Geber C; Department of Neurology, University Medical Center, 55101, Mainz, Germany.; DRK Pain Center Mainz, 55131, Mainz, Germany., Wassenberg M; Department of Neurology, Justus Liebig University of Giessen, 35392, Giessen, Germany., Fangerau T; Department of Neurology, University of Ulm, 89081, Ulm, Germany., Karst U; Institute of Inorganic and Analytical Chemistry, University of Münster, 48149, Münster, Germany., Schänzer A; Institute of Neuropathology, Justus Liebig University Giessen, 35392, Giessen, Germany. anne.schaenzer@patho.med.uni-giessen.de., van Thriel C; IfADo-Leibniz Research Centre for Working Environment and Human Factors, 44139, Dortmund, Germany. Thriel@ifado.de.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2023 Aug; Vol. 270 (8), pp. 3981-3991. Date of Electronic Publication: 2023 May 04.
DOI: 10.1007/s00415-023-11740-z
Abstrakt: Small fiber neuropathy (SFN) affects unmyelinated and thinly myelinated nerve fibers causing neuropathic pain with distal distribution and autonomic symptoms. In idiopathic SFN (iSFN), 30% of the cases, the underlying aetiology remains unknown. Gadolinium (Gd)-based contrast agents (GBCA) are widely used in magnetic resonance imaging (MRI). However, side-effects including musculoskeletal disorders and burning skin sensations were reported. We investigated if dermal Gd deposits are more prevalent in iSFN patients exposed to GBCAs, and if dermal nerve fiber density and clinical parameters are likewise affected. 28 patients (19 females) with confirmed or no GBCA exposure were recruited in three German neuromuscular centers. ISFN was confirmed by clinical, neurophysiological, laboratory and genetic investigations. Six volunteers (two females) served as controls. Distal leg skin biopsies were obtained according to European recommendations. In these samples Gd was quantified by elemental bioimaging and intraepidermal nerve fibers (IENF) density via immunofluorescence analysis. Pain phenotyping was performed in all patients, quantitative sensory testing (QST) only in a subset (15 patients; 54%). All patients reported neuropathic pain, described as burning (n = 17), jabbing (n = 16) and hot (n = 11) and five QST scores were significantly altered. Compared to an equal distribution significantly more patients reported GBCA exposures (82%), while 18% confirmed no exposures. Compared to unexposed patients/controls significantly increased Gd deposits and lower z-scores of the IENF density were confirmed in exposed patients. QST scores and pain characteristics were not affected. This study suggests that GBCA exposure might alter IENF density in iSFN patients. Our results pave the road for further studies investigating the possible role of GBCA in small fiber damage, but more investigations and larger samples are needed to draw firm conclusions.
(© 2023. The Author(s).)
Databáze: MEDLINE
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