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Beck MC, Glimm AM, Ohrndorf S, Minden K, Trauzeddel R, Werner SG, Horneff G, Backhaus M, Burmester GR, Kallinich T, Girschick H, Klotsche J. Fluorescence optical imaging in pediatric patients with inflammatory and non-inflammatory joint diseases: a comparative study with ultrasonography. Arthritis Res Ther 2017; 19:233. [PMID: 29041986 PMCID: PMC5646108 DOI: 10.1186/s13075-017-1440-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/21/2017] [Indexed: 11/15/2022] Open
Abstract
Background Valid detection of arthritis is essential in differential diagnosis of joint pain. Indocyanin green (ICG)-enhanced fluorescence optical imaging (FOI) is a new imaging method that visualizes inflammation in wrist and finger joints. Objectives of this study were to compare FOI with ultrasonography (US, by gray-scale (GS) and power Doppler (PD)) and clinical examination (CE) and to estimate the predictive power of FOI for discrimination between inflammatory and non-inflammatory juvenile joint diseases. Methods FOI and GSUS/PDUS were performed in both hands of 76 patients with joint pain (53 with juvenile idiopathic arthritis (JIA), 23 with non-inflammatory joint diseases). Inflammation was graded by a semiquantitative score (grades 0–3) for each imaging method. Joints were defined clinically active if swollen or tender with limited range of motion. Sensitivity and specificity of FOI in three phases dependent on ICG enhancement (P1–P3) were analyzed with CE and GSUS/PDUS as reference. Results For JIA patients, FOI had an overall sensitivity of 67.3%/72.0% and a specificity of 65.0%/58.8% with GSUS/PDUS as reference; specificity was highest in P3 (GSUS 94.3%/PDUS 91.7%). FOI was more sensitive for detecting clinically active joints than GSUS/PDUS (75.2% vs 57.3%/32.5%). In patients with non-inflammatory joint diseases both FOI and US showed positive (i.e., pathological) findings (25% and 14% of joints). The predictive value for discrimination between inflammatory and non-inflammatory joint diseases was 0.79 for FOI and 0.80/0.85 for GSUS/PDUS. Conclusions Dependent on the phase evaluated, FOI had moderate to good agreement with CE and US. Both imaging methods revealed limitations and should be interpreted cautiously. FOI may provide an additional diagnostic method in pediatric rheumatology. Trial registration Deutsches Register Klinischer Studien DRKS00012572. Registered 31 July 2017.
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Affiliation(s)
- Marisa Christin Beck
- German Rheumatism Research Center, a Leibniz Institute, Program Area Epidemiology, Charitéplatz 1, 10117, Berlin, Germany. .,Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany.
| | - Anne-Marie Glimm
- Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Ohrndorf
- Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany
| | - Kirsten Minden
- German Rheumatism Research Center, a Leibniz Institute, Program Area Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany
| | - Ralf Trauzeddel
- Department of Pediatric Rheumatology, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | | | - Gerd Horneff
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin, Arnold-Janssen-Straße 29, 53757, Sankt Augustin, Germany
| | - Marina Backhaus
- Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany.,Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Schönstraße 80, 13086, Berlin, Germany
| | - Gerd Rüdiger Burmester
- Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany
| | - Tilmann Kallinich
- Charité University Medicine Berlin, Pediatric Pneumology and Immunology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Hermann Girschick
- Children's Hospital, Vivantes Hospital im Friedrichshain, Landsberger Allee 49, 10249, Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Center, a Leibniz Institute, Program Area Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité University Berlin, Luisenstraße 57, 10117, Berlin, Germany
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Gløersen M, Mulrooney E, Mathiessen A, Hammer HB, Slatkowsky-Christensen B, Faraj K, Isaksen T, Neogi T, Kvien TK, Magnusson K, Haugen IK. A hospital-based observational cohort study exploring pain and biomarkers in patients with hand osteoarthritis in Norway: The Nor-Hand protocol. BMJ Open 2017; 7:e016938. [PMID: 28947452 PMCID: PMC5623515 DOI: 10.1136/bmjopen-2017-016938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION We have limited knowledge about the underlying disease mechanisms and causes of pain in hand osteoarthritis (OA). Consequently, no disease-modifying drug exists, and more knowledge about the pathogenesis of hand OA is needed, as well as a validation of different outcome measures. Our first aim of this study is to explore the validity of various imaging modalities for the assessment of hand OA. Second, we want to gain a better understanding of the disease processes, with a special focus on pain mechanisms. METHODS AND ANALYSIS The Nor-Hand study is a hospital-based observational study including 300 patients with evidence of hand OA by ultrasound and/or clinical examination. The baseline examination consists of functional tests and joint assessment of the hands, medical assessment, pain sensitisation tests, ultrasound (hands, acromioclavicular joint, hips, knees and feet), CT and MRI of the dominant hand, conventional radiographs of the hands and feet, fluorescence optical imaging of the hands, collection of blood and urine samples as well as self-reported demographic factors and OA-related questionnaires. Two follow-up examinations are planned. Cross-sectional analyses will be used to investigate agreements and associations between different relevant measures at the baseline examination, whereas the longitudinal data will be used for evaluation of predictors for clinical outcomes. ETHICS AND DISSEMINATION The protocol is approved by the Norwegian Regional Committee for Medical and Health Research Ethics (Ref. no: 2014/2057). The participants receive oral and written information about the project and sign a consent form before participation. They can, whenever they want, withdraw from the study, and all de-identified data will be safely stored on the research server at Diakonhjemmet Hospital. Results will be presented at international and national congresses and in peer-reviewed rheumatology journals. TRIAL REGISTRATION NUMBER NCT03083548; Pre-results.
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Affiliation(s)
- Marthe Gløersen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | | | | | - Karwan Faraj
- Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway
| | - Thore Isaksen
- Department of Radiology, Volvat Medical Center, Oslo, Norway
| | - Tuhina Neogi
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, USA
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- The Medical Faculty, Institute for Clinical Medicine, University of Oslo, Olso, Norway
| | - Karin Magnusson
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Klein A, Just GW, Werner SG, Oommen PT, Minden K, Becker I, Langer HE, Klee D, Horneff G. Fluorescence optical imaging and musculoskeletal ultrasonography in juvenile idiopathic polyarticular disease before and during antirheumatic treatment - a multicenter non-interventional diagnostic evaluation. Arthritis Res Ther 2017; 19:147. [PMID: 28666454 PMCID: PMC5493121 DOI: 10.1186/s13075-017-1355-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Valid detection of inflamed joints is essential for correct classification, therapeutic decisions, prognosis and assessment of treatment efficacy in juvenile idiopathic arthritis (JIA). Fluorescence optical imaging (FOI) enables visualization of inflammation in arthritis of finger and hand joints and might be used for monitoring. Methods A 24-week observational study in polyarticular JIA patients newly starting treatment with methotrexate or an approved biologic was performed in three centers. Patients were evaluated clinically, by gray-scale ultrasonography (GSUS), power-Doppler ultrasonography (PDUS) and FOI at baseline, week 12 and week 24. Results Of 37 patients enrolled, 24 patients started methotrexate and 13 patients a biologic for the first time (etanercept n = 11, adalimumab and tocilizumab n = 1 each). Mean JADAS 10 decreased significantly from 17.7 at baseline to 12.2 and 7.2 at week 12 and 24 respectively. PedACR 30/50/70/100 response rates at week 24 were 85%/73%/50%/27%. The total number of clinically active joints in hand and fingers at baseline/week 12/week 24 was 262 (23.6%)/162 (16.4%)/162 (9.0%). By GSUS, at baseline/week 12/week 24, 192 (19.4%)/135 (16.1%)/83 (11.5%) joints showed effusions and 186 (18.8%)/107 (12.7%)/69 (9.6%) showed synovial thickening, and by PDUS 68 (6.9%)/15 (1.8%)/36 (5%) joints showed hyperperfusion. Any sign of arthritis was detected by US in a total of 243 joints (24.5%) at baseline, 161 joints (19.2%) at week 12 and 123 joints (17%) at week 24. By FOI at baseline/week 12/week 24, 430 (38.7%)/280 (29.2%)/215 (27.6%) showed a signal enhancement in at least one phase. Summarizing all three points of time, the highest numbers of signals were detected by FOI with 32% of joints, especially in phase 2, while by US 20.7% and by clinical examination 17.5% of joints were active. A high number of joints (21.1%) had FOI signals but were inactive by clinical examination. A total 20.1% of joints with signals in FOI did not show effusion, synovial thickening or hyperperfusion by US. Because of the high number of negative results, specificity of FOI compared with clinical examination/US/PD was high (84–95%), and sensitivity was only moderate. Conclusion FOI and US could detect clinical but also subclinical inflammation. FOI detected subclinical inflammation to a higher extent than US. Improvement upon treatment with either methotrexate or a biologic can be visualized by FOI and US. Trial registration Deutsches Register Klinischer Studien DRKS00011579. Registered 10 January 2017.
