From Mouse to Man and Back: Closing the Correlation Gap between Imaging and Histopathology for Lung Diseases

Lung diseases such as fibrosis, asthma, cystic fibrosis, infection and cancer are life-threatening conditions that slowly deteriorate quality of life and for which our diagnostic power is high, but our knowledge on etiology and/or effective treatment options still contains important gaps. In the context of day-to-day practice, clinical and preclinical studies, clinicians and basic researchers team up and continuously strive to increase insights into lung disease progression, diagnostic and treatment options. To unravel disease processes and to test novel therapeutic approaches, investigators typically rely on end-stage procedures such as serum analysis, cyto-/chemokine profiles and selective tissue histology from animal models. These techniques are useful but provide only a snapshot of disease processes that are essentially dynamic in time and space. Technology allowing evaluation of live animals repeatedly is indispensable to gain a better insight into the dynamics of lung disease progression and treatment effects. Computed tomography (CT) is a clinical diagnostic imaging technique that can have enormous benefits in a research context too. Yet, the implementation of imaging techniques in laboratories lags behind. In this review we want to showcase the integrated approaches and novel developments in imaging, lung functional testing and pathological techniques that are used to assess, diagnose, quantify and treat lung disease and that may be employed in research on patients and animals. Imaging approaches result in often novel anatomical and functional biomarkers, resulting in many advantages, such as better insight in disease progression and a reduction in the numbers of animals necessary. We here showcase integrated assessment of lung disease with imaging and histopathological technologies, applied to the example of lung fibrosis. Better integration of clinical and preclinical imaging technologies with pathology will ultimately result in improved clinical translation of (therapy) study results.

Low-Dose Imaging in a New Preclinical Total-Body PET/CT Scanner

Ionizing radiation constitutes a health risk to imaging scientists and study animals. Both PET and CT produce ionizing radiation. CT doses in pre-clinical in vivo imaging typically range from 50 to 1,000 mGy and biological effects in mice at this dose range have been previously described. [¹⁸F]FDG body doses in mice have been estimated to be in the range of 100 mGy for [¹⁸F]FDG. Yearly, the average whole body doses due to handling of activity by PET technologists are reported to be 3–8 mSv. A preclinical PET/CT system is presented with design features which make it suitable for small animal low-dose imaging. The CT subsystem uses a X-source power that is optimized for small animal imaging. The system design incorporates a spatial beam shaper coupled with a highly sensitive flat-panel detector and very fast acquisition (<10 s) which allows for whole body scans with doses as low as 3 mGy. The mouse total-body PET subsystem uses a detector architecture based on continuous crystals, coupled to SiPM arrays and a readout based in rows and columns. The PET field of view is 150 mm axial and 80 mm transaxial. The high solid-angle coverage of the sample and the use of continuous crystals achieve a sensitivity of 9% (NEMA) that can be leveraged for use of low tracer doses and/or performing rapid scans. The low-dose imaging capabilities of the total-body PET subsystem were tested with NEMA phantoms, in tumor models, a mouse bone metabolism scan and a rat heart dynamic scan. The CT imaging capabilities were tested in mice and in a low contrast phantom. The PET low-dose phantom and animal experiments provide evidence that image quality suitable for preclinical PET studies is achieved. Furthermore, CT image contrast using low dose scan settings was suitable as a reference for PET scans. Total-body mouse PET/CT studies could be completed with total doses of <10 mGy.

HIF-1α metabolically controls collagen synthesis and modification in chondrocytes

Endochondral ossification, an important process in vertebrate bone formation, is highly dependent on correct functioning of growth plate chondrocytes1. Proliferation of these cells determines longitudinal bone growth and the matrix deposited provides a scaffold for future bone formation. However, these two energy-dependent anabolic processes occur in an avascular environment1,2. In addition, the centre of the expanding growth plate becomes hypoxic, and local activation of the hypoxia-inducible transcription factor HIF-1α is necessary for chondrocyte survival by unidentified cell-intrinsic mechanisms3-6. It is unknown whether there is a requirement for restriction of HIF-1α signalling in the other regions of the growth plate and whether chondrocyte metabolism controls cell function. Here we show that prolonged HIF-1α signalling in chondrocytes leads to skeletal dysplasia by interfering with cellular bioenergetics and biosynthesis. Decreased glucose oxidation results in an energy deficit, which limits proliferation, activates the unfolded protein response and reduces collagen synthesis. However, enhanced glutamine flux increases α-ketoglutarate levels, which in turn increases proline and lysine hydroxylation on collagen. This metabolically regulated collagen modification renders the cartilaginous matrix more resistant to protease-mediated degradation and thereby increases bone mass. Thus, inappropriate HIF-1α signalling results in skeletal dysplasia caused by collagen overmodification, an effect that may also contribute to other diseases involving the extracellular matrix such as cancer and fibrosis.

Multimodal pore formation in calcium phosphate cements

Calcium phosphate cements (CPCs) are commonly used as bone substitute materials. However, their slow degradation rate and lack of macroporosity hinders new bone formation. Poly(dl-lactic-co-glycolic acid) (PLGA) incorporation is of great interest as, upon degradation, produces acidic by-products that enhance CPC degradation. Yet, new bone formation is delayed until PLGA degradation occurs a few weeks after implantation. Therefore, the aim of this study was to accelerate the early stage pore formation within CPCs in vitro. With that purpose, we incorporated the water-soluble porogen sucrose at different weight percentages (10 or 20 wt %) to CPC and CPC/PLGA composites. The results revealed that incorporation of sucrose porogens increased mass loss within the first week of in vitro degradation in groups containing sucrose compared to control groups. After week 1, a further mass loss was observed related to PLGA and CPC degradation. Macroporosity analysis confirmed that macroporosity formation is influenced by the dissolution of sucrose at an early stage and by the degradation of PLGA and CPC at a later stage. We concluded that the combination of sucrose and PLGA porogens in CPC is a promising approach to promote early stage bone tissue ingrowth and complete replacement of CPC through multimodal pore formation. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 500-509, 2018.

