Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple different organs, including the kidneys and central nervous system (CNS). Conventional radiological examinations in SLE patients include volumetric/ anatomical computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US). The utility of these modalities is limited, however, due to the complexity of the disease. Furthermore, CT and MRI contrast agents are contraindicated in patients with renal impairment. Various radiologic methods are currently being developed to improve disease characterization in patients with SLE beyond simple anatomical endpoints. Physiological non-contrast MRI protocols have been developed to assess tissue oxygenation, glomerular filtration, renal perfusion, interstitial diffusion, and inflammation-driven fibrosis in lupus nephritis (LN) patients. For neurological symptoms, vessel size imaging (VSI, an MRI approach utilizing T2-relaxing iron oxide nanoparticles) has shown promise as a diagnostic tool. Molecular imaging probes (mostly for MRI and nuclear medicine imaging) have also been developed for diagnosing SLE with high sensitivity, and for monitoring disease activity. This paper reviews the challenges in evaluating disease activity in patients with LN and neuropsychiatric systemic lupus erythematosus (NPSLE). We describe novel MRI and positron-emission tomography (PET) molecular imaging protocols using targeted iron oxide nanoparticles and radioactive ligands, respectively, for detection of SLE-associated inflammation.

Advanced Therapeutic Strategies for Chronic Lung Disease Using Nanoparticle-Based Drug Delivery

“…It allows nanoparticles to have a better chance to have contact with the surrounding tissues and cells, thus increasing the efficiency of cellular delivery [ 18 , 19 ]. Furthermore, systemically injected nanoparticles in vivo generally show enhanced accumulation to the pathological lesions found in tumors, hemorrhagic diseases, and inflammatory diseases [ 20 , 21 , 22 ]. These findings suggest that nanoparticles have ideal properties to be used as innovative carriers for drug delivery.…”

Molecular Imaging of Inflammation: Current Status

“…On the other hand, in a study comparing MRI with 11 C-PK11195 PET to identify joint inflammation in rheumatoid arthritis patients before clinical symptoms appeared (39), the latter method was found to be more predictive of the development of clinical flare than MRI. Finally, a study on imaging renal inflammation in animals and humans (40) showed that the use of 18 F-FDG PET and USPIO was generally able to identify regions of macrophage infiltration and its extent, especially in the setting of autoimmune diseases such as systemic lupus erythematosus and Sjögren syndrome.…”