Biography
Brent Wagner is a native New Mexican and a graduate of the University of New Mexico (1990, 1992), the University of New Mexico Biomedical Sciences Graduate Program (1995), and the University of New Mexico School of Medicine (1999). His residency training was on the American Board of Internal Medicine Research Investigator Pathway at the University of Texas Health System. He is a certified specialist in Internal Medicine and Nephrology. His positions included Clinical Nephrology Fellowship Program Director for the University of Texas Health System and Audie Murphy Memorial VA Hospital staff physician (Renal Section). In 2017 he became a Tenured Associate Professor. In 2018 he returned to his hometown of Albuquerque to assume the role of Renal Section Chief for the New Mexico Veterans Administration Health Care System and the Directorship of the Kidney Institute of New Mexico.
Personal Statement
Brent Wagner studies the molecular and cellular mechanisms of magnetic resonance imaging contrast agent-induced complications. He is a world-renowned expert in nephrogenic systemic fibrosis, gadolinium retention, and nanotoxicology. Nephrogenic systemic fibrosis is a severely disabling and potentially fatal disorder in patients with compromised kidney function. It is associated with exposure to gadolinium, a non-physiologic metal. (Living organisms never contain any element with an f-block electron orbital, e.g., gadolinium.) However, not all exposed patients with renal disease acquire nephrogenic systemic fibrosis. The pathogenesis is entirely unexplored. Fibrotic lesions stain strongly for CD34 and procollagen type I. The theory was that the cellularity was from circulating, bone marrow-derived white blood cells termed “fibrocytes.” Dr. Wagner’s laboratory was the first to prove this experimentally.Furthermore, he was the first to demonstrate that bone marrow possesses a ‘memory’ of gadolinium exposure—fibrosis is more severe in those who have had repeated magnetic resonance imaging contrast administrations.
Since his return to New Mexico, he has recruited a Program Manager (Ms. Julie Harris), a Research Scientist (Dr. G. Patricia Escobar, D.V.M.), a postdoctoral fellow (Dr. Soraya Arzhan, M.D.), a Biomedical Sciences Graduate Program student (Mr. Josh DeAguero), and an exceptionally talented physician-scientist (Dr. Catherine Do, M.D., d., 1983-2022).
By 2017 the Food & Drug Administration warned that all patients exposed to magnetic resonance imaging contrast agents retain gadolinium—a non-physiologic metal—in every vital organ, including the brain. Now there are thousands of members of social media groups focused on the chronic adverse effects of gadolinium-based contrast agents. Dr. Wagner’s research team was ideally situated to embark on human studies in 2020.
A novel pathogen, severe acute respiratory syndrome coronavirus-2 (SARS Cov-2), spilled out of Wuhan, Hubei Province of China, in November 2019. The resultant pandemic has been catastrophic. Dr. Wagner mobilized the response at the Raymond G. Murphy Medical Center through compassionate use programs (convalescent plasma), and sponsored trials (Regeneron, Janssen/Johnson & Johnson, Atea Pharmaceuticals, Kintor Pharmaceutical Limited).
Areas of Specialty
Clinical nephrology, nanotoxicology/rare earth metallosis, nephrogenic systemic fibrosis/magnetic resonance imaging contrast agent complications, applied material science (scanning/transmission electron microscopy with energy-dispersive spectroscopy, inductively-coupled plasma mass spectroscopy),clinical nephrology fellowship training
Certifications
ABIM Internal Medicine ABIM Nephrology
Achievements & Awards
Sterling Scholarship, University of New Mexico, 1986-1990
Graduated with distinction, University of New Mexico Biomedical Sciences Graduate Program, 1995
Student Research Fellowship, Alpha Omega Alpha, 1998
Award for excellence in research, Western Student Medical Research Committee, 1998
Graduated with commendation for research, University of New Mexico School of Medicine, 1999
Recognition for exemplary care of patients, Department of Medicine, University of Texas Health Care Center at San Antonio, 2000
Department of Medicine Research Day Winner, Resident Category, University of Texas Health Science Center at San Antonio, 2002
Outstanding Contribution to Basic Science Research Award, Southern Society of Clinical Investigation, 2002
Extramural Loan Repayment Program recipient, National Institutes of Health, 2003
Chairs Residents Forum, Southern Society of Clinical Investigation, 2004
Outstanding Accomplishments, Department of Medicine, 2006
Most money raised by an individual, Polycystic Kidney Disease Foundation (San Antonio), 2013
Tenure, University of Texas Health Science Center, 2017
Guest Editor, Advances in Chronic Kidney Disease (Renal Imaging issue), 2017
Member, University of Texas Health Science Center at San Antonio Department of Medicine Promotion & Tenure Committee, 2017
Member, University of New Mexico Health Sciences Center Department of Medicine Dossier Review committee, 2018-2020
Key Publications
Journal Article
Wagner, Brent, 2018 Gadolinium-based contrast agents: why nephrologists need to be concerned. Curr Opin Nephrol Hypertens. 2018 Dec 3. Doi: 10.1097/MNH. .0000000000000475 Pubmed PMID: 30531473
Journal Article
Wagner, Brent, 2007 Mitogenic signaling via platelet-derived growth factor beta in metanephric mesenchymal cells. J Am Soc Nephrol. 2007 Nov;18(11):2903-11. Epub 2007 Oct 17. PubMed PMID: 17942966.
