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Carroll BJ, Singhal D. Advances in lymphedema: An under-recognized disease with a hopeful future for patients. Vasc Med 2024; 29:70-84. [PMID: 38166534 DOI: 10.1177/1358863x231215329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Lymphedema has traditionally been underappreciated by the healthcare community. Understanding of the underlying pathophysiology and treatments beyond compression have been limited until recently. Increased investigation has demonstrated the key role of inflammation and resultant fibrosis and adipose deposition leading to the clinical sequelae and associated reduction in quality of life with lymphedema. New imaging techniques including magnetic resonance imaging (MRI), indocyanine green lymphography, and high-frequency ultrasound offer improved resolution and understanding of lymphatic anatomy and flow. Nonsurgical therapy with compression, exercise, and weight loss remains the mainstay of therapy, but growing surgical options show promise. Physiologic procedures (lymphovenous anastomosis and vascularized lymph node transfers) improve lymphatic flow in the diseased limb and may reduce edema and the burden of compression. Debulking, primarily with liposuction to remove the adipose deposition that has accumulated, results in a dramatic decrease in limb girth in appropriately selected patients. Though early, there are also exciting developments of potential therapeutic targets tackling the underlying drivers of the disease. Multidisciplinary teams have developed to offer the full breadth of evaluation and current management, but the development of a greater understanding and availability of therapies is needed to ensure patients with lymphedema have greater opportunity for optimal care.
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Affiliation(s)
- Brett J Carroll
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dhruv Singhal
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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2
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Bauer C, Scala M, Sekyra P, Fellner F, Tulzer G. Non-Contrast MR Lymphography and Intranodal Dynamic Contrast MR Lymphangiography in Children with Congenital Heart Disease-Imaging Findings as well as Impact on Patient Management and Outcome. Int J Mol Sci 2023; 24:14827. [PMID: 37834274 PMCID: PMC10573489 DOI: 10.3390/ijms241914827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Lymphatic flow disorders are rare but devastating complications in children with congenital heart disease. T2-weighted magnetic resonance lymphography and intranodal dynamic contrast magnetic resonance lymphangiography are imaging modalities that can depict central lymphatic anatomy and flow pattern. Our objective was to describe the technical aspects and our imaging findings of central lymphatic abnormalities and their impact on patient management and outcomes: We conducted a retrospective review of 26 children with congenital heart disease who presented for lymphatic imaging between 2015 and 2020 at our institution. Eleven had postoperative chylothorax, six had plastic bronchitis, seven had protein-losing enteropathy and three had Noonan syndrome. Our lymphatic imaging demonstrated severely abnormal lymphatic flow in all of the children, but only minor abnormalities in protein-losing enteropathy. No major procedure-related complication occurred. Lymphatic interventions were performed in six patients, thoracic duct decompression in two patients and chylothorax revision in three patients. This led to symptomatic improvements in all of the patients: Lymphatic imaging is safe and essential for the diagnosis of lymphatic flow disorders and therapy planning. Our intranodal lymphangiography depicts an abnormal lymphatic flow pattern from the central lymphatics but failed to demonstrate an abnormal lymphatic flow in protein-losing enteropathy. These imaging techniques are the basis for selective lymphatic interventions, which are promising to treat lymphatic flow disorders.
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Affiliation(s)
- Christoph Bauer
- Department of Paediatric Cardiology, Kepler University Hospital GmbH, Krankenhausstrasse 26–30, 4020 Linz, Austria (G.T.)
- Johannes Kepler University Linz, Altenbergerstrasse 68, 4040 Linz, Austria; (P.S.); (F.F.)
| | - Mario Scala
- Johannes Kepler University Linz, Altenbergerstrasse 68, 4040 Linz, Austria; (P.S.); (F.F.)
- Central Radiology Institute, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Pavel Sekyra
- Johannes Kepler University Linz, Altenbergerstrasse 68, 4040 Linz, Austria; (P.S.); (F.F.)
- Central Radiology Institute, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Franz Fellner
- Johannes Kepler University Linz, Altenbergerstrasse 68, 4040 Linz, Austria; (P.S.); (F.F.)
- Central Radiology Institute, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Gerald Tulzer
- Department of Paediatric Cardiology, Kepler University Hospital GmbH, Krankenhausstrasse 26–30, 4020 Linz, Austria (G.T.)
- Johannes Kepler University Linz, Altenbergerstrasse 68, 4040 Linz, Austria; (P.S.); (F.F.)