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Affiliation(s)
- Ariane Klein
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin, Arnold-Janssen-Strasse 29, 53757, Sankt Augustin, Germany.
| | - Georg Werner Just
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin, Arnold-Janssen-Strasse 29, 53757, Sankt Augustin, Germany
| | | | - Prasad T Oommen
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Kirsten Minden
- Charité University Medicine and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Ingrid Becker
- Institute of Medical Statistics, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Hans-Eckhard Langer
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf, Düsseldorf, Germany
| | - Dirk Klee
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Gerd Horneff
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin, Arnold-Janssen-Strasse 29, 53757, Sankt Augustin, Germany
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Fluorescence optical imaging and 3T-MRI for detection of synovitis in patients with rheumatoid arthritis in comparison to a composite standard of reference. Eur J Radiol 2017; 90:6-13. [DOI: 10.1016/j.ejrad.2017.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 01/16/2017] [Accepted: 02/12/2017] [Indexed: 11/22/2022]
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Abstract
This work focuses on developing a 2D Canny edge-based deformable image registration (Canny DIR) algorithm to register in vivo white light images taken at various time points. This method uses a sparse interpolation deformation algorithm to sparsely register regions of the image with strong edge information. A stability criterion is enforced which removes regions of edges that do not deform in a smooth uniform manner. Using a synthetic mouse surface ground truth model, the accuracy of the Canny DIR algorithm was evaluated under axial rotation in the presence of deformation. The accuracy was also tested using fluorescent dye injections, which were then used for gamma analysis to establish a second ground truth. The results indicate that the Canny DIR algorithm performs better than rigid registration, intensity corrected Demons, and distinctive features for all evaluation matrices and ground truth scenarios. In conclusion Canny DIR performs well in the presence of the unique lighting and shading variations associated with white-light-based image registration.
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Affiliation(s)
- Vasant Kearney
- Department of Radiation Oncology, University of California, San Francisco, CA, USA. Department of Bioengineering, University of Texas Arlington, Arlington, TX, USA
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Jung C, Drummer K, Oelzner P, Figulla HR, Boettcher J, Franz M, Betge S, Foerster M, Wolf G, Pfeil A. The association between endothelial microparticles and inflammation in patients with systemic sclerosis and Raynaud's phenomenon as detected by functional imaging. Clin Hemorheol Microcirc 2016; 61:549-57. [PMID: 26410864 DOI: 10.3233/ch-151956] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
UNLABELLED Systemic sclerosis (SSc) is a systemic, autoimmune connective tissue disease characterized by vasculopathy and microvascular changes. Fluorescence Optical Imaging (FOI) is a technique used to assess inflammation in patients with arthritis; in this study FOI is used to quantify inflammation in the hand. Endothelial Microparticle (EMP) can reflect damage or activation of the endothelium but also actively modulate processes of inflammation, coagulation and vascular function. The aim of the present study was to quantify EMP and FOI, to determine an association between these microparticles and inflammation and to endothelial function. METHODS EMP were quantified in plasma samples of 25 patients (24 female, 1 male, age: 41 ± 9 years) with SSc using flow cytometry. EMP was defined as CD31+/CD42- MP, and CD62+ MP. Perivascular inflammation was assessed using fluorescence optical imaging (FOI) of the hand. Macrovascular endothelial function was non-invasively estimated using the Endopat system. RESULTS Plasma levels of CD31+/CD42- EMP and CD62+ EMP were lower in patients with SSc compared to controls (both p < 0.05). An impaired endothelial function with an increased hyperemia index was observed. A strong association could be demonstrated between CD62+ EMP and perivascular soft tissue inflammation as assessed by the FOI global score (Spearman, p = 0.002, r = 0.61). CONCLUSIONS EMP indicate molecular vascular damage in SSc; in this study a strong association between EMP and perivascular inflammation as quantified by FOI is demonstrated. Consequently EMP, using FOI, may be a potential marker benefitting the diagnosis and therapy monitoring of patients with SSc with associated Raynaud's phenomenon.
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Affiliation(s)
- Christian Jung
- Jena University Hospital, Clinic of Internal Medicine I, Jena, Germany
| | - Karl Drummer
- Jena University Hospital, Clinic of Internal Medicine III, Jena, Germany
| | - Peter Oelzner
- Jena University Hospital, Clinic of Internal Medicine III, Jena, Germany
| | - Hans R Figulla
- Jena University Hospital, Clinic of Internal Medicine I, Jena, Germany
| | - Joachim Boettcher
- Institute of Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera gGmbH, Straße des Friedens, Gera, Germany
| | - Marcus Franz
- Jena University Hospital, Clinic of Internal Medicine I, Jena, Germany
| | - Stefan Betge
- Jena University Hospital, Clinic of Internal Medicine I, Jena, Germany
| | - Martin Foerster
- Jena University Hospital, Clinic of Internal Medicine I, Jena, Germany
| | - Gunter Wolf
- Jena University Hospital, Clinic of Internal Medicine III, Jena, Germany
| | - Alexander Pfeil
- Jena University Hospital, Clinic of Internal Medicine III, Jena, Germany
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D'Agostino MA, Haavardsholm EA, van der Laken CJ. Diagnosis and management of rheumatoid arthritis; What is the current role of established and new imaging techniques in clinical practice? Best Pract Res Clin Rheumatol 2016; 30:586-607. [PMID: 27931956 DOI: 10.1016/j.berh.2016.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 10/19/2016] [Indexed: 01/05/2023]
Abstract
Ultrasound and magnetic resonance imaging (MRI) have become established imaging techniques for the management of rheumatoid arthritis. Several publications have pointed out the advantages of these techniques for a more complete evaluation of the inflammation and structural damage at joint level. Recently new imaging techniques as the positron emission tomography (PET) associated with computed tomography (CT) or MRI scan, and the optical imaging have been introduced in the panorama. This article presents the advantages and limitations of each imaging techniques in light with the recent publications.
