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Unger, Mark

Mayo Clinic

Interventional AnalgesiX Inc., Durham, North Carolina, USA

Citations 5

Response to “Unilateral Periganglionic Resiniferatoxin (RTX) for Personalized Pain Treatment”
Beutler, Andreas S. , Unger, Mark, Banck, Michaela S., Maus, Timothy P.

Pain Medicine | October 31, 2020 | Volume: 22 | Issue: 3 | Pages: 768-769

10.1093/pm/pnaa394 Get It

Quantitation of Gait and Stance Alterations Due to Monosodium Iodoacetate–induced Knee Osteoarthritis in Yucatan Swine
LaVallee, Katherine T, Maus, Timothy P. , Stock, Joseph D. , Karriker, Locke A. , Murthy, Naveen S. , Kanwar, Rahul , Beutler, Andrea S, Unger, Mark, Unger, Mark D, Stalder, Kenneth J. , Beutler, Andreas S.

Comparative Medicine | April 24, 2020 | Volume: 70 | Issue: 3 | Pages: 248-257

10.30802/aalas-cm-19-000075 Get It

Knee osteoarthritis is one of the most common causes of chronic pain worldwide, and several animal models have been developed to investigate disease mechanisms and treatments to combat associated morbidities. Here we describe a novel method for assessment of locomotor pain behavior in Yucatan swine. We used monosodium iodoacetate (MIA) to induce osteoarthritis in the hindlimb knee, and then conducted live observation, quantitative gait analysis, and quantitative weight-bearing stance analysis. We used these methods to test the hypothesis that locomotor pain behaviors after osteoarthritis induction would be detected by multiparameter quantitation for at least 12 wk in a novel large animal model of osteoarthritis. MIA-induced knee osteoarthritis produced lameness quantifiable by all measurement techniques, with onset at 2 to 4 wk and persistence until the conclusion of the study at 12 wk. Both live observation and gait analysis of kinetic parameters identified mild and moderate osteoarthritis phenotypes corresponding to a binary dose relationship. Quantitative stance analysis demonstrated the greatest sensitivity, discriminating between mild osteoarthritis states induced by 1.2 and 4.0 mg MIA, with stability of expression for as long as 12 wk. The multiparameter quantitation used in our study allowed rejection of the null hypothesis. This large animal model of quantitative locomotor pain resulting from MIA-induced osteoarthritis may support the assessment of new analgesic strategies for human knee osteoarthritis.
Quantitative Knee Arthrography in a Large Animal Model of Osteoarthritis Using Photon-Counting Detector CT
Murthy, Naveen S. , Frick, Matthew A., Tao, Shengzhen , Unger, Mark, LaVallee, Katherine T, Larson, Nicholas B. , Maus, Timothy P. , Larson, Nicholas B , Rajendran, Kishore , Leng, Shuai , McCollough, Cynthia H.

Investigative Radiology | January 27, 2020 | Volume: 55 | Issue: 6 | Pages: 349-356