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3
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Sevick-Muraca EM, Fife CE, Rasmussen JC. Imaging peripheral lymphatic dysfunction in chronic conditions. Front Physiol 2023; 14:1132097. [PMID: 37007996 PMCID: PMC10050385 DOI: 10.3389/fphys.2023.1132097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/17/2023] [Indexed: 03/17/2023] Open
Abstract
The lymphatics play important roles in chronic diseases/conditions that comprise the bulk of healthcare worldwide. Yet the ability to routinely image and diagnose lymphatic dysfunction, using commonly available clinical imaging modalities, has been lacking and as a result, the development of effective treatment strategies suffers. Nearly two decades ago, investigational near-infrared fluorescence lymphatic imaging and ICG lymphography were developed as routine diagnostic for clinically evaluating, quantifying, and treating lymphatic dysfunction in cancer-related and primary lymphedema, chronic venous disease, and more recently, autoimmune and neurodegenerative disorders. In this review, we provide an overview of what these non-invasive technologies have taught us about lymphatic (dys) function and anatomy in human studies and in corollary animal studies of human disease. We summarize by commenting on new impactful clinical frontiers in lymphatic science that remain to be facilitated by imaging.
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Affiliation(s)
- Eva M. Sevick-Muraca
- Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Caroline E. Fife
- Department of Geriatrics, Baylor College of Medicine, Houston, TX, United States
| | - John C. Rasmussen
- Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
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4
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Khadria A, Paavola CD, Zhang Y, Davis SPX, Grealish PF, Maslov K, Shi J, Beals JM, Oladipupo SS, Wang LV. Long-Duration and Non-Invasive Photoacoustic Imaging of Multiple Anatomical Structures in a Live Mouse Using a Single Contrast Agent. Adv Sci (Weinh) 2022; 9:e2202907. [PMID: 35975459 PMCID: PMC9534965 DOI: 10.1002/advs.202202907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/29/2022] [Indexed: 06/15/2023]
Abstract
Long-duration in vivo simultaneous imaging of multiple anatomical structures is useful for understanding physiological aspects of diseases, informative for molecular optimization in preclinical models, and has potential applications in surgical settings to improve clinical outcomes. Previous studies involving simultaneous imaging of multiple anatomical structures, for example, blood and lymphatic vessels as well as peripheral nerves and sebaceous glands, have used genetically engineered mice, which require expensive and time-consuming methods. Here, an IgG4 isotype control antibody is labeled with a near-infrared dye and injected into a mouse ear to enable simultaneous visualization of blood and lymphatic vessels, peripheral nerves, and sebaceous glands for up to 3 h using photoacoustic microscopy. For multiple anatomical structure imaging, peripheral nerves and sebaceous glands are imaged inside the injected dye-labeled antibody mass while the lymphatic vessels are visualized outside the mass. The efficacy of the contrast agent to label and localize deep medial lymphatic vessels and lymph nodes using photoacoustic computed tomography is demonstrated. The capability of a single injectable contrast agent to image multiple structures for several hours will potentially improve preclinical therapeutic optimization, shorten discovery timelines, and enable clinical treatments.
