Insights into gadolinium uptake and release dynamics of a macrocyclic contrast agent in blood cells

Background: Gadolinium-based contrast agents (GBCAs) are routinely used in magnetic resonance imaging (MRI). Although macrocyclic GBCAs were initially considered biologically inert, it is now known that a fraction of patients retains gadolinium (Gd) for prolonged periods in tissues such as blood, bone, and brain. Because the first cellular interactions of GBCAs occur in the bloodstream, this study aimed to elucidate the uptake mechanism but also the intracellular persistence and release dynamics of gadoterate meglumine, one of the most widely used macrocyclic agents, in white blood cells (WBCs). Methodology and principal findings: WBCs and K562 cells were incubated with gadoterate meglumine under different conditions to investigate its cellular entry mechanisms. Uptake of the contrast agent was quantified by measuring intracellular Gd using single-cell inductively coupled plasma mass spectrometry (SC-ICP-MS). Time and concentration-dependent incubation of K562 cells revealed saturable uptake kinetics consistent with a Michaelis-Menten model which is independent of the phase of the cell cycle. Gadoterate meglumine uptake in both WBCs and K562 cells was shown to be an active process, as uptake was strongly reduced or abolished at low temperature (16C and 4C) and in the presence of metabolic inhibitors (sodium azide and 2-deoxyglucose). Co-incubation with multiple endocytosis inhibitors (Dyngo 4a, Dynole 2-24 and chlorpromazine) did not significantly decrease intracellular Gd levels in K562 cells and caused only a slight reduction in WBCs, indicating that endocytosis is not the main entry pathway for gadoterate meglumine in these cells. Furthermore, we assessed the retention time of the Gd inside the cells, showing that only after 24 hours post incubation 80% percent of the intracellular Gd was released through an active process. Finally, we demonstrate that one of the mechanisms of Gd release from WBCs involves extracellular vesicles, which may substantially increase its potential for downstream accumulation in different tissues, including immunoprivileged tissues like brain. Significance: The observed time-dependent accumulation, temperature and energy dependence of gadoterate meglumine uptake demonstrate that active cellular mechanisms are primarily responsible for GBCA internalization. Furthermore, our results indicate that macropinocytosis, phagocytosis, and clathrin-mediated endocytosis are not the primary routes of gadoterate meglumine entry. Hereby, we also describe that Gd externalization is an active process involving extracellular vesicles which may influence the Gd distribution in different tissues and its consequent long-term retention. Further studies are required to explore strategies to block this process in order to mitigate potential long-term gadolinium retention.