Journal Article
Wagner, Brent, 2016 Pathophysiology of gadolinium-associated systemic fibrosis. Am J Physiol Renal Physiol. 2016 Jul 1;311(1):F1-F11. doi: 10.1152/ajprenal.00166.2016. Epub 2016 May 4. Review. PubMed PMID: 27147669; PubMed Central PMCID: PMC4967166.
Journal Article
Lee, David, Wagner, Brent, 2016 Centrality of bone marrow in the severity of gadolinium-based contrast-induced systemic fibrosis. FASEB J. 2016 Sep;30(9):3026-38. doi: 10.1096/fj.201500188R. Epub 2016 May 24. PubMed PMID: 27221979; PubMed Central PMCID: PMC5001515
Book Chapter
Wagner, Brent, 2019 Nephrogenic Systemic Fibrosis In: Ferri‘s Clinical Advisor 2020. Amsterdam: Elsevier Health Sciences, Amsterdam, Netherlands; 2019
Gender
Male
Languages
- English
Courses Taught
Throughout my tenure as a physician-scientist in an academic center, a priority was made to fulfill roles as a teacher and a mentor. This was recognized within the University of Texas Health System by an appointment as the Associate Program Director for the Clinical Nephrology Fellowship in 2007 and then as the permanent Director in 2010 (after a requisite of 5 years as faculty). Compared to other clinical nephrology fellowships the program was very large under my leadership. The scientific method was emphasized; all of the fellows were provided with four months of research in their second year.
As the Clinical Nephrology Program Director (University of Texas Health System San Antonio) from 2010 to 2018, I authored the curricula for most of the clinical rotations (inpatient nephrology consultation services, outpatient clinical rotations, and research rotations). In these curricula, and as a regular supervising faculty attending physician, emphasis is always placed on fundamentals of physiology and clinical medicine. Medical students should be expected to know the Stanford 25 bedside exam skills and embark on a career that employs regular critical thinking. Comparative physiology is the foundation of how nephrologists—the specialists of homeostasis—approach patients. As an expert in nephrogenesis, I provide regular lectures that cover homeostasis in vertebrates from the pre-Cambrian through the Phanerozoic Eons and the relevance to embryology. This topic pertains to neonatal, pediatric, and adult clinical care, particularly in the realms of sodium handling, nephron endowment, essential hypertension, and chronic kidney disease. Lectures often reference Claude Bernard (1813-1878) and Homer W. Smith (1895-1962), the founders of experimental medicine and the dean of renal physiology, respectively.
Research and Scholarship
Systemic fibrosis is a severely disabling and potentially fatal disorder of particular concern in high-risk patients, such as those with compromised kidney function. Because the fibrotic lesions stain strongly for CD34 and procollagen type I, it was theorized that the majority of the cellularity was from circulating, bone marrow-derived, white blood cells. My laboratory was the first to prove this experimentally in rodents using tagged bone marrow in lethally-irradiated recipients. Our work (in combination with the growing concern about gadolinium retention in patients with normal renal function) led to the invitation by the Medical Imaging Drugs Advisory Committee of the United States Food and Drug Administration (FDA) to provide the introductory address, “Pathophysiology of gadolinium-based contrast agents and retention of gadolinium.” Our research team is among the few in existence poised to address the questions concerning the biologic consequence of long-term metal retention and how this induces disease. Veteran patients have flown to Albuquerque to be evaluated for potential gadolinium-induced conditions. Our proposal, 'Speciating Gadolinium Nanoparticle Composition, Identifying Molecular Mechanisms in Renal Injury, and Defining Magnetic Resonance Imaging Contrast Agent Use,' will provide actionable discoveries for the safer design of metal-based contrast and therapeutic targets. Our team will not be divested of the responsibility for those who have retained gadolinium and the sequelae.
1. Do C, DeAguero J, Brearley A, Trejo X, Howard T, Escobar GP, Wagner B. Gadolinium-based contrast agents, their use, their safety, and practice evolution. Kidney360. 2020 June;1(6):561-568. (In press, doi:10.34067/KID.0000272019)
2. Do C, Drel V, Tan C, Lee D, Wagner B. Nephrogenic Systemic Fibrosis Is Mediated by Myeloid C-C Chemokine Receptor 2. J Invest Dermatol. 2019 Oct;139(10):2134-2143.e2. PubMed PMID: 30978353; PubMed Central PMCID: PMC6756957.
3. Do C, Ford B, Lee DY, Tan C, Escobar P, Wagner B. Gadolinium-based contrast agents: Stimulators of myeloid-induced renal fibrosis and major metabolic disruptors. Toxicol Appl Pharmacol. 2019 Jul 15;375:32-45. PubMed PMID: 31082427; PubMed Central PMCID: PMC6588162.
4. Leyba K, Wagner B. Gadolinium-based contrast agents: why nephrologists need to be concerned. Curr Opin Nephrol Hypertens. 2019 Mar;28(2):154-162. PubMed PMID: 30531473; PubMed Central PMCID: PMC6416778.
5. Drel VR, Tan C, Barnes JL, Gorin Y, Lee DY, Wagner B. Centrality of bone marrow in the severity of gadolinium-based contrast-induced systemic fibrosis. FASEB J. 2016 Sep;30(9):3026-38. PubMed PMID: 27221979; PubMed Central PMCID: PMC5001515.