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Affiliation(s)
- Anjul Khadria
- Caltech Optical Imaging LaboratoryAndrew and Peggy Cherng Department of Medical EngineeringCalifornia Institute of TechnologyPasadenaCA91125USA
| | - Chad D. Paavola
- Lilly Research LaboratoriesEli Lilly and CompanyLilly Corporate CenterIndianapolisIN46285USA
| | - Yang Zhang
- Caltech Optical Imaging LaboratoryAndrew and Peggy Cherng Department of Medical EngineeringCalifornia Institute of TechnologyPasadenaCA91125USA
| | - Samuel P. X. Davis
- Caltech Optical Imaging LaboratoryAndrew and Peggy Cherng Department of Medical EngineeringCalifornia Institute of TechnologyPasadenaCA91125USA
| | - Patrick F. Grealish
- Lilly Research LaboratoriesEli Lilly and CompanyLilly Corporate CenterIndianapolisIN46285USA
| | - Konstantin Maslov
- Caltech Optical Imaging LaboratoryAndrew and Peggy Cherng Department of Medical EngineeringCalifornia Institute of TechnologyPasadenaCA91125USA
| | - Junhui Shi
- Caltech Optical Imaging LaboratoryAndrew and Peggy Cherng Department of Medical EngineeringCalifornia Institute of TechnologyPasadenaCA91125USA
| | - John M. Beals
- Lilly Research LaboratoriesEli Lilly and CompanyLilly Biotechnology CenterSan DiegoCA92121USA
| | - Sunday S. Oladipupo
- Lilly Research LaboratoriesEli Lilly and CompanyLilly Corporate CenterIndianapolisIN46285USA
| | - Lihong V. Wang
- Caltech Optical Imaging LaboratoryAndrew and Peggy Cherng Department of Medical EngineeringCalifornia Institute of TechnologyPasadenaCA91125USA
- Caltech Optical Imaging LaboratoryDepartment of Electrical EngineeringCalifornia Institute of TechnologyPasadenaCA91125USA
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5
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Lee J, Stanley K, Lowe MC. Plastic bronchitis: A rare complication following a motor vehicle collision. Lymphology 2022; 55:65-69. [PMID: 36170580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Plastic bronchitis, more appropriately termed chyloptysis, is a rare and potentially fatal condition caused by chylous coating of the airways. These cast coating can dislodge and become an obstructive mass in the patient's airway, necessitating rapid intervention. PB is well described to occur following single ventricle physiology heart disease corrective procedures, particularly following Fontan procedures. It is less commonly seen in traumatic settings. We present the youngest known case of a traumatic injury induced plastic bronchitis. A 19-year-old man was involved in a motor vehicle accident with airbag deployment. The airbags struck him in the chest; however, the patient felt well at the time and did not seek medical attention. Several months later the patient began coughing up milky white masses identified as casts. He was initially diagnosed with asthma but did not respond to therapy. He ultimately was found to have evidence of thoracic duct injury. Options for therapy were discussed, including possible thoracic duct ligation. The patient opted to continue a lowfat diet and has remained cast free. This case highlights the importance of considering plastic bronchitis in patients with cast production and a history of trauma to the chest.
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Affiliation(s)
- J Lee
- Pediatric Residency, Department of Pediatrics, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - K Stanley
- Pediatric Residency, Department of Pediatrics, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - M C Lowe
- Division of Pediatric Hospital Medicine, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
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6
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Cox T, Vance C, Daley S, Papendieck C, McGregor H, Kuo PH, Witte MH. Imaging of lymphatic dysplasia in Noonan syndrome: Case studies and historical atlas. Lymphology 2021; 54:23-40. [PMID: 34506085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To determine the historical use and utility of various lymphatic imaging modalities in Noonan syndrome (NS) patients, we performed a comprehensive literature review by collecting the published medical imaging of NS lymphatic dysplasias. We correlated imaging findings with clinical phenotypes and treatment. Our analysis of lymphatic imaging modalities provides an algorithmic approach to imaging and patient care across the spectrum of NS developmental defects. A total of 54 NS cases have been published since 1975. Using the observations reported in 15 reviewed publications, an association was made between disruptions in central lymphatic flow and poor clinical presentations/outcomes in NS patients.
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Affiliation(s)
- T Cox
- Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | - C Vance
- Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | - S Daley
- Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | | | - H McGregor
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - P H Kuo
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - M H Witte
- Department of Surgery, University of Arizona, Tucson, Arizona, USA
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7
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Moosmann J, Schroeder C, Cesnjevar R, Rottermann K, Weigelt A, Dittrich S. Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio in Univentricular Patients From Birth to Follow-Up After Fontan-Predicting Lymphatic Abnormalities. Front Pediatr 2021; 9:740951. [PMID: 34956972 PMCID: PMC8692875 DOI: 10.3389/fped.2021.740951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Reliable laboratory parameters identifying complications after Fontan surgery including the lymphatic abnormalities and the development of protein-losing enteropathy (PLE) are rare. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocte ratio (PLR) are inflammatory markers and have been studied to predict outcome and prognosis in various diseases. The aim of this study was to investigate NLR and PLR from birth to follow-up after Fontan and evaluate their use as prognostic parameters for single ventricle patients regarding the development of lymphatic malformations during follow-up. Materials and Methods: Sixty-six univentricular patients who underwent Fontan surgery and had 6-month follow-up magnetic resonance imaging (MRI) with T2 weighted lymphatic imaging after total cavopulmonary connection (TCPC) surgery were included in the study. NLR and PLR were determined at specific time points, from neonatal age to follow-up after Fontan operation and correlated to data from the MRI 6 months after Fontan. Results: NLR and PLR increase significantly over time from the first surgery during infancy to the follow-up after Fontan (both p < 0.0001), with a significant increase after the Glenn surgery for both ratios (each p < 0.0001). Higher NLR (p = 0.002) and higher PLR (p = 0.004) correlated with higher-grade classification of lymphatic abnormalities in T2-weighted imaging 6 months after Fontan surgery and higher NLR correlated with higher transpulmonary gradient prior to Fontan surgery (p = 0.035) Both ratios showed a significant correlation to total protein at follow-up (NLR p = 0.0038; PLR<0.0001). Conclusion: Increased NLR and PLR correlate with higher degree lymphatic malformations after TCPC and therefore might contribute as valuable additional biomarker during follow-up after TCPC. NLR and PLR are simple, inexpensive and easily available parameters to complement diagnostics after TCPC.