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Affiliation(s)
- Maria Antonietta D'Agostino
- Rheumatology Department, APHP, Hôpital Ambroise Paré, 92100, Boulogne-Billancourt, France; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, 78180, Saint-Quentin en Yvelines, France.
| | - Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vindern, 0319, Oslo, Norway
| | - Conny J van der Laken
- Department of Rheumatology, Amsterdam Rheumatology & Immunology Center - Location VU University Medical Center, Amsterdam, The Netherlands
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Wu HY, Filer A, Styles I, Dehghani H. Development of a multi-wavelength diffuse optical tomography system for early diagnosis of rheumatoid arthritis: simulation, phantoms and healthy human studies. BIOMEDICAL OPTICS EXPRESS 2016; 7:4769-4786. [PMID: 27896015 PMCID: PMC5119615 DOI: 10.1364/boe.7.004769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/30/2016] [Accepted: 07/22/2016] [Indexed: 05/21/2023]
Abstract
A multi-wavelength diffuse optical tomography (DOT) system has been developed to directly extract physiological information, such as total haemoglobin concentration, from tissue in human hand joints. Novel methods for 3D surface imaging and spectrally constrained image reconstruction are introduced and their potential application to imaging of rheumatoid arthritis is discussed. Results are presented from simulation studies as well as experiments using phantoms and data from imaging of three healthy volunteers. The image features are recovered partially for phantom data using transmission measurements only. Images that reveal joint regions and surrounding features within the hand are shown to co-register with co-acquired ultrasound images which are shown to be related to total haemoglobin concentration.
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Affiliation(s)
- Hao Yang Wu
- The Centre for Physical Sciences of Imaging in Biomedical Sciences (PSIBS), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Andrew Filer
- The Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Iain Styles
- The Centre for Physical Sciences of Imaging in Biomedical Sciences (PSIBS), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- School of Computer Science, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Hamid Dehghani
- The Centre for Physical Sciences of Imaging in Biomedical Sciences (PSIBS), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- School of Computer Science, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Finsterer S, Moog P, Meier R, Thürmel K. A novel arthritis in vivo fluorescence optical imaging technology pushed to the limits continued-unravelling the signals: quantitative analysis does not distinguish inflammatory skin lesions from active synovitis. Rheumatology (Oxford) 2016; 55:1912-4. [PMID: 27330165 DOI: 10.1093/rheumatology/kew257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Reinhard Meier
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Munich, Technical University Munich Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
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Onishi S, Sakane M, Tsukanishi T, Funayama T, Ozeki E, Hara I, Yamazaki M. Near-infrared fluorescence imaging with indocyanine green-lactosomes in a mouse model of rheumatoid arthritis. Mod Rheumatol 2016; 26:885-890. [PMID: 27141810 DOI: 10.3109/14397595.2016.1170946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The early diagnosis and treatment of rheumatoid arthritis (RA) is important to reduce joint destruction. Many of the current imaging techniques have disadvantages, such as the need for contrast agents and interpretation by specialists. Fluorescence imaging is an emerging technique that overcomes some of these problems. The aim of this study was to determine whether near-infrared (NIR) fluorescence imaging of indocyanine green (ICG)-lactosomes can detect joint inflammation in a mouse model of RA. METHODS Control and arthritic SKG/Jcl mice were injected with ICG alone or ICG-lactosomes and examined by NIR fluorescence imaging. Arthritis severity was assessed macroscopically and histopathologically. RESULTS ICG fluorescence was detected in the liver soon after injection and then decreased over the next several hours. ICG was not detected in the joints of control or arthritic mice. In contrast, ICG-lactosomes remained in mice for at least 48 h and accumulated specifically at inflamed joints. ICG-lactosome fluorescence was higher in arthritic versus normal joints at all times examined and was maximal at 24 h after injection. CONCLUSIONS NIR fluorescence imaging of ICG-lactosomes detects arthritic joints in a mouse model of RA. ICG-lactosomes may preferentially localize to inflamed joints via enhanced permeability and retention.
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Affiliation(s)
- Shinzo Onishi
- a Department of Orthopaedic Surgery , University of Tsukuba , Tsukuba , Ibaraki , Japan
| | - Masataka Sakane
- a Department of Orthopaedic Surgery , University of Tsukuba , Tsukuba , Ibaraki , Japan
| | - Toshinori Tsukanishi
- b Department of Orthopaedic Surgery , Kenpoku Medical Center Takahagi Kyodo Hospital , Ibaraki , Japan , and
| | - Toru Funayama
- b Department of Orthopaedic Surgery , Kenpoku Medical Center Takahagi Kyodo Hospital , Ibaraki , Japan , and
| | - Eiichi Ozeki
- c Technology Research Laboratory , Shimadzu Corporation , Kyoto , Japan
| | - Isao Hara
- c Technology Research Laboratory , Shimadzu Corporation , Kyoto , Japan
| | - Masashi Yamazaki
- a Department of Orthopaedic Surgery , University of Tsukuba , Tsukuba , Ibaraki , Japan
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Reindl J, Pesek J, Krüger T, Wendler S, Nemitz S, Muckova P, Büchler R, Opitz S, Krieg N, Norgauer J, Rhode H. Proteomic biomarkers for psoriasis and psoriasis arthritis. J Proteomics 2016; 140:55-61. [DOI: 10.1016/j.jprot.2016.03.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/18/2016] [Accepted: 03/29/2016] [Indexed: 02/07/2023]
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Bootz F, Neri D. Immunocytokines: a novel class of products for the treatment of chronic inflammation and autoimmune conditions. Drug Discov Today 2016; 21:180-189. [PMID: 26526566 PMCID: PMC5144993 DOI: 10.1016/j.drudis.2015.10.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/21/2015] [Accepted: 10/15/2015] [Indexed: 12/18/2022]
Abstract
Antibody-cytokine fusion proteins, often referred to as immunocytokines, represent a novel class of biopharmaceutical agents that combine the disease-homing activity of certain antibodies with the immunomodulatory properties of cytokine payloads. Originally, immunocytokines were mainly developed for cancer therapy applications. More recently, however, the use of anti-inflammatory cytokines for the treatment of chronic inflammatory conditions and to treat autoimmune diseases has been considered. This review analyzes basic principles in the design of immunocytokines and describes the most advanced products in preclinical and clinical development.
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Affiliation(s)
- Franziska Bootz
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH Zürich), Vladimir Prelog Weg 1-5/10, CH-8093 Zürich, Switzerland
| | - Dario Neri
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH Zürich), Vladimir Prelog Weg 1-5/10, CH-8093 Zürich, Switzerland.
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Haugen IK, Hammer HB. A need for new imaging modality to detect inflammation in rheumatoid arthritis and osteoarthritis? Ann Rheum Dis 2015; 75:479-80. [PMID: 26698851 DOI: 10.1136/annrheumdis-2015-208661] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/30/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Scales HE, Ierna M, Smith KM, Ross K, Meiklejohn GR, Patterson-Kane JC, McInnes IB, Brewer JM, Garside P, Maffia P. Assessment of murine collagen-induced arthritis by longitudinal non-invasive duplexed molecular optical imaging. Rheumatology (Oxford) 2015; 55:564-72. [PMID: 26475798 DOI: 10.1093/rheumatology/kev361] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the present study we evaluated the use of four commercially available fluorescent probes to monitor disease activity in murine CIA and its suppression during glucocorticoid therapy. METHODS Arthritis was induced in male DBA/1 mice by immunization with type II collagen in Complete Freund's Adjuvant, followed by a boost of collagen in PBS. Four fluorescent probes from PerkinElmer in combination [ProSense 750 fluorescent activatable sensor technology (FAST) with Neutrophil Elastase 680 FAST and MMPSense 750 FAST with CatK 680 FAST] were used to monitor disease development from day 5 through to day 40 post-immunization. Fluorescence generated in vivo by the probes was correlated with clinical and histological score and paw measurements. RESULTS The fluorescence intensity emitted by each probe was shown to correlate with the conventional measurements of disease. The highest degree of correlation was observed with ProSense 750 FAST in combination with Neutrophil Elastase 680 FAST; these probes were then used to successfully assess CIA suppression during dexamethasone treatment. CONCLUSION We have demonstrated that longitudinal non-invasive duplexed optical fluorescence imaging provides a simple assessment of arthritic disease activity within the joints of mice following the induction of CIA and may represent a powerful tool to monitor the efficacy of drug treatments in preclinical studies.
