Successful cancer treatment continues to elude modern medicine and its arsenal of therapeutic strategies. Therapy resistance is driven by tumor heterogeneity, complex interactions between tumor and its microenvironment. Advances in molecular characterization technologies have helped unravel this interaction network and identify therapeutic targets such as tyrosine kinase inhibitors (TKI). However, while tumors may initially respond to TKI therapy, disease progression is inevitable due to acquired resistance. With the ultimate goal of improved molecularly targeted therapeutic efficacy, we have developed and optimized a fluorescence imaging platform termed TRIPODD (Therapeutic Response Imaging through Proteomic and Optical Drug Distribution), resulting in the only methodology capable of simultaneous quantification of single-cell drug target availability and protein expression with preserved spatial context within a tumor. Analysis of preclinical tumor models with TRIPODD enabled discovery of unique cell subpopulations of TKI therapeutic response, where the relationship between drug target availability and therapeutic response was unraveled.
Iatrogenic nerve injuries are a major concern in various surgical fields, causing significant morbidity. These injuries lead to impaired sensory and motor functions, chronic pain, reduced limb control, and increased healthcare needs. Surgeons use techniques like white light visualization and intraoperative neuromonitoring (e.g., electromyography [EMG]) to identify nerve damage. However, the incidence rate remains high, necessitating better alternatives. Our team developed near-infrared (NIR) nerve-specific fluorophores to enhance nerve visualization, and one of our lead fluorophores exhibited reduced fluorescence intensity in injured nerve regions, providing contrast shortly after nerve injury. These results led us to hypothesize that the fluorophore could be used as an intraoperative neuromonitoring tool during fluorescence-guided surgery. Ultimately, this tool can be used intraoperatively to aid surgeons in timely detection and accurate assessment of nerve health, mitigating complications and improving patient outcomes. The culmination of our work will bring forth a novel methodology for localizing nerve injuries, benefiting both patients and surgical procedures.
Cancer remains one of the leading causes of death worldwide despite advances in diagnostic and treatment approaches. Current methods of detection and diagnosis remain inaccessible or expensive in nature; therefore, the development of non-invasive strategies towards early-stage cancer detection are important to allow for early intervention, treatment, and access. Liquid biopsies have emerged as a non-invasive source to improve routine cancer monitoring, however cancer biomarker abundance is low, leading to limitations in detection and accuracy. The recent discovery of neoplastic circulating hybrid cells (CHCs) in peripheral patient blood provide the potential to improve detection sensitivity of blood-based assays using novel molecular-targeting contrast agents specific to both circulating tumor cells (CTCs) and CHCs. Additionally, these contrast agents can be detected using diffuse in vivo flow cytometry (DiFC), enabling non-invasive enumeration of cancer cell burden. Herein, the development and validation of near infrared (NIR) molecularly-targeted contrast agents with specificity towards epithelial biomarkers expressed on CHC and CTCs is discussed.
The failure rate of drug development is high, especially in Phase III clinical trials after significant time and monetary investment. This can be observed in oncology trials, where drug failure rates are much higher than non-oncological trials due to inadequate improvement in overall survival. To address this problem, we propose the use of fluorescence paired-agent imaging (PAI) to monitor drug-receptor interactions in vivo in individual patients. Therapeutic agents can be conjugated to fluorophores used for measuring target-specific interactions. Our preclinical progress will be discussed for both oncology and non-oncology applications with promising translation to clinical applications in the future.
Gross total resection of low grade gliomas is associated with prolonged time to malignant transformation and ultimately overall survival. Unfortunately, rates of gross total resection are reported to be as low as 20-40%. Current strategies in fluorescence guidance are lacking for low grade gliomas and represent an unmet need. We have developed a novel fluorescence exploiting the highly conserved IDH mutant protein that is present in >80% of these tumors. To date there are well described small molecule IDH mutant inhibitors in clinical trial. We describe the development of small molecule fluorescent inhibitors of the IDH mutant protein and their potential applications in surgery for LGG.
Quantifying intracellular drug target validation and target engagement has presented significant challenges, as drugs tend to accumulate non-specifically due to variations in drug affinity, biodistribution, pharmacokinetics, and metabolism. We have developed a ratiometric imaging approach, termed intracellular Paired Agent Imaging (iPAI), for estimating the concentration of protein receptors. This innovative technique holds great potential for revitalizing quantitative intracellular protein receptor imaging, offering a potential solution to quantify the availability of intracellular drug targets. Our approach involves the utilization of fluorophore-labeled small molecule therapeutics as imaging agents. We show it is now possible to use small molecule fluorophore labeled therapeutic inhibitors to visualize their targeted proteins intracellularly, providing a chemical tool kit to generate maps of bound and unbound inhibitors at the single-cell level both in vitro and ex vivo. iPAI platform provides a powerful new opportunity to study numerous other drugs in cells and tissues, resulting in a comprehensive spatial view of drug distribution and binding for improved personalized therapy.
We discuss our work in development of ‘Diffuse in vivo Flow Cytometry’ (DiFC) for non-invasive fluorescence enumeration of circulating tumor cells (CTCs) and describe recent progress towards human translation of DiFC. DiFC is an emerging technique wherein highly-scattered light is used to non-invasively sample blood flowing in large deep-seated blood vessels and detect fluorescently-labeled cells. The key advantages are that it allows continuous sampling of large circulating blood volumes and enumeration of rare cells over time. We discuss progress in development an application of near-infrared fluorescent molecular contrast agents for sensitive and specific labeling of CTCs directly in vivo. Candidate contrast agents include a folate receptor-targeted probe (OTL38, Cytalux), as well as new, purpose-designed pan-epithelial CTC-specific probes. We also discuss relevant tissue optics and instrumentation considerations for potential future human translation. Ultimately, DiFC could represent a new method for continuously enumerating CTCs without drawing blood samples that may enable early detection of cancer metastasis or monitoring of response to cancer therapies.
Fluorescence-guided surgery (FGS) has the potential to significantly enhance patient outcomes by enabling precise real-time visualization of vital nerve structures during surgical procedures. However, a clinically approved nerve-specific contrast agent does not exist. To address this need, we adopted a medicinal chemistry approach to design and develop novel near-infrared (NIR) nerve-binding small molecule fluorophore libraries. Our first-in-class NIR nerve-binding small molecule fluorophores represent a significant advancement in the field. By enabling precise nerve visualization in real-time during surgery, these contrast agents have the potential to revolutionize nerve-sparing procedures and ultimately improve patient outcomes.
Intracellular drug target validation and target engagement quantification have proven to be challenging, and all drugs have some degree of non-specific accumulation due to variable drug affinity, biodistribution, pharmacokinetics, and metabolism. A dynamic ratiometric imaging approach for estimating the concentration of cell surface receptors, termed Paired Agent Imaging, could have