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Affiliation(s)
- Julia Moosmann
- Department of Pediatric Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Schroeder
- Department of Pediatric Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Robert Cesnjevar
- Department of Pediatric Cardiac Surgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Kathrin Rottermann
- Department of Pediatric Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Annika Weigelt
- Department of Pediatric Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany
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8
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Aldrich MB, Rasmussen JC, Fife CE, Shaitelman SF, Sevick-Muraca EM. The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors. Cancers (Basel) 2020; 12:E2280. [PMID: 32823928 PMCID: PMC7466081 DOI: 10.3390/cancers12082280] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 02/08/2023] Open
Abstract
Breast-cancer-acquired lymphedema is routinely diagnosed from the appearance of irreversible swelling that occurs as a result of lymphatic dysfunction. Yet in head and neck cancer survivors, lymphatic dysfunction may not always result in clinically overt swelling, but instead contribute to debilitating functional outcomes. In this review, we describe how cancer metastasis, lymph node dissection, and radiation therapy alter lymphatic function, as visualized by near-infrared fluorescence lymphatic imaging. Using custom gallium arsenide (GaAs)-intensified systems capable of detecting trace amounts of indocyanine green administered repeatedly as lymphatic contrast for longitudinal clinical imaging, we show that lymphatic dysfunction occurs with cancer progression and treatment and is an early, sub-clinical indicator of cancer-acquired lymphedema. We show that early treatment of lymphedema can restore lymphatic function in breast cancer and head and neck cancer patients and survivors. The compilation of these studies provides insights to the critical role that the lymphatics and the immune system play in the etiology of lymphedema and associated co-morbidities.
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Affiliation(s)
- Melissa B. Aldrich
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX 77030, USA; (M.B.A.); (J.C.R.)
| | - John C. Rasmussen
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX 77030, USA; (M.B.A.); (J.C.R.)
| | - Caroline E. Fife
- Department of Geriatrics, Baylor College of Medicine, Houston, TX 77030, USA;
- The Wound Care Clinic, CHI St. Luke’s Health, The Woodlands Hospital, The Woodlands, TX 77381, USA
| | - Simona F. Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Eva M. Sevick-Muraca
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX 77030, USA; (M.B.A.); (J.C.R.)
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Montana DM, Nasilowski M, Hess WR, Saif M, Carr JA, Nienhaus L, Bawendi MG. Monodisperse and Water-Soluble Quantum Dots for SWIR Imaging via Carboxylic Acid Copolymer Ligands. ACS Appl Mater Interfaces 2020; 12:35845-35855. [PMID: 32805785 DOI: 10.1021/acsami.0c08255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Compared to the visible and near-infrared, the short-wave infrared region (SWIR; 1000-2000 nm) has excellent properties for in vivo imaging: low autofluorescence, reduced scattering, and a low-absorption cross-section of blood or tissue. However, the general adoption of SWIR imaging in biomedical research will be enhanced by a broader availability of versatile and bright contrast materials. Quantum dots (QDs) are bright and compact SWIR emitters with narrow size distributions and emission spectra, but their use is limited by the shortcomings of established ligand systems for SWIR QDs. Established ligands often result in SWIR probes with either limited colloidal stability, large size, or broad size distribution or a combination of all three. We present a polymeric QD ligand designed to be compatible with oleate-coated QDs. Our polymeric acid ligand is a copolymer bearing carboxylic acid anchoring groups and PEG-550 chains to solubilize the QD-ligand construct. After a mild and rapid ligand exchange, the resulting constructs are compact (<11 nm hydrodynamic diameter) and have narrow size distribution. Both qualities are preserved for several months in isotonic saline. The constructs are bright in vivo, and to demonstrate their suitability for imaging, we perform whole-body imaging and lymphatic imaging, including visualization of lymphatic flow.