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Affiliation(s)
- Hannah E Scales
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, MD Biosciences
| | | | | | - Kirsty Ross
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK and
| | | | - Janet C Patterson-Kane
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Iain B McInnes
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - James M Brewer
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Paul Garside
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Pasquale Maffia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Department of Pharmacy, University of Naples Federico II, Naples, Italy
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van Onna M, Ten Cate DF, Tsoi KL, Meier AJL, Jacobs JWG, Westgeest AAA, Meijer PBL, van Beek MC, Rensen WHJ, Bijlsma JWJ. Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique. Ann Rheum Dis 2015; 75:511-8. [PMID: 26452538 PMCID: PMC4789697 DOI: 10.1136/annrheumdis-2015-207315] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 09/20/2015] [Indexed: 01/30/2023]
Abstract
Objectives In rheumatoid arthritis (RA), treat-to-target strategies require instruments for valid detection of joint inflammation. Therefore, imaging modalities are increasingly used in clinical practice. Optical spectral transmission (OST) measurements are non-invasive and fast and may therefore have benefits over existing imaging modalities. We tested whether OST could measure disease activity validly in patients with RA. Methods In 59 patients with RA and 10 patients with arthralgia, OST, joint counts, Disease Activity Score (DAS) 28 and ultrasonography (US) were performed. Additionally, MRI was performed in patients with DAS28<2.6. We developed and validated within the same cohort an algorithm for detection of joint inflammation by OST with US as reference. Results At the joint level, OST and US performed similarly inproximal interphalangeal-joints (area under the receiver-operating curve (AUC) of 0.79, p<0.0001) andmetacarpophalangeal joints (AUC 0.78, p<0.0001). Performance was less similar in wrists (AUC 0.62, p=0.006). On the patient level, OST correlated moderately with clinical examination (DAS28 r=0.42, p=0.001), and US scores (r=0.64, p<0.0001). Furthermore, in patients with subclinical and low disease activity, there was a correlation between OST and MRI synovitis score (RAMRIS (Rheumatoid Arthritis MRI Scoring) synovitis), r=0.52, p=0.005. Conclusions In this pilot study, OST performed moderately in the detection of joint inflammation in patients with RA. Further studies are needed to determine the diagnostic performance in a new cohort of patients with RA.
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Affiliation(s)
- M van Onna
- Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
| | - D F Ten Cate
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K L Tsoi
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A J L Meier
- Department of Rheumatology, Regional Rheumatology Center, Eindhoven, The Netherlands
| | - J W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A A A Westgeest
- Department of Rheumatology, Regional Rheumatology Center, Eindhoven, The Netherlands
| | | | | | | | - J W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Glimm AM, Werner SG, Burmester GR, Backhaus M, Ohrndorf S. Analysis of distribution and severity of inflammation in patients with osteoarthitis compared to rheumatoid arthritis by ICG-enhanced fluorescence optical imaging and musculoskeletal ultrasound: a pilot study. Ann Rheum Dis 2015; 75:566-70. [PMID: 26311723 PMCID: PMC4789689 DOI: 10.1136/annrheumdis-2015-207345] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 07/14/2015] [Indexed: 01/24/2023]
Abstract
Background In rheumatoid arthritis (RA), hand synovitis appears especially in wrist, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. In hand osteoarthritis (OA), potential inflammatory changes are mainly present in PIP and distal interphalangeal (DIP) joints. Joint inflammation can be visualised by fluorescence optical imaging (FOI) and musculoskeletal ultrasound (US). Objective Comparison of the amount and distribution of inflammatory signs in wrist and finger joints of the clinically dominant hand in patients with OA and RA by FOI and gray-scale (GSUS) and power Doppler US (PDUS). Methods FOI and GSUS/PDUS were performed in 1.170 joints (wrists, MCP, PIP, DIP) in 90 patients (67 RA, 23 OA). Joint inflammation was graded by a semiquantitative score (0–3) for each imaging method. Results GSUS/PDUS showed wrist and MCP joints mostly affected in RA. DIP joints were graded higher in OA. In FOI, RA and OA featured inflammatory changes in the respective joint groups depending on the phase of fluorescence dye flooding. Conclusions US and FOI detected inflammation in both RA and OA highlighting the inflammatory component in the course of OA. The different inflammatory patterns and various shapes of fluorescence enhancement in FOI may offer opportunities to distinguish and determine the inflammatory status in both diseases.
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Affiliation(s)
- A-M Glimm
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - S G Werner
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - G R Burmester
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - M Backhaus
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - S Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
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The Application of Fluorescence Optical Imaging in Systemic Sclerosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:658710. [PMID: 26357658 PMCID: PMC4555360 DOI: 10.1155/2015/658710] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/03/2015] [Indexed: 01/30/2023]
Abstract
Objective. The aim of this study was to visualize soft tissue inflammation using FOI on patients with Systemic Sclerosis (SSc) characterized by SSc-related Raynaud's phenomenon and to detect the therapeutic response to treatment with iloprost or alprostadil. Methods. Twenty-one patients with SSc and Raynaud's phenomenon and twenty-six healthy controls were prospectively included. The SSc patients were intravenously treated with iloprost or alprostadil over seven days. FOI was performed at baseline and after seven days using an intravenous application of indocyanine green (ICG). The hands were divided into nineteen segments per hand. All segments were quantitatively evaluated to determine changes in ICG. Results. The sensitivity and specificity of FOI in the detection of ICG enhancement in patients with SSc were 95% versus 96%. At baseline, 31.5% hand segments showed ICG enhancement. After seven days of either iloprost or alprostadil therapy a significant reduction in the ICG was observed which ranged from 40.9% to 24.7%. Conclusion. The study demonstrates that the FOI technique is able to visualize soft-tissue inflammation with both high sensitivity and specificity. The anti-inflammatory therapeutic effects of iloprost were slightly stronger than alprostadil. FOI offers promising benefits in the diagnosis and therapy of patients with SSc-associated Raynaud's phenomenon.
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Predicting Response to Therapy for Autoimmune and Inflammatory Diseases Using a Folate Receptor-Targeted Near-Infrared Fluorescent Imaging Agent. Mol Imaging Biol 2015; 18:201-8. [DOI: 10.1007/s11307-015-0876-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kisten Y, Györi N, Af Klint E, Rezaei H, Levitsky A, Karlsson A, van Vollenhoven R. Detection of clinically manifest and silent synovitis in the hands and wrists by fluorescence optical imaging. RMD Open 2015; 1:e000106. [PMID: 26535142 PMCID: PMC4612680 DOI: 10.1136/rmdopen-2015-000106] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 01/11/2023] Open
Abstract
Objectives The correct identification of synovitis is critical for achieving optimal therapy results. Fluorescence optical imaging (FOI) is a novel modality based on the use of an intravenous fluorophore, which enables fluorescent imaging of the hands and wrists with increased focal optical signal intensities in areas of high perfusion and/or capillary leakage. The study objective was to determine the diagnostic utility of FOI in detecting apparent and clinically non-apparent active synovitis. Methods Bilateral hand and wrist joints (n=872) of 26 patients with inflammatory arthritis assessed by standard clinical examination, musculoskeletal ultrasound (MSUS) and FOI were studied. Synovitis was defined as tender and swollen joints on clinical examination, presence of synovial thickening and intra-articular Doppler signals on MSUS, and abnormal focal optical signal intensities on FOI, respectively. Subclinical synovitis was defined as being clinically non-apparent, but positively inflamed on MSUS. Results Depending on the standard used to define inflammation, FOI ranged from 73–83% sensitive and 83–95% specific for detecting manifest synovitis. For detecting clinically silent synovitis, the sensitivity, specificity and positive and negative predictive values of FOI were 80%, 96%, 77% and 97%, respectively. Conclusions The high degree of agreement between MSUS and FOI suggest its use in clinical practice, especially when MSUS is not available, in order to identify synovitis earlier and with greater confidence. FOI may be particularly useful in identifying patients with clinically non-apparent joint inflammation of the hands and/or wrists.
