Background
Nephrogenic systemic fibrosis (NSF) is an incurable, debilitating disease found exclusively in patients with decreased kidney function and comprises a fibrosing disorder of the skin and systemic tissues. The disease is associated with exposure to Gadolinium based contrast agents (GBCA) used in magnetic resonance imaging (MRI). Tissue samples from many NSF patients contain micron-sized insoluble Gd-containing deposits. However, the precise composition and chemical nature of these particles is unclear.
Objectives
To clarify the precise chemical structure of the Gd-containing deposits in NSF tissues.
Methods
Autopsy skin tissues from a NSF patient are examined in situ using synchrotron x-ray fluorescence (SXRF) microscopy and extended absorption fine structure (EXAFS) spectroscopy and in correlation with light microscopy and the results of SEM/EDS analyses.
Results
The insoluble Gd deposits are shown to contain Gd no longer coordinated by GBCA chelator molecules but rather in a sodium calcium phosphate material. SXRF microscopy shows a clear correlation between Gd, Ca and P. EXAFS spectroscopy shows a very different spectrum from the GBCAs, with Gd-P distances at 3.11 Å and 3.72 Å as well as Gd-Gd distances at an average of 4.05 Å, consistent with a GdPO4 structure.
Conclusions
This is the first direct evidence for the chemical release of Gd from GBCA in human tissue. This supports the physical-chemical, clinical, and epidemiological data indicating a link between stability and dose of GBCA to the development of NSF.