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Affiliation(s)
- Daniel M Montana
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Michel Nasilowski
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Whitney R Hess
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Mari Saif
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Jessica A Carr
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Lea Nienhaus
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, Florida 32306, United States
| | - Moungi G Bawendi
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
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10
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Deng G, Li S, Sun Z, Li W, Zhou L, Zhang J, Gong P, Cai L. Near-infrared fluorescence imaging in the largely unexplored window of 900-1,000 nm. Theranostics 2018; 8:4116-4128. [PMID: 30128040 PMCID: PMC6096386 DOI: 10.7150/thno.26539] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/03/2018] [Indexed: 12/17/2022] Open
Abstract
Near-infrared (NIR) fluorescence imaging has relied on fluorophores that emit in the 700-900 nm NIR-Ia or 1,000-1,700 nm NIR-II window for generating deep-tissue images. Up until now, there have been few fluorophores developed for the 900-1,000 nm NIR-Ib window. This is largely because NIR-Ib light is thought to be strongly absorbed by water. Methods: Here we found that six heptamethine dyes had distinct emission peaks in both the NIR-Ia and NIR-Ib window. We tested the performance of these contrast agents by introducing them into the leaves of the common house plant Epipremnum aureum with early stage anthracnose leaf infections from Khaya senegalensis, as well as injecting them into the hind feet of nude mice and tails of tumour-bearing mice in vivo. Results: Heptamethine dyes yielded superior images of leaf venation, anthracnose infection locations, sentinel lymph nodes, brain tumours and subcutaneous tumours in the NIR-Ib window. We found that NIR-Ib images had markedly enhanced signal-to-background ratio because autofluorescence, scattering and light absorption by biological tissues and water were weaker at longer wavelengths. Conclusion: NIR-Ib fluorescence imaging was a powerful method for studying sentinel lymph nodes, tumours, leaf veins and early anthracnose infection locations in plant leaves. The findings challenge our current view of NIR fluorescence imaging and may have important implications for biomedical research and image-guided cancer surgery.
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11
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Li Y, Gu Y, Yuan W, Cao T, Li K, Yang S, Zhou Z, Li F. Core-Shell-Shell NaYbF4:Tm@CaF2@NaDyF4 Nanocomposites for Upconversion/T2-Weighted MRI/Computed Tomography Lymphatic Imaging. ACS Appl Mater Interfaces 2016; 8:19208-19216. [PMID: 27366965 DOI: 10.1021/acsami.6b02856] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
To circumvent the defects of different bioimaging techniques, the development of multifunctional probes for multimodality bioimaging is required. In the present study, a lanthanide-based core-shell-shell nanocomposite NaYbF4:Tm@CaF2@NaDyF4 composed of an ∼9.5 nm NaYbF4:Tm nanocrystal as the core, ∼2 nm CaF2 as the middle layer, and 1-2 nm NaDyF4 as the outermost shell was designed and synthesized. Following surface modification with the ligand, citrate acid, this nanocomposite was hydrophilic, emitted intense upconversion luminescence (UCL), and displayed a high X-ray computed tomography (CT) value of ∼490 Hounsfield units (HU) and excellent r2 relaxivity of 41.1 mM(-1) s(-1). These results confirmed that the introduction of a middle CaF2 layer was necessary as a barrier to reduce cross-relaxation and the surface quenching effect, thus enhancing the upconversion emission of Tm(3+). This citrate-modified NaYbF4:Tm@CaF2@NaDyF4 nanocomposite was used as a multifunctional contrast agent for trimodal lymphatic bioimaging with T2-weighted magnetic resonance imaging (MRI), CT, and UCL imaging. The concept of fabricating a core-multishell nanostructure and the introduction of a Dy(3+)-based host as an outer layer is a useful strategy and can be used to develop a novel multifunctional nanoprobe for multimodality bioimaging.