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Affiliation(s)
- Yogan Kisten
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Noémi Györi
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Erik Af Klint
- The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Hamed Rezaei
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden ; The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Adrian Levitsky
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Anna Karlsson
- The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Ronald van Vollenhoven
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden ; The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
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Krohn M, Ohrndorf S, Werner SG, Schicke B, Burmester GR, Hamm B, Backhaus M, Hermann KGA. Near-infrared Fluorescence Optical Imaging in Early Rheumatoid Arthritis: A Comparison to Magnetic Resonance Imaging and Ultrasonography. J Rheumatol 2015; 42:1112-8. [PMID: 25934821 DOI: 10.3899/jrheum.141244] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Near-infrared fluorescence optical imaging (FOI) is a novel imaging technology in the detection and evaluation of different arthritides. FOI was validated in comparison to magnetic resonance imaging (MRI), greyscale ultrasonography (GSUS), and power Doppler ultrasonography (PDUS) in patients with early rheumatoid arthritis (RA). METHODS Hands of 31 patients with early RA were examined by FOI, MRI, and US. In each modality, synovitis of the wrist, metacarpophalangeal joints (MCP) 2-5, and proximal interphalangeal joints (PIP) 2-5 were scored on a 4-point scale (0-3). Sensitivity and specificity of FOI were analyzed in comparison to MRI and US as reference methods, differentiating between 3 phases of FOI enhancement (P1-3). Intraclass correlation coefficients (ICC) were calculated to evaluate the agreement of FOI with MRI and US. RESULTS A total of 279 joints (31 wrists, 124 MCP and 124 PIP joints) were evaluated. With MRI as the reference method, overall sensitivity/specificity of FOI was 0.81/0.00, 0.49/0.84, and 0.86/0.38 for wrist, MCP, and PIP joints, respectively. Under application of PDUS as reference, sensitivity was even higher, while specificity turned out to be low, except for MCP joints (0.88/0.15, 0.81/0.76, and 1.00/0.27, respectively). P2 appears to be the most sensitive FOI phase, while P1 showed the highest specificity. The best agreement of FOI was shown for PDUS, especially with regard to MCP and PIP joints (ICC of 0.57 and 0.53, respectively), while correlation with MRI was slightly lower. CONCLUSION FOI remains an interesting diagnostic tool for patients with early RA, although this study revealed limitations concerning the detection of synovitis. Further research is needed to evaluate its full diagnostic potential in rheumatic diseases.
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Affiliation(s)
- Michaela Krohn
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Sarah Ohrndorf
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Stephanie G Werner
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Bernd Schicke
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Gerd-Rüdiger Burmester
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Bernd Hamm
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Marina Backhaus
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Kay-Geert A Hermann
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital.
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Botz B, Bölcskei K, Kereskai L, Kovács M, Németh T, Szigeti K, Horváth I, Máthé D, Kovács N, Hashimoto H, Reglődi D, Szolcsányi J, Pintér E, Mócsai A, Helyes Z. Differential regulatory role of pituitary adenylate cyclase-activating polypeptide in the serum-transfer arthritis model. Arthritis Rheumatol 2014; 66:2739-50. [PMID: 25048575 PMCID: PMC4320777 DOI: 10.1002/art.38772] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/01/2014] [Indexed: 01/07/2023]
Abstract
Objective Pituitary adenylate cyclase–activating polypeptide (PACAP) expressed in capsaicin-sensitive sensory neurons and immune cells has divergent functions in inflammatory and pain processes. This study was undertaken to investigate the involvement of PACAP in a mouse model of rheumatoid arthritis. Methods Arthritis was induced in PACAP−/− and wild-type (PACAP+/+) mice by K/BxN serum transfer. General features of the disease were investigated by semiquantitative scoring, plethysmometry, and histopathologic analysis. Mechano- and thermonociceptive thresholds and motor functions were also evaluated. Metabolic activity was assessed by positron emission tomography. Bone morphology was measured by in vivo micro–computed tomography, myeloperoxidase activity and superoxide production by bioluminescence imaging with luminol and lucigenin, respectively, and vascular permeability by fluorescent indocyanine green dye study. Results PACAP+/+ mice developed notable joint swelling, reduced grasping ability, and mechanical (but not thermal) hyperalgesia after K/BxN serum transfer. In PACAP−/− mice clinical scores and edema were significantly reduced, and mechanical hyperalgesia and motor impairment were absent, throughout the 2-week period of observation. Metabolic activity and superoxide production increased in the tibiotarsal joints of wild-type mice but were significantly lower in PACAP−/− animals. Myeloperoxidase activity in the ankle joints of PACAP−/− mice was significantly reduced in the early phase of arthritis, but increased in the late phase. Synovial hyperplasia was also significantly increased, and progressive bone spur formation was observed in PACAP-deficient mice only. Conclusion In PACAP-deficient mice with serum-transfer arthritis, joint swelling, vascular leakage, hyperalgesia, and early inflammatory cell accumulation are reduced; in the later phase of the disease, immune cell function and bone neoformation are increased. Elucidation of the underlying pathways of PACAP activity may open promising new avenues for development of therapy in inflammatory arthritis.
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Affiliation(s)
- Bálint Botz
- Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, and Molecular Pharmacology Research Team, János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
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Vogl T, Eisenblätter M, Völler T, Zenker S, Hermann S, van Lent P, Faust A, Geyer C, Petersen B, Roebrock K, Schäfers M, Bremer C, Roth J. Alarmin S100A8/S100A9 as a biomarker for molecular imaging of local inflammatory activity. Nat Commun 2014; 5:4593. [PMID: 25098555 PMCID: PMC4143994 DOI: 10.1038/ncomms5593] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/03/2014] [Indexed: 12/19/2022] Open
Abstract
Inflammation has a key role in the pathogenesis of various human diseases. The early detection, localization and monitoring of inflammation are crucial for tailoring individual therapies. However, reliable biomarkers to detect local inflammatory activities and to predict disease outcome are still missing. Alarmins, which are locally released during cellular stress, are early amplifiers of inflammation. Here, using optical molecular imaging, we demonstrate that the alarmin S100A8/S100A9 serves as a sensitive local and systemic marker for the detection of even sub-clinical disease activity in inflammatory and immunological processes like irritative and allergic contact dermatitis. In a model of collagen-induced arthritis, we use S100A8/S100A9 imaging to predict the development of disease activity. Furthermore, S100A8/S100A9 can act as a very early and sensitive biomarker in experimental leishmaniasis for phagocyte activation linked to an effective Th1-response. In conclusion, the alarmin S100A8/S100A9 is a valuable and sensitive molecular target for novel imaging approaches to monitor clinically relevant inflammatory disorders on a molecular level.
