Molecular Imaging of Inflammatory Disease

Imaging in inflammatory arthritis: progress towards precision medicine

Imaging techniques such as ultrasonography and MRI have gained ground in the diagnosis and management of inflammatory arthritis, as these imaging modalities allow a sensitive assessment of musculoskeletal inflammation and damage. However, these techniques cannot discriminate between disease subsets and are currently unable to deliver an accurate prediction of disease progression and therapeutic response in individual patients. This major shortcoming of today's technology hinders a targeted and personalized patient management approach. Technological advances in the areas of high-resolution imaging (for example, high-resolution peripheral quantitative computed tomography and ultra-high field MRI), functional and molecular-based imaging (such as chemical exchange saturation transfer MRI, positron emission tomography, fluorescence optical imaging, optoacoustic imaging and contrast-enhanced ultrasonography) and artificial intelligence-based data analysis could help to tackle these challenges. These new imaging approaches offer detailed anatomical delineation and an in vivo and non-invasive evaluation of the immunometabolic status of inflammatory reactions, thereby facilitating an in-depth characterization of inflammation. By means of these developments, the aim of earlier diagnosis, enhanced monitoring and, ultimately, a personalized treatment strategy looms closer.

Advances in Imaging of Inflammation, Fibrosis, and Cancer in the Gastrointestinal Tract

Gastrointestinal disease is prevalent and broad, manifesting itself in a variety of ways, including inflammation, fibrosis, infection, and cancer. However, historically, diagnostic technologies have exhibited limitations, especially with regard to diagnostic uncertainty. Despite development of newly emerging technologies such as optoacoustic imaging, many recent advancements have focused on improving upon pre-existing modalities such as ultrasound, computed tomography, magnetic resonance imaging, and endoscopy. These advancements include utilization of machine learning models, biomarkers, new technological applications such as diffusion weighted imaging, and new techniques such as transrectal ultrasound. This review discusses assessment of disease processes using imaging strategies for the detection and monitoring of inflammation, fibrosis, and cancer in the context of gastrointestinal disease. Specifically, we include ulcerative colitis, Crohn's disease, diverticulitis, celiac disease, graft vs. host disease, intestinal fibrosis, colorectal stricture, gastric cancer, and colorectal cancer. We address some of the most recent and promising advancements for improvement of gastrointestinal imaging, including unique discussions of such advancements with regard to imaging of fibrosis and differentiation between similar disease processes.

Redox-Responsive MRI Probes Based on First-Row Transition-Metal Complexes

The presence of multiple oxidation and spin states of first-row transition-metal complexes facilitates the development of switchable MRI probes. Redox-responsive probes capitalize on a change in the magnetic properties of the different oxidation states of the paramagnetic metal ion center upon exposure to biological oxidants and reductants. Transition-metal complexes that are useful for MRI can be categorized according to whether they accelerate water proton relaxation (T₁ or T₂ agents), induce paramagnetic shifts of ¹H or ¹⁹F resonances (paraSHIFT agents), or are chemical exchange saturation transfer (CEST) agents. The various oxidation state couples and their properties as MRI probes are summarized with a focus on Co(II)/Co(III) or Fe(II)/Fe(III) complexes as small molecules or as liposomal agents. Solution studies of these MRI probes are reviewed with an emphasis on redox changes upon treatment with oxidants or with enzymes that are physiologically important in inflammation and disease. Finally, we outline the challenges of developing these probes further for in vivo MRI applications.

A Pilot Study of Radiomics Models Combining Multi-Probe and Multi-Modality Images of 68Ga-NOTA-PRGD2 and 18F-FDG PET/CT for Differentiating Benign and Malignant Pulmonary Space-Occupying Lesions

Background

This is a pilot study of radiomics based on ⁶⁸Ga-NOTA-PRGD2 [NOTA-PEG4-E[c(RGDfK)]2)] and ¹⁸F-FDG PET/CT to (i) evaluate the diagnostic efficacy of radiomics features of ⁶⁸Ga-NOTA-PRGD2 PET in the differential diagnosis of benign and malignant pulmonary space-occupying lesions and (ii) compare the diagnostic efficacy of multi-modality and multi-probe images.

Methods

We utilized a dataset of 48 patients who participated in ⁶⁸Ga-NOTA-PRGD2 PET/CT and ¹⁸F-FDG PET/CT clinical trials to extract image features and evaluate their diagnostic efficacy in the differentiation of benign and malignant lesions by the Mann-Whitney U test. After feature selection with sequential forward selection, random forest models were developed with tenfold cross-validation. The diagnostic performance of models based on different image features was visualized by receiver operating characteristic (ROC) curves and compared by permutation tests.

Results

Fourteen of the ⁶⁸Ga-NOTA-PRGD2 PET features between benign and malignant pulmonary space-occupying lesions had significant differences (P<0.05, Mann-Whitney U test). Eighteen of the ⁶⁸Ga-NOTA-PRGD2 PET features demonstrated higher AUC values than all CT features in the differential diagnosis of pulmonary lesions. The AUC value (0.908) ​​of the three-modal feature model was significantly higher (P<0.05, permutation test) than those of the single- and dual-modal models.