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Affiliation(s)
- Ying Li
- The Key Laboratory of Resource Chemistry of Ministry of Education, Shanghai Municipal Education Committee Key Laboratory of Molecular Imaging Probes and Sensors, Shanghai Normal University , Shanghai 200234, P.R. China
| | - Yuyang Gu
- Department of Chemistry, Fudan University , 220 Handan Road, Shanghai 200433, P.R. China
| | - Wei Yuan
- Department of Chemistry, Fudan University , 220 Handan Road, Shanghai 200433, P.R. China
| | - Tianye Cao
- Department of Chemistry, Fudan University , 220 Handan Road, Shanghai 200433, P.R. China
| | - Kai Li
- Department of Chemistry, Fudan University , 220 Handan Road, Shanghai 200433, P.R. China
| | - Shiping Yang
- The Key Laboratory of Resource Chemistry of Ministry of Education, Shanghai Municipal Education Committee Key Laboratory of Molecular Imaging Probes and Sensors, Shanghai Normal University , Shanghai 200234, P.R. China
| | - Zhiguo Zhou
- The Key Laboratory of Resource Chemistry of Ministry of Education, Shanghai Municipal Education Committee Key Laboratory of Molecular Imaging Probes and Sensors, Shanghai Normal University , Shanghai 200234, P.R. China
| | - Fuyou Li
- Department of Chemistry, Fudan University , 220 Handan Road, Shanghai 200433, P.R. China
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Opina AC, Wong KJ, Griffiths GL, Turkbey BI, Bernardo M, Nakajima T, Kobayashi H, Choyke PL, Vasalatiy O. Preparation and long-term biodistribution studies of a PAMAM dendrimer G5-Gd-BnDOTA conjugate for lymphatic imaging. Nanomedicine (Lond) 2014; 10:1423-37. [PMID: 25392239 DOI: 10.2217/nnm.14.113] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
AIMS To demonstrate the use of gadolinium (Gd)-labeled dendrimers as lymphatic imaging agents and establish the long-term biodistribution (90-day) of this type of agent in mice. MATERIALS & METHODS A G5-Gd-BnDOTA dendrimer was prepared and injected into mice and monkeys for MR lymphangiography, and long-term biodistribution of the conjugate was studied. RESULTS Administration of G5-Gd-BnDOTA in mice demonstrated a rapid uptake in the deep lymphatic system while injection in monkeys showed enhanced internal iliac nodes, indicating its general utility for lymphatic tracking. Biodistribution studies to 90 days showed that gadolinium conjugate is slowly being eliminated from the liver and other organs. CONCLUSION The use of G5-Gd-BnDOTA holds great promise for lymphatic imaging, but its slow clearance from the body might hamper its eventual clinical translation.
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Affiliation(s)
| | - Karen J Wong
- 2Molecular Imaging Program, National Cancer Institute, MD, USA
| | - Gary L Griffiths
- 3Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, MD, USA
| | - Baris I Turkbey
- 2Molecular Imaging Program, National Cancer Institute, MD, USA
| | | | | | | | - Peter L Choyke
- 2Molecular Imaging Program, National Cancer Institute, MD, USA
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13
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Weiler M, Dixon JB. Differential transport function of lymphatic vessels in the rat tail model and the long-term effects of Indocyanine Green as assessed with near-infrared imaging. Front Physiol 2013; 4:215. [PMID: 23966950 PMCID: PMC3744037 DOI: 10.3389/fphys.2013.00215] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/27/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction: Near-infrared (NIR) imaging has emerged as a novel imaging modality for assessing lymphatic function in vivo. While the technique has provided quantitative data previously unavailable, questions remain in regards to the spatiotemporal capabilities of the approach. We address three of the more important issues here using the rodent tail, one of the most widely utilized in vivo model systems in the lymphatic literature. Specifically we demonstrate (1) the transient vs. steady state response of lymphatics to tracer injection, (2) the functional characteristics of multiple collecting vessels draining the same tissue space in parallel, and (3) the long-term consequences of fluorescent tracers on lymphatic function to repeated functional measurements. Methods: Rat tails were imaged with NIR and metrics of function were calculated for both collecting vessels that drain the tail. A nitric oxide donor cream (GTNO) was applied to the tail. Additionally, two different NIR dyes, indocyanine green (ICG) and LI-COR IRDye 800CW PEG, were utilized for function imaging at the time of initial injection and at 1, 2, and 4 week follow-up time points after which both draining lymph nodes were harvested. Results and Discussion: Significant differences were found between the two collecting vessels such that the vessel first showing fluorescence (dominant) produced enhanced functional metrics compared to the second vessel (non-dominant). GTNO significantly reduced lymphatic function in the non-dominant vessel compared to the dominant. ICG remained visible in the tail for 2 weeks after injection and was accompanied by significant losses in lymphatic function and enlarged draining lymph nodes. The Licor tracer also remained visible for 2 weeks. However, the dye produced significantly lower effects on lymphatic function than ICG, and lymph nodes were not enlarged at any time point, suggesting that this may be a more appropriate contrast agent for longitudinal lymphatic imaging.
