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Advances in Brief |
Center for Molecular Imaging Research, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts
| ABSTRACT |
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| Introduction |
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We hypothesized that a multimodal nanoparticle contrast agent consisting of an optically detectable NIRF fluorochrome conjugated to a MRI-detectable iron oxide core might offer a novel approach to the surgical resection of brain tumors. Magnetic nanoparticles have been evaluated preclinically and clinically for their ability to aid in brain tumor visualization by MRI (8, 9, 10) . We found that the multimodal nanoparticle probe termed Cy5.5-CLIO permitted the preoperative visualization of brain tumors by serving as an MRI contrast agent and afforded an intraoperative discrimination of tumors from brain tissue because of its near-IR fluorescence. The ability to track the same probe by both preoperative MR and intraoperative optical imaging offers a new approach to visualization and accurate resection of tumors.
| Materials and Methods |
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Animal Model.
A 9L rat gliosarcoma cell line stably transfected to express GFP (14)
was cultured at 37°C in a humidified 5% CO2 atmosphere in DMEM supplemented with 10% fetal bovine serum, 1% penicillin/streptomycin, and 500 µg/ml Geniticin G418 (all products from Cellgro, Herndon, VA). The medium was changed every 3 days, and cells were passaged once/week (1:10 split ratio).
Eight Fisher 344 rats (Charles River Laboratories, Wilmington, MA), 200250 g, were anesthetized with ketamine/xylazine (i.p., 65/10 mg/kg) and immobilized in a stereotactic frame. A linear skin incision was made over the bregma, and a 1-mm diameter burrhole was drilled into the skull 3 mm posterior and 3 mm lateral to the bregma. A 10-µl gas-tight syringe (Hamilton, Reno, NV) was then used to inject 5 µl of the 9L-GFP-cell suspension (106 cells in HBSS) in the striatum at a depth of 3 mm from the dural surface. The injection was done slowly over 5 min, and the needle was withdrawn over another 10 min. The burrhole was occluded with bone wax (Ethicon, Sommerville, NJ) to prevent leakage of cerebrospinal fluid, and the skin was closed with nonmagnetic sutures. MRI of rats was performed 1014 days after tumor inoculation, when the tumors had reached diameters of
25 mm, 24 h after i.v. injection of 15 mg Fe/kg Cy5.5-CLIO.
MRI.
Animals were injected with 15 mg/kg body weight Cy5.5-CLIO via tail vein injection. After 24 h, MRI was performed at 4.7 T (Bruker Instruments, Billerica, MA) equipped with a 30 gauss/cm gradient set and a 37-mm diameter birdcage coil resonating at 200 MHz. Multiple slice multiple echo Proton-density/T2-weighted (TR/TE 15, 30, 45, 60/2000) spin echo sequences were obtained using 2 NEX, a 256 x 256 matrix, a 3.0-cm field of view (resulting in an in-plane resolution of 117 µm), a slice thickness of 1 mm and a total imaging time of 17 min. For MRI-histology correlation, rats were sacrificed (pentobarbital, i.p. 200 mg/kg), perfused with 250 ml of PBS, and brains were stained (H&E and DAB-amplified Prussian Blue).
Optical Imaging.
Twenty-four h after i.v. injection of 15 mg/kg body weight Cy5.5-CLIO, a craniotomy was performed to operatively expose the tumor and surrounding tissue. Noninvasive optical imaging was performed using a custom built surface reflectance imaging system (Siemens Medical Systems, Erlangen, Germany) based on a multichannel imaging system design (15)
. The system is capable of near simultaneous data acquisition in four channels, including a broad spectrum visible white light similar as seen by the unaided eye, an excitation/emission filter set for GFP imaging, and a filter set for Cy5.5 imaging. Images were acquired with an exposure time of 400, 500, and 200 ms for the GFP, Cy5.5, and white light channels, respectively.
Histology.
The distribution of tumor in the brain was determined by GFP fluorescence and Cy5.5 fluorescence 24 h after i.v. injection of 15 mg/kg body weight Cy5.5-CLIO. Tumors were cryosectioned, and fluorescence microscopy of GFP and Cy5.5 fluorescence was performed on air-dried sections using an inverted epifluorescence microscope (Axiovert 100; Zeiss, Thornwood, NY). A cooled charge-coupled device camera (Sensys; Photometrics, Tucson, AZ) was used for image capture. Sections were subsequently stained with H&E and DAB-amplified Prussian Blue and examined with bright light microscopy.
Slices were also examined by laser-scanning confocal microscopy using a Zeiss LSM 5 Pascal. Glial cells were identified immunohistochemically using a primary monoclonal mouse-antirat antibody against CD11b (Serotec, Raleigh, NC) and a secondary rhodamine-labeled rabbit antimouse antibody (Jackson Immnunoresearch Laboratories, West Grove, PA). The fluorescence from GFP (tumor), Cy5.5 (nanoparticle), and the rhodamine (glia cells and macrophages) were obtained by selecting appropriate excitation and emission settings.
Accuracy of Determining Tumor Extent via Cy5.5 Fluorescence.