Evaluation of Root Canal Preparation Using Rotary System and Hand Instruments Assessed by Micro-Computed Tomography

Background

Complete mechanical preparation of the root canal system is rarely achieved. Therefore, the purpose of this study was to evaluate and compare the root canal shaping efficacy of ProTaper rotary files and standard stainless steel K-files using micro-computed tomography.

Material/Methods

Sixty extracted upper second premolars were selected and divided into 2 groups of 30 teeth each. Before preparation, all samples were scanned by micro-computed tomography. Thirty teeth were prepared with the ProTaper system and the other 30 with stainless steel files. After preparation, the untouched surface and root canal straightening were evaluated with micro-computed tomography. The percentage of untouched root canal surface was calculated in the coronal, middle, and apical parts of the canal. We also calculated straightening of the canal after root canal preparation. Results from the 2 groups were statistically compared using the Minitab statistical package.

Results

ProTaper rotary files left less untouched root canal surface compared with manual preparation in coronal, middle, and apical sector (p<0.001). Similarly, there was a statistically significant difference in root canal straightening after preparation between the techniques (p<0.001).

Conclusions

Neither manual nor rotary techniques completely prepared the root canal, and both techniques caused slight straightening of the root canal.

Effects of preparation techniques on root canal shaping assessed by micro-computed tomography

Background

Root canal shaping without any procedural error is of the utmost preference. Therefore, the purpose of this study was to use micro-computed tomography to evaluate and compare the root canal shaping efficacy of ProTaper rotary files and standard stainless steel K-files.

Material/Methods

Sixty extracted upper second premolars were selected and were divided into 2 groups of 30. Before preparation, all samples were scanned by micro-CT. Then, 30 teeth were prepared with stainless steel files and the remaining 30 with ProTaper rotary files. Canal transportation and centering ability before and after root canal shaping were assessed using micro-CT. The amount and direction of canal transportation and the centering ratio of each instrument were determined in the coronal, middle, and apical parts of the canal. The 2 groups were statistically compared using one-way ANOVA.

Results

ProTaper rotary files gave less transportation (p<0.001) and better centering ability (p<0.00001) compared with stainless steel files.

Conclusions

The manual technique for preparation of root canals with stainless steel files produces more canal transportation, whereas rotary files remain more centered in the canal.

Development of micro-CT protocols for in vivo follow-up of mouse bone architecture without major radiation side effects

In vivo micro-computed tomography (micro-CT) will offer unique information on the time-related changes in bone mass and structure of living mice, provided that radiation-induced side effects are prevented. Lowering the radiation dose, however, inevitably decreases the image quality. In this study we developed and validated a protocol for in vivo micro-CT imaging of mouse bone architecture that retains high quality images but avoids radiation-induced side effects on bone structure and hematological parameters. The left hindlimb of male C57Bl/6 mice was scanned in vivo at 3 consecutive time points, separated each time by a 2-week interval. Two protocols for in vivo micro-CT imaging were evaluated, with pixel sizes of 9 and 18 μm and administered radiation doses of 434 mGy and 166 mGy per scan, respectively. These radiation doses were found not to influence trabecular or cortical bone architecture in pre-pubertal or adult mice. In addition, there was no evidence for hematological side effects as peripheral blood cell counts and the colony-forming capacity of hematopoietic progenitor cells from bone marrow and spleen were not altered. Although the images obtained with these in vivo micro-CT protocols were more blurred than those obtained with high resolution (5 μm) ex vivo CT imaging, longitudinal follow-up of trabecular bone architecture in an orchidectomy model proved to be feasible using the 9 μm pixel size protocol in combination with a suitable bone segmentation technique (i.e. local thresholding). The image quality of the 18 μm pixel size protocol was too degraded for accurate bone segmentation and the use of this protocol is therefore restricted to monitor marked changes in bone structure such as bone metastatic lesions or fracture healing. In conclusion, we developed two micro-CT protocols which are appropriate for detailed as well as global longitudinal studies of mouse bone architecture and lack noticeable radiation-induced side effects.

Inactivation of Smad5 in endothelial cells and smooth muscle cells demonstrates that Smad5 is required for cardiac homeostasis

Smads are intracellular signaling proteins that transduce signals elicited by members of the transforming growth factor (TGF)-beta superfamily. Smad5 and Smad1 are highly homologous, and they mediate primarily bone morphogenetic protein (Bmp) signals. We used the Cre-loxP system and Sm22-Cre and Tie-1-Cre mice to study the function of Smad5 in the developing blood vessel wall. Analysis of embryos demonstrated that deletion of Smad5 in endothelial or smooth muscle cells resulted in a normal organization of embryonic and extra-embryonic vasculature. Angiogenic assays performed in adult mice revealed that mutant mice display a comparable angiogenic and vascular remodeling response to control mice. In Sm22-Cre; Smad5(fl/-) mice, Smad5 is also deleted in cardiomyocytes. Echocardiographic analysis on those 9-month-old female mice demonstrated larger left ventricle internal diameters and decreased fractional shortening compared with control littermates without signs of cardiac hypertrophy. The decreased cardiac contractility was associated with a decreased performance in a treadmill experiment. In isolated cardiomyocytes, fractional shortening was significantly reduced compared with control cells. These data demonstrate that restricted deletion of Smad5 in the blood vessel wall results in viable mice. However, loss of Smad5 in cardiomyocytes leads to a mild heart defect.