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Affiliation(s)
- Thomas Vogl
- Institute of Immunology, University of Münster, 48149 Münster, Germany
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
- These authors contributed equally to this work
| | - Michel Eisenblätter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London SE1 7EH, UK
- Department of Clinical Radiology, University of Münster, 48149 Münster, Germany
- These authors contributed equally to this work
| | - Tom Völler
- Institute of Immunology, University of Münster, 48149 Münster, Germany
| | - Stefanie Zenker
- Institute of Immunology, University of Münster, 48149 Münster, Germany
| | - Sven Hermann
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
- European Institute for Molecular Imaging, University of Münster, 48149 Münster, Germany
| | - Peter van Lent
- Department of Rheumatology, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Andreas Faust
- European Institute for Molecular Imaging, University of Münster, 48149 Münster, Germany
| | - Christiane Geyer
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
- Department of Clinical Radiology, University of Münster, 48149 Münster, Germany
| | - Beatrix Petersen
- Institute of Immunology, University of Münster, 48149 Münster, Germany
| | - Kirsten Roebrock
- Institute of Immunology, University of Münster, 48149 Münster, Germany
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
| | - Michael Schäfers
- European Institute for Molecular Imaging, University of Münster, 48149 Münster, Germany
- Cluster of Excellence EXC 1003 ‘Cells in Motion - CiM’, University of Münster, 48149 Münster, Germany
| | - Christoph Bremer
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
- Department of Radiology, St Franziskus Hospital Münster, 48145 Münster, Germany
| | - Johannes Roth
- Institute of Immunology, University of Münster, 48149 Münster, Germany
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
- Cluster of Excellence EXC 1003 ‘Cells in Motion - CiM’, University of Münster, 48149 Münster, Germany
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Schäfer VS, Hartung W, Hoffstetter P, Berger J, Stroszczynski C, Müller M, Fleck M, Ehrenstein B. Quantitative assessment of synovitis in patients with rheumatoid arthritis using fluorescence optical imaging. Arthritis Res Ther 2014; 15:R124. [PMID: 24432363 PMCID: PMC3978726 DOI: 10.1186/ar4304] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction To prospectively evaluate quantitative assessment of fluorescence optical imaging (FOI) for differentiation of synovitic from non-synovitic joints in patients suffering from rheumatoid arthritis (RA). Methods FOI of the hands was performed in patients with active RA, and a stratified quantitative fluorescence readout (FLRO) of 3 phases (1-120 s; 121-240 s; 241-360 s) was generated for 5 individual joints of the clinical predominant hand (carpal joint, metacarpophalangeal and proximal interphalangeal joints of digits II & III). To dissect the effect of the overall perfusion of the hand from the perfusion due to synovitis, a fluorescence ratio (FLRA) was additionally calculated, dividing each FLRO by the readout of the eponychium of digit II. The mean FLRO and FLRA were compared between joints with absent vs. present synovitis determined by clinical examination, grayscale, color Doppler ultrasonography, or magnetic resonance imaging (MRI). Results The analysis for 90 individual joints from 18 patients yielded FLRO ranging from 4.4 to 49.0 × 103, and FLRAs ranging from 0.37 to 2.27. Overall, the analyses based on the FLRA revealed a higher discrimination than the analyses related to the FLRO, demonstrating most significant differences in phases 2 and 3. A sensitivity of 26/39 (67%) and a specificity of 31/40 (77%) were calculated for FLRA of phase 3 using a cut-off value of more than 1.2 to detect MRI-confirmed synovitis with FOI. Conclusions FOI has a potential for visualizing synovitis in subjects with RA. For adequate FOI interpretation, quantitative analysis should be based on the novel FLRA calculated for phases 2 and 3.
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Abstract
Magnetic resonance imaging (MRI) is ideal for imaging the joints of rheumatoid arthritis (RA) patients. It produces anatomically detailed images of bone, cartilage, tendons and synovial membrane. It can reveal structural damage, in the form of bone erosion, cartilage thinning and/or tendon rupture, and regions of inflammation, using sequences that reveal water content and vascularity. MRI synovitis, tenosynovitis and bone oedema/osteitis all have prognostic significance, and MRI studies of RA have helped elucidate the mechanisms whereby bone and synovial inflammation lead to joint damage. Bone oedema/osteitis has become an important imaging biomarker, and can be used to help predict progression from undifferentiated arthritis to definite RA. Recent MRI studies have confirmed that subclinical inflammation is often present in patients in clinical remission, and these data may affect disease management. Finally, recent clinical trials are reviewed, in which MRI outcome measures are being established as sensitive response markers.
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Affiliation(s)
- Fiona M McQueen
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand,
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75
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Hermann KGA, Ohrndorf S, Werner SG, Finzel S, Backhaus M. [Imaging modalities in psoriatic arthritis]. Z Rheumatol 2014; 72:771-8. [PMID: 24085530 DOI: 10.1007/s00393-013-1188-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review presents an overview of the range of imaging modalities used in the diagnostic evaluation of patients with psoriatic arthritis (PsA). Conventional radiography is used to detect structural changes of the joints and tendon attachments. These changes occur late in the course of PsA hence conventional radiography contributes little to the early detection of PsA; however, the detection of periosteal proliferations on radiographs allows a relatively specific diagnosis of PsA. Skeletal scintigraphy and computed tomography are rarely used in PsA. Arthrosonography (ultrasound of the joints) is gaining increasing importance in the early identification of inflammatory soft tissue signs of PsA in the peripheral joints. Sonography enables early detection of synovitis and tenosynovitis as well as superficial erosions and also inflammatory processes of the tendon attachments. Magnetic resonance imaging (MRI) is indispensable for identifying possible involvement of the axial skeleton. Moreover, it allows good visualization of periostitis and arthritis. High resolution microcomputed tomography is an interesting novel diagnostic tool which allows highly sensitive evaluation of the bone structure and can detect very tiny bone lesions where typical signs of PsA are omega-shaped erosions and small corona-like spikes. Another interesting new diagnostic technique is fluorescence optical imaging (FOI) with the Xiralite system which is highly sensitive for detecting inflammatory processes of the hands.
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Affiliation(s)
- K-G A Hermann
- Institut für Radiologie, Charité - Universitätsmedizin Berlin, Universitätsklinikum Charité - Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland,
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76
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Vollmer S, Gemeinhardt I, Vater A, Schnorr B, Schnorr J, Voigt J, Ebert B. In vivo therapy monitoring of experimental rheumatoid arthritis in rats using near-infrared fluorescence imaging. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:36011. [PMID: 24638248 DOI: 10.1117/1.jbo.19.3.036011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/11/2014] [Indexed: 06/03/2023]
Abstract
An in vivo near-infrared fluorescence (NIRF) imaging technique is described for therapy monitoring of ankle joints affected by collagen-induced arthritis, a model of human rheumatoid arthritis. Arthritis was induced in rats by intradermal injections of collagen and Freund's incomplete adjuvant. For in vivo imaging, the nonspecific NIR dye tetrasulfocyanine (TSC) was used. Prior to and after treatment with a nonsteroidal anti-inflammatory drug, meloxicam, or analgesic drug, tramadol hydrochloride (which served as no-therapy control), normalized fluorescence intensities of each ankle joint were measured. Additionally, each ankle joint was characterized by clinical arthritis scoring and histopathology. Over a 3-week treatment period, a significant difference in disease progression between animals treated with meloxicam and tramadol hydrochloride was detected. A statistically significant improvement in ankle joint pathology from high- or moderate-grade to moderate- or low-grade upon meloxicam therapy, as determined by clinical evaluation, translated into a significant decrease in fluorescence intensity. In contrast, all arthritic joints of the no-therapy control group deteriorated to high-grade arthritis with high-fluorescence intensities in NIRF imaging.