10.1097/rli.0000000000000648 Get It

Objective The aim of this study was to grade cartilage damage in a swine model of osteoarthritis using a whole-body photon-counting detector (PCD) CT. Materials and Methods A multienergy phantom containing gadolinium (Gd) (2, 4, 8, and 16 mg/mL) and hydroxyapatite (200 and 400 mg/cc) was scanned using a PCD-CT system (48 × 0.25 mm collimation, 80 kV, 800 mAs, D50 reconstruction kernel) to serve as calibration for material decomposition and to assess quantification accuracy. Osteoarthritis was induced in Yucatan miniswine (n = 8) using 1.2 mg monoiodoacetate (MIA) injected into a randomized knee, whereas the contralateral control knee received saline. Twenty-one days later, a contrast bolus (gadoterate meglumine, 4 mL/knee) was intra-articularly administered into both knees. The knees were simultaneously scanned on the PCD-CT system (48 × 0.25 mm collimation, 80 kV, 800 mAs). Multienergy images were reconstructed with a sharp “V71” kernel and a quantitative “D50” kernel. Image denoising was applied to the V71 images before grading cartilage damage, and an iterative material decomposition technique was applied to D50 images to generate the Gd maps. Two radiologists blinded to the knee injection status graded the cartilage integrity based on a modified International Cartilage Repair Society scoring system. Histology was performed on excised cartilage using methylene blue/basic fuchsin. Statistical analysis of grade distribution was performed using an exact test of omnibus symmetry with P < 0.05 considered significant. Results Material decomposed images from the multienergy phantom scan showed delineation and quantification of Gd and hydroxyapatite with a root-mean-squared error of 0.3 mg/mL and 18.4 mg/cc, respectively. In the animal cohort, the radiologists reported chondromalacia in the MIA knees with International Cartilage Repair Society scores ranging from grade 1 (cartilage heterogeneity, n = 4 knees) to grade 3 (up to 100% cartilage loss, n = 4 knees). Grade 1 was characterized by cartilage heterogeneity and increased joint space in the patellofemoral compartment, whereas grade 3 was characterized by cartilage erosion and bone-on-bone articulation in the patellofemoral compartment. All control knees were scored as grade 0 (normal cartilage). Significant difference (P = 0.004) was observed in the grade distribution between the MIA and control knees. Gross examination of the excised knees showed cartilage lesions in the grade 3 MIA knees. The Gd maps from material decomposition showed lower contrast levels in the joint space of the MIA knee compared with the contralateral control knee due to joint effusion. Histology revealed chondrocyte loss in the MIA knee cartilage confirming the chondrotoxic effects of MIA on cartilage matrix. Conclusions We demonstrated a high-resolution and quantitative PCD-CT arthrography technique for grading cartilage damage in a large animal model of osteoarthritis. Photon-counting detector CT offers simultaneous high-resolution and multienergy imaging capabilities that allowed morphological assessment of cartilage loss and quantification of contrast levels in the joint as a marker of joint disease. Cartilage damage in the MIA knees was graded using PCD-CT images, and the image-based findings were further confirmed using histology and gross examination of the excised knees.
Unilateral Epidural Targeting of Resiniferatoxin Induces Bilateral Neurolysis of Spinal Nociceptive Afferents
Unger, Mark, Pleticha, Josef, Steinauer, Joanne , Kanwar, Rahul , LaVallee, Katherine T, Banck, Michaela S., Jones, Bryan, Yaksh, Tony L. , Maus, Timothy P. , Beutler, Andreas S. , Unger, Mark D, Diehn, Felix, Diehn, Felix E.

Pain Medicine | November 6, 2018 | Volume: 20 | Issue: 5 | Pages: 897-906

10.1093/pm/pny276 Get It

Human interleukin‐10 delivered intrathecally by self‐complementary adeno‐associated virus 8 induces xenogeneic transgene immunity without clinical neurotoxicity in swine
Unger, Mark, Pleticha, Josef, Heilmann, L. , Newman, Laura K. , Maus, Timothy P. , Beutler, Andreas S. , Unger, Mark D, Heilmann, Lukas F

The Journal of Gene Medicine | May 25, 2018 | Volume: 20 | Issue: 7-8 | Pages: No page available

10.1002/jgm.3026 Get It

AbstractIntroductionIntrathecal interleukin (IL)‐10 delivered by plasmid or viral gene vectors has been proposed for clinical testing because it is effective for chronic pain in rodents, is a potential therapeutic for various human diseases, and was found to be nontoxic in dogs, when the human IL‐10 ortholog was tested. However, recent studies in swine testing porcine IL‐10 demonstrated fatal neurotoxicity. The present study aimed to deliver vector‐encoded human IL‐10 in swine, measure expression of the transgene in cerebrospinal fluid and monitor animals for signs of neurotoxicity.ResultsHuman IL‐10 levels peaked 2 weeks after vector administration followed by a rapid decline that occurred concomitant with the emergence of anti‐human IL‐10 antibodies in the cerebrospinal fluid and serum. Animals remained neurologically healthy throughout the study period.ConclusionsThe findings of the present study suggest that swine are not idiosyncratically sensitive to intrathecal IL‐10 because, recapitulating previous reports in dogs, they suffered no clinical neurotoxicity from the human ortholog. These results strongly infer that toxicity of intrathecal IL‐10 in large animal models was previously overlooked because of a species mismatch between transgene and host. The present study further suggests that swine were protected from interleukin‐10 by a humoral immune response against the xenogeneic cytokine. Future safety studies of IL‐10 or related therapeutics may require syngeneic large animal models.