Conclusion

⁶⁸Ga-NOTA-PRGD2 PET features have better diagnostic capacity than CT features for pulmonary space-occupying lesions. The combination of multi-modality and multi-probe images can improve the diagnostic efficiency of models. Our preliminary clinical hypothesis of using radiomics based on ⁶⁸Ga-NOTA-PRGD2 PET images and multimodal images as a diagnostic tool warrants further validation in a larger multicenter sample size.

68Ga-WRWWWW Is a Potential Positron Emission Tomography Probe for Imaging Inflammatory Diseases by Targeting Formyl Peptide Receptor 2

Inflammation plays a significant role in many physiological and pathological processes. Molecular imaging could provide functional as well as anatomical information for visualizing various inflammatory diseases. Advancements in imaging tracers for inflammation would improve the accuracy of diagnosis and monitoring, thus facilitating patient care. The positron emission tomography (PET) imaging tracer, ⁶⁸Ga-labeled antagonist peptide Trp-Arg-Trp-Trp-Trp-Trp (WRWWWW, WRW⁴), targets formyl peptide receptor 2 (FPR2), which is in turn widely distributed in a variety of tissues and is associated with many inflammatory diseases. In the current study, we aimed to investigate the potential of ⁶⁸Ga-WRW⁴ for detecting and monitoring inflammatory lesions in mice. We established an inflammation mouse model by the intramuscular injection of turpentine oil into the left thigh. WRW⁴ was labeled with ⁶⁸Ga with an overall radiochemical yield >90% and radiochemical purity >99%. ⁶⁸Ga-WRW⁴ uptake in inflamed muscle peaked on day 2 (1.14 ± 0.01 percentage of the injected dose per gram of tissue (%ID/g)) and the uptake ratio of inflammatory/normal muscle also reached a maximum (12.36 ± 2.35). Strong PET signals were detected in the left thigh at 60 min after the injection of ⁶⁸Ga-WRW⁴ in experimental mice, but weak or no signals were detected in mice in the blocking and control groups. ⁶⁸Ga-WRW⁴ uptake was in agreement with the dynamics of immune cell infiltration during the inflammatory reaction. These results suggest that ⁶⁸Ga-WRW⁴ is a promising PET tracer suitable for the noninvasive detection of FPR2 expression and for monitoring inflammatory activity in inflammation-bearing mice.

Anti-Inflammatory Effects of Camellia fascicularis Polyphenols via Attenuation of NF-κB and MAPK Pathways in LPS-Induced THP-1 Macrophages

Purpose

Plant polyphenols possess beneficial functions against various diseases. This study aimed to identify phenolic ingredients in Camellia fascicularis (C. fascicularis) and investigate its possible underlying anti-inflammatory mechanism in lipopolysaccharide (LPS)-induced human monocytes (THP-1) macrophages.

Methods

C. fascicularis polyphenols (CFP) were characterized by ultra-performance liquid chromatography (UPLC) combined with quadrupole-time-of-flight mass/mass spectrometry (Q-TOF-MS/MS). The THP-1 cells were differentiated into macrophages under the stimulation of phorbol 12-myristate 13-acetate (PMA) and then treated with LPS to build a cellular inflammation model. The cell viability was detected by CCK-8 assay. The levels of reactive oxygen species (ROS) were assessed by flow cytometry. The secretion and expression of inflammatory cytokines were tested by enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction (RT-PCR). In addition, the nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathways were analyzed by Western blotting.

Results

Twelve phenolic constituents including (–)-epicatechin, casuariin, agastachoside, etc. in CFP were identified. The CCK-8 assay showed that CFP exhibited no significant cytotoxicity between 100 and 300 μg/mL. After treated with CFP, the release of ROS was significantly suppressed. CFP inhibited inflammation in macrophages by attenuating the polarization of LPS-induced THP-1 macrophages, down-regulating the expression of the pro-inflammatory cytokines IL-6, IL-1β and TNF-α, and up-regulating the expression of the anti-inflammatory cytokine IL-10. Western blotting experiments manifested that CFP could markedly inhibit the phosphorylation of p65, ERK and JNK, thereby suppressing the activation of NF-κB and MAPK signaling pathways.

Conclusion

These findings indicated that CFP exerted anti-inflammatory activity by inhibiting the activation NF-κB and MAPK pathways which may induce the secretion of pro-inflammatory cytokines. This study offers a reference for C. fascicularis as the source of developing natural, safe anti-inflammatory agents in the future.

ROS/RNS and Base Dual Activatable Merocyanine-Based NIR-II Fluorescent Molecular Probe for in vivo Biosensing

Inflammation usually results in high-level reactive oxygen species (ROS) and reactive nitrogen species (RNS) not only in acidic tissue but also in alkaline tissue. However, noninvasively in vivo monitoring reactive species specifically within alkaline tissue remains a huge challenge. Here we introduce a dual activatable fluorescent probe PN910 located in the second near-infrared window (NIR-II, 900-1700 nm), which shows high selectivity toward H₂ O₂ and OONO^- at pH beyond 7.4. Then we verified that PN910 could be used for the real-time, specific and accurate monitoring of cystitis and colitis for living animals. This report presents a unique approach to the development of dual activatable probe for in vivo biosensing.