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Affiliation(s)
- Sonja Vollmer
- Bayer Pharma AG, Global Drug Discovery, Berlin 13353, Germany
| | - Ines Gemeinhardt
- Charité-Universitaetsmedizin Berlin, Department of Radiology 10117, Germany
| | - Axel Vater
- Bayer Pharma AG, Global Drug Discovery, Berlin 13353, GermanycNOXXON Pharma AG, Drug Discovery, Berlin 10589, Germany
| | - Beatrix Schnorr
- Charité-Universitaetsmedizin Berlin, Department of Radiology 10117, Germany
| | - Jörg Schnorr
- Charité-Universitaetsmedizin Berlin, Department of Radiology 10117, Germany
| | - Jan Voigt
- Physikalisch-Technische Bundesanstalt, Department of Biomedical Optics, Berlin 10587, GermanyeMedical School Hannover, Department of Radiotherapy and Special Oncology, Hannover 30625, Germany
| | - Bernd Ebert
- Physikalisch-Technische Bundesanstalt, Department of Biomedical Optics, Berlin 10587, Germany
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77
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Pfeil A, Drummer KF, Oelzner P, Böttcher J, Jung C, Wolf G. Fluorescence optical imaging as a novel technique for the visualisation of inflammation in patients with systemic sclerosis with Raynaud’s phenomenon: a pilot study. Ann Rheum Dis 2014; 73:1279-80. [DOI: 10.1136/annrheumdis-2013-204958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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78
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Piper SK, Habermehl C, Schmitz CH, Kuebler WM, Obrig H, Steinbrink J, Mehnert J. Towards whole-body fluorescence imaging in humans. PLoS One 2013; 8:e83749. [PMID: 24391820 PMCID: PMC3877082 DOI: 10.1371/journal.pone.0083749] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/07/2013] [Indexed: 12/11/2022] Open
Abstract
Dynamic near-infrared fluorescence (DNIF) whole-body imaging of small animals has become a popular tool in experimental biomedical research. In humans, however, the field of view has been limited to body parts, such as rheumatoid hands, diabetic feet or sentinel lymph nodes. Here we present a new whole-body DNIF-system suitable for adult subjects. We explored whether this system (i) allows dynamic whole-body fluorescence imaging and (ii) can detect modulations in skin perfusion. The non-specific fluorescent probe indocyanine green (ICG) was injected intravenously into two subjects, and fluorescence images were obtained at 5 Hz. The in- and out-flow kinetics of ICG have been shown to correlate with tissue perfusion. To validate the system, skin perfusion was modulated by warming and cooling distinct areas on the chest and the abdomen. Movies of fluorescence images show a bolus passage first in the face, then in the chest, abdomen and finally in the periphery (~10, 15, 20 and 30 seconds, respectively). When skin perfusion is augmented by warming, bolus arrives about 5 seconds earlier than when the skin is cooled and perfusion decreased. Calculating bolus arrival times and spatial fitting of basis time courses extracted from different regions of interest allowed a mapping of local differences in subcutaneous skin perfusion. This experiment is the first to demonstrate the feasibility of whole-body dynamic fluorescence imaging in humans. Since the whole-body approach demonstrates sensitivity to circumscribed alterations in skinperfusion, it may be used to target autonomous changes in polyneuropathy and to screen for peripheral vascular diseases.
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Affiliation(s)
- Sophie K. Piper
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
- Machine Learning Department, Berlin Institute of Technology, Berlin, Germany
- Center for Stroke Research, Charité University Medicine Berlin, Berlin, Germany
- * E-mail:
| | - Christina Habermehl
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
- Machine Learning Department, Berlin Institute of Technology, Berlin, Germany
- Center for Stroke Research, Charité University Medicine Berlin, Berlin, Germany
| | - Christoph H. Schmitz
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
- NIRx Medizintechnik, Berlin, Germany
| | - Wolfgang M. Kuebler
- Institute of Physiology, Charité University Medicine Berlin, Berlin, Germany
| | - Hellmuth Obrig
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Jens Steinbrink
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
- Center for Stroke Research, Charité University Medicine Berlin, Berlin, Germany
| | - Jan Mehnert
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
- Machine Learning Department, Berlin Institute of Technology, Berlin, Germany
- Center for Stroke Research, Charité University Medicine Berlin, Berlin, Germany
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79
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Werner SG, Langer HE, Schott P, Bahner M, Schwenke C, Lind-Albrecht G, Spiecker F, Kurtz B, Burmester GR, Backhaus M. Indocyanine Green-Enhanced Fluorescence Optical Imaging in Patients With Early and Very Early Arthritis: A Comparative Study With Magnetic Resonance Imaging. ACTA ACUST UNITED AC 2013; 65:3036-44. [DOI: 10.1002/art.38175] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 08/22/2013] [Indexed: 01/18/2023]
Affiliation(s)
- Stephanie G. Werner
- Charité University Medicine Berlin; Berlin Germany
- RHIO Center Dusseldorf and RHIO Research Institute; Dusseldorf Germany
| | | | - Peter Schott
- Evangelisches Krankenhaus Dusseldorf; Dusseldorf Germany
| | | | | | | | | | - Bernward Kurtz
- Evangelisches Krankenhaus Dusseldorf; Dusseldorf Germany
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80
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Christensen JM, Brat GA, Johnson KE, Chen Y, Buretta KJ, Cooney DS, Brandacher G, Lee WPA, Li X, Sacks JM. Monocytes loaded with indocyanine green as active homing contrast agents permit optical differentiation of infectious and non-infectious inflammation. PLoS One 2013; 8:e81430. [PMID: 24282595 PMCID: PMC3839882 DOI: 10.1371/journal.pone.0081430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/13/2013] [Indexed: 01/10/2023] Open
Abstract
Distinguishing cutaneous infection from sterile inflammation is a diagnostic challenge and currently relies upon subjective interpretation of clinical parameters, microbiological data, and nonspecific imaging. Assessing characteristic variations in leukocytic infiltration may provide more specific information. In this study, we demonstrate that homing of systemically administered monocytes tagged using indocyanine green (ICG), an FDA-approved near infrared dye, may be assessed non-invasively using clinically-applicable laser angiography systems to investigate cutaneous inflammatory processes. RAW 264.7 mouse monocytes co-incubated with ICG fluoresce brightly in the near infrared range. In vitro, the loaded cells retained the ability to chemotax toward monocyte chemotactic protein-1. Following intravascular injection of loaded cells into BALB/c mice with induced sterile inflammation (Complete Freund’s Adjuvant inoculation) or infection (Group A Streptococcus inoculation) of the hind limb, non-invasive whole animal imaging revealed local fluorescence at the inoculation site. There was significantly higher fluorescence of the inoculation site in the infection model than in the inflammation model as early as 2 hours after injection (p<0.05). Microscopic examination of bacterial inoculation site tissue revealed points of near infrared fluorescence, suggesting the presence of ICG-loaded cells. Development of a non-invasive technique to rapidly image inflammatory states without radiation may lead to new tools to distinguish infectious conditions from sterile inflammatory conditions at the bedside.