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Affiliation(s)
- Michael Weiler
- Wallace H. Coulter Department of Biomedical Engineering, George W. Woodruff School of Mechanical Engineering, Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology Atlanta, GA, USA
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Hirche C, Engel H, Kolios L, Cognie J, Hünerbein M, Lehnhardt M, Kremer T. An experimental study to evaluate the Fluobeam 800 imaging system for fluorescence-guided lymphatic imaging and sentinel node biopsy. Surg Innov 2012; 20:516-23. [PMID: 23275469 DOI: 10.1177/1553350612468962] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Visualization of the lymphatic system is challenging. Lymphatic imaging is a crucial diagnostic tool for benign and malignant lymphatic pathologies. Fluorescence-guided imaging allows selective lymphatic mapping and sentinel lymph node (SLN) identification. There are a few fluorescence systems, but some drawbacks remain due to technical and ergonomic aspects. The aim of this study was to evaluate the feasibility of the new Fluobeam 800 imaging system. METHODS After approval by the ethics committee, the system was evaluated for lymphography and SLN biopsy in an animal model. Five pigs each with 4 lymph node (LN) stations (n = 20 LN stations) were subjected to lymphatic imaging using indocyanine green (ICG). Additionally, the use of ICG was compared with ICG adsorbed to human serum albumin (ICG-HSA). Lymphatic vessels and SLN identification rates were measured. RESULTS After injection, a clear fluorescence signal of the lymphatic vessels was visualized leading to the LN station. Overall, ICG fluorescence imaging identified a mean of 2.0 lymphatic vessels and 1.1 (range = 1-2) SLN in 20 of 20 LN stations. Reverse lymphography was feasible. A clinical difference in resolution was not detected between use of ICG-HSA and ICG. CONCLUSION This is the first study analyzing the feasibility of the Fluobeam 800 imaging system allowing transcutaneous real-time imaging. It enables detection of the SLN by fluorescence retention with increased detection depth and resolution. After fixation to the ceiling, the ergonomics advanced for simultaneous field navigation and dissection. The new system can be applied for lymphatic imaging for lympatico-reconstructive surgery and SLN biopsy.
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Davies-Venn CA, Angermiller B, Wilganowski N, Ghosh P, Harvey BR, Wu G, Kwon S, Aldrich MB, Sevick-Muraca EM. Albumin-binding domain conjugate for near-infrared fluorescence lymphatic imaging. Mol Imaging Biol 2012; 14:301-14. [PMID: 21688052 PMCID: PMC3346932 DOI: 10.1007/s11307-011-0499-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study was to develop and characterize a novel peptide imaging agent for noninvasive near-infrared fluorescence imaging of protein transport by the lymphatics. An imaging agent consisting of a cyclic albumin-binding domain (cABD) peptide, with sequence, Arg-Leu-Ile-Glu-Asp-Ile-Cys-Leu-Pro-Arg-Trp-Gly-Cys-Leu-Trp-Glu-Asp-Asp-Lys, was conjugated to a near-infrared fluorophore, IRDye800CW, allowing for enhanced vascular uptake, retention, and fluorescence imaging. PROCEDURE Characterization of the cABD-IRDye800 peptide conjugate was performed using fluorescence spectroscopy to assess optical properties and SDS-PAGE and Biacore binding assays to determine binding affinity and specificity. Fluorescence imaging of normal C57BL/6 mice was conducted to monitor lymphatic uptake and retention. RESULTS cABD-IRDye800 exhibited approximately six times greater fluorescent yield and greater stability than indocyanine green, an agent previously used in humans to image lymphatic vasculature. The agent exhibited affinity for albumin with IC(50) and Kd in the nanomolar range and demonstrated superior retention characteristics within mouse lymphatics when compared with IRDye800CW. CONCLUSIONS cABD-IRDye800 has utility for assessing lymphatic function in mouse models of human lymphatic disease and the potential for use in clinical diagnostic imaging of the lymphatic vasculature.