Five brain tumors were cryosectioned into four to eight slices each, resulting in 25 slices (20-µm slice thickness with an interleave of 500 µm) and digital images of tumors and surrounding brain tissue captured using an inverted fluorescence microscope equipped with a charge-coupled device camera (Zeiss Axiovert 100). Regions of interest were placed on digitized images around borders of the tumor as defined by GFP and Cy5.5 fluorescence using CMIR-Image [developed in Interactive Data Language (Research Systems Inc, Boulder, CO)]. The area of each region of interest on each slice was computed, and the values of Cy5.5 and GFP-positive areas plotted with a linear regression analysis using Microsoft Excel.
| Results |
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We next examined whether Cy5.5-CLIO could be used to delineate brain tumors in a model intraoperative setting. Fig. 2
shows images of a rat after craniotomy and exposition of the tumor in the white light channel (Fig. 2A)
, in the GFP channel serving as the gold standard for delineation of true tumor extent (Fig. 2B)
, and in the Cy5.5 channel (Fig. 2C)
. Even with exposure times as short as 500 milliseconds, ample Cy5.5 fluorescence was obtained (Fig. 2C)
to clearly visualize the tumor, as indicated by the correlation with the tumor extent as determined by GFP fluorescence (Fig. 2B)
. The relationship between tumor and Cy5.5 fluorescence was additionally examined by histology, using epifluorescence microscopy as shown in Fig. 2F
. H&E staining (Fig. 2D)
was compared with GFP fluorescence (Fig. 2E)
and Cy5.5 fluorescence (Fig. 2F)
. To compare the accuracy of tumor margin delineation by Cy5.5-CLIO uptake with tumor margin delineation by GFP fluorescence, region of interest analysis of Cy5.5 and GFP-positive areas on 25 slices from five brain tumors was performed (see "Materials and Methods"). The areas obtained from these regions of interest were fitted with a linear regression analysis for all 25 slices as shown in Fig. 3
. The data showed an excellent fit to a linear equation with a slope of 1.013, an intercept of 0.820 mm2 and a R2 of 0.996. The slightly higher estimate of tumor volumes obtained with Cy5.5 is caused by the uptake of Cy5.5-CLIO by microglia, as described below.
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| Discussion |
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The attachment of the NIRF fluorochrome Cy5.5 to the NH2-CLIO nanoparticle afforded several key advantages over a nonfluorescent nanoparticles or the use of non-IR fluorochromes. First, the NIRF signal from Cy5.5-CLIO was sufficiently strong that acquisition times as short as 500 ms provided easy identification of the tumor in a model intraoperative setting (Fig. 2C)
. Second, by using near-IR fluorescence, tissue autofluorescence was minimized because near-IR fluorescent fluorochromes have not been reported in brain, as illustrated in NIRF micrograph of brain tissue surrounding tumor in Fig. 2C
. Third, near-IR fluorescence permitted the visualization of probes such as Cy5.5-CLIO through several millimeters of overlaying tissue, i.e., before complete dissection of the tumor has been accomplished (20)
. Fourth, the NIRF obtained from our optical/magnetic nanoparticle was visualized with simple, low cost instrumentation, a version of which might easily be adapted to an operating room setting for human patients.
The correspondence between preoperative and intraoperative tumor coordinates is a significant challenge in surgery and one that the combined magnetic and optical properties of Cy5.5-CLIO can be used to overcome. However, a second problem in tumor resection is the often poorly defined tumor margins because of finger-like projections of tumor cells from the tumor or tumor cells that have migrated and are not continuous with the tumor itself. The sensitivity of the method will depend not only on the amount and pattern of agent uptake by tumors but also on the detection limit of the NIRF-detecting instrumentation used. Additional research with multimodal nanoparticles is needed to address issues of tumor margin pathology, agent accumulation, and instrumentation in greater detail.
In conclusion, a multimodal magneto/optical nanoparticle offers a unique method for comparing the visual presentation of brain tumors during surgery with the multislice topographical capability of preoperative MRI. Our results indicate the feasibility of this approach using nanoparticles that are similar to those used clinically, which can be synthesized simply and which provide a strong NIRF signal enabling real-time imaging. The method can use existing MRI and simple NIRF/optical instrumentation and therefore can be cost effective. Key features of nanoparticles metabolism, namely intracellular sequestration and slow degradation, together with the combined optical and magnetic properties of Cy5.5-CLIO, may allow radiologists and neurosurgeons for the first time to see the same probe in the same cells. This may increase the precision of surgical resection and improve the outlook for many brain cancer patients.
| FOOTNOTES |
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Requests for reprints: Lee Josephson, Center for Molecular Imaging Research, Massachusetts General Hospital, 13th Street, Building 149, Room 5406, Charlestown, MA 02129. Phone: (617) 726-6478; Fax: (617) 726-5708; E-mail: josephso{at}helix.mgh.harvard.edu
1 The abbreviations used are: MRI, magnetic resonance imaging; CLIO, cross-linked iron oxide nanoparticle; NIRF, near-infrared fluorescence; IR, infrared; GFP, green fluorescence protein; DAB, 3,3'-diaminobenzidine. ![]()
Received 8/ 5/03. Revised 9/23/03. Accepted 9/29/03.
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