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Affiliation(s)
- Joani M. Christensen
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Gabriel A. Brat
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Kristine E. Johnson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States of America
| | - Yongping Chen
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Kate J. Buretta
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Damon S. Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - W. P. Andrew Lee
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Xingde Li
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Justin M. Sacks
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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81
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Meier R, Thuermel K, Noël PB, Moog P, Sievert M, Ahari C, Nasirudin RA, Golovko D, Haller B, Ganter C, Wildgruber M, Schaeffeler C, Waldt S, Rummeny EJ. Synovitis in patients with early inflammatory arthritis monitored with quantitative analysis of dynamic contrast-enhanced optical imaging and MR imaging. Radiology 2013; 270:176-85. [PMID: 23901126 DOI: 10.1148/radiol.13130039] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate quantitative perfusion measurements of dynamic indocyanine green (ICG)-enhanced optical imaging for monitoring synovitis in the hands of patients with inflammatory arthritis compared with dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging and clinical outcome. MATERIALS AND METHODS This study was approved by the ethics committee at the institution. Individual joints (n = 840) in the hands and wrists of 28 patients (14 women; mean age, 53.3 years) with inflammatory arthritis were examined at three different time points: before start of therapy and 12 and 24 weeks after start of therapy or therapy escalation. Treatment response was assessed by using clinical measures (simple disease activity index [SDAI]), ICG-enhanced optical imaging, and DCE MR imaging. Dynamic images were obtained for optical imaging and DCE MR imaging. The rate of early enhancement (REE) of the perfusion curves of each joint was calculated by using in-house developed software. Correlation coefficients were estimated to evaluate the associations of changes of imaging parameters and SDAI change. RESULTS Quantitative perfusion measurements with optical imaging and MR imaging correctly identified patients who responded (n = 18) and did not respond to therapy (n = 10), as determined by SDAI. The difference of REE after 24 weeks of treatment compared with baseline in responders was significantly reduced in optical imaging and MR imaging (optical imaging: mean, -21.5%; MR imaging: mean, -41.0%; P < .001 for both), while in nonresponders it was increased (optical imaging: mean, 10.8%; P = .075; MR imaging: mean, 8.7%; P = .03). The REE of optical imaging significantly correlated with MR imaging (ρ = 0.80; P < .001) and SDAI (ρ = 0.61; P < .001). CONCLUSION Quantitative analysis of contrast-enhanced optical imaging allows for potential therapeutic monitoring of synovitis in patients with inflammatory arthritis.
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Affiliation(s)
- Reinhard Meier
- From the Departments of Radiology (R.M., P.B.N., M.S., C.A., R.A.N., C.G., M.W., C.S., S.W., E.J.R.) and Rheumatology (K.T., P.M.), II. Medizinische Klinik, and Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar (B.H.), Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany; and Department of Internal Medicine, University of Colorado, Denver, Colo (D.G.)
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82
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Bierry G, Dietemann JL. Imaging evaluation of inflammation in the musculoskeletal system: current concepts and perspectives. Skeletal Radiol 2013; 42:1347-59. [PMID: 23685709 DOI: 10.1007/s00256-013-1636-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/08/2013] [Accepted: 04/22/2013] [Indexed: 02/02/2023]
Abstract
Inflammation is the non-specific stereotyped reaction of the musculoskeletal system to various types of aggression, such as infection, tumor, autoimmune diseases, or trauma. Precise evaluation and, increasingly, reliable quantification of inflammation are now key factors for optimal patient management, as targeted therapies (e.g., anti-angiogenesis, anti-macrophages, anti-cytokines) are emerging as everyday drugs. In current practice, inflammation is evaluated mostly using MRI and US on the basis of its non-specific extracellular component due to the increased volume of free water. Inflamed tissue is described as areas of low T1 signal and high T2 signal on magnetic resonance imaging or as hypoechogenic areas on ultrasound imaging, and the evaluation of the increased tissue vascularity can be performed using gadolinium-enhanced MRI or power Doppler US. Emerging new imaging tools, regrouped under the label "cellular and molecular imaging" and defined as the in vivo characterization and measurement of biologic processes at the cellular and molecular level, demonstrate the possible shift of medical imaging from a macroscopic and non-specific level to a microscopic and targeted scale. Cellular and molecular imaging now allows the investigation of specific pathways involved in inflammation (e.g., angiogenesis, cell proliferation, and recruitment, proteases generation, metabolism, gene expression). PET and SPECT imaging are the most commonly used "molecular" imaging modalities, but recent progress in MR, US, and optical imaging has been made. In the future, those techniques might enable a detection of inflammation at its very early stage, its quantification through the definition of biomarkers, and possibly demonstrate the response to therapy at molecular and cellular levels.
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Affiliation(s)
- Guillaume Bierry
- Department of Radiology, University Hospital of Strasbourg, 10 Avenue Molière, 67098 Strasbourg, France.
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83
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Abstract
OBJECTIVE A review of the innovative role molecular imaging plays in musculoskeletal radiology is provided. Musculoskeletal molecular imaging is under development in four key areas: imaging the activity of osteoblasts and osteoclasts, imaging of molecular and cellular biomarkers of arthritic joint destruction, cellular imaging of osteomyelitis, and imaging generators of musculoskeletal pain. CONCLUSION Together, these applications suggest that next-generation musculoskeletal radiology will facilitate quantitative visualization of molecular and cellular biomarkers, an advancement that appeared futuristic just a decade ago.
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84
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Hartung W. [Value of fluorescence imaging for detection of synovitis of the hand in comparison to 3 T MRI]. Z Rheumatol 2013; 72:488-90. [PMID: 23685855 DOI: 10.1007/s00393-013-1181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- W Hartung
- Klinik und Poliklinik für Rheumatologie und Klinische Immunologie, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Deutschland.
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85
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Musculoskeletal ultrasound and other imaging modalities in rheumatoid arthritis. Curr Opin Rheumatol 2013; 25:367-74. [DOI: 10.1097/bor.0b013e32835fad45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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86
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Schäfer VS, Hartung W, Ehrenstein B, Hoffstetter P, Müller M, Fleck M. A novel arthritis in vivo fluorescence optical imaging technology pushed to the limits. Rheumatology (Oxford) 2012; 52:1144-5. [PMID: 23221324 DOI: 10.1093/rheumatology/kes301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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87
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Meier AJL, Rensen WHJ, de Bokx PK, de Nijs RNJ. Potential of optical spectral transmission measurements for joint inflammation measurements in rheumatoid arthritis patients. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:081420. [PMID: 23224181 DOI: 10.1117/1.jbo.17.8.081420] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Frequent monitoring of rheumatoid arthritis (RA) patients enables timely treatment adjustments and improved outcomes. Currently this is not feasible due to a shortage of rheumatologists. An optical spectral transmission device is presented for objective assessment of joint inflammation in RA patients, while improving diagnostic accuracy and clinical workflow. A cross-sectional, nonrandomized observational study was performed with this device. In the study, 77 proximal interphalangeal (PIP) joints in 67 patients have been analyzed. Inflammation of these PIP joints was also assessed by a rheumatologist with a score varying from 1 (not inflamed) to 5 (severely inflamed). Out of 77 measurements, 27 were performed in moderate to strongly inflamed PIP joints. Comparison between the clinical assessment and an optical measurement showed a correlation coefficient r=0.63, p<0.001, 95% CI [0.47, 0.75], and a ROC curve (AUC=0.88) that shows a relative good specificity and sensitivity. Optical spectral transmission measurements in a single joint correlate with clinical assessment of joint inflammation, and therefore might be useful in monitoring joint inflammation in RA patients.
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Affiliation(s)
- A J Louise Meier
- Regional Rheumatic Centre (RRC), Department of Rheumatology, Ds. Th. Fliednerstraat 1, 5631 BM, Eindhoven, The Netherlands.
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88
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Meier R, Thürmel K, Moog P, Noël PB, Ahari C, Sievert M, Dorn F, Waldt S, Schaeffeler C, Golovko D, Haller B, Ganter C, Weckbach S, Woertler K, Rummeny EJ. Detection of synovitis in the hands of patients with rheumatologic disorders: Diagnostic performance of optical imaging in comparison with magnetic resonance imaging. ACTA ACUST UNITED AC 2012; 64:2489-98. [DOI: 10.1002/art.34467] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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89
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Biomarker in der Rheumatologie. Z Rheumatol 2012; 71:314-8. [DOI: 10.1007/s00393-011-0781-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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