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Affiliation(s)
- Cynthia A. Davies-Venn
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
- Translational Biology and Molecular Medicine Program, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Bonnie Angermiller
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Nathaniel Wilganowski
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Pradip Ghosh
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Barrett R. Harvey
- The Center for Immunology and Autoimmune Diseases, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler St. SRB 330A, Houston, TX 77030 USA
| | - Grace Wu
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Sunkuk Kwon
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Melissa B. Aldrich
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
| | - Eva M. Sevick-Muraca
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, 1825 Pressler Street, SRB 330A, Houston, TX 77030 USA
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Abstract
Near-infrared imaging of lymphatic drainage of injected indocyanine green (ICG) has emerged as a new technology for clinical imaging of lymphatic architecture and quantification of vessel function, yet the imaging capabilities of this approach have yet to be quantitatively characterized. We seek to quantify its capabilities as a diagnostic tool for lymphatic disease. Imaging is performed in a tissue phantom for sensitivity analysis and in hairless rats for in vivo testing. To demonstrate the efficacy of this imaging approach to quantifying immediate functional changes in lymphatics, we investigate the effects of a topically applied nitric oxide (NO) donor glyceryl trinitrate ointment. Premixing ICG with albumin induces greater fluorescence intensity, with the ideal concentration being 150 μg/mL ICG and 60 g/L albumin. ICG fluorescence can be detected at a concentration of 150 μg/mL as deep as 6 mm with our system, but spatial resolution deteriorates below 3 mm, skewing measurements of vessel geometry. NO treatment slows lymphatic transport, which is reflected in increased transport time, reduced packet frequency, reduced packet velocity, and reduced effective contraction length. NIR imaging may be an alternative to invasive procedures measuring lymphatic function in vivo in real time.
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Affiliation(s)
- Michael Weiler
- Georgia Institute of Technology, George W. Woodruff School of Mechanical Engineering, Wallace H. Coulter Department of Biomedical Engineering, Parker H. Petit Institute for Bioengineering and Bioscience, IBB 2312, 315 Ferst Drive, Atlanta, Georgia 30332-0405
| | - Timothy Kassis
- Georgia Institute of Technology, George W. Woodruff School of Mechanical Engineering, Wallace H. Coulter Department of Biomedical Engineering, Parker H. Petit Institute for Bioengineering and Bioscience, IBB 2312, 315 Ferst Drive, Atlanta, Georgia 30332-0405
| | - J. Brandon Dixon
- Georgia Institute of Technology, George W. Woodruff School of Mechanical Engineering, Wallace H. Coulter Department of Biomedical Engineering, Parker H. Petit Institute for Bioengineering and Bioscience, IBB 2312, 315 Ferst Drive, Atlanta, Georgia 30332-0405
- Address all correspondence to: J. Brandon Dixon, Georgia Institute of Technology, George W. Woodruff School of Mechanical Engineering, Wallace H. Coulter Department of Biomedical Engineering, Parker H. Petit Institute for Bioengineering and Bioscience, IBB 2312, 315 Ferst Drive, Atlanta, GA 30332-0405. Tel: (404) 385-3915; Fax: (404) 385-1397; E-mail:
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Kobayashi H, Koyama Y, Barrett T, Hama Y, Regino CAS, Shin IS, Jang BS, Le N, Paik CH, Choyke PL, Urano Y. Multimodal nanoprobes for radionuclide and five-color near-infrared optical lymphatic imaging. ACS Nano 2007; 1:258-64. [PMID: 19079788 PMCID: PMC2600721 DOI: 10.1021/nn700062z] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Current contrast agents generally have one function and can only be imaged in monochrome; therefore, the majority of imaging methods can only impart uniparametric information. A single nanoparticle has the potential to be loaded with multiple payloads. Such multimodality probes have the ability to be imaged by more than one imaging technique, which could compensate for the weakness or even combine the advantages of each individual modality. Furthermore, optical imaging using different optical probes enables us to achieve multicolor in vivo imaging, wherein multiple parameters can be read from a single image. To allow differentiation of multiple optical signals in vivo, each probe should have a close but different near-infrared emission. To this end, we synthesized nanoprobes with multimodal and multicolor potential, which employed a polyamidoamine dendrimer platform linked to both radionuclides and optical probes, permitting dual-modality scintigraphic and five-color near-infrared optical lymphatic imaging using a multiple-excitation spectrally resolved fluorescence imaging technique.
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Affiliation(s)
- Hisataka Kobayashi
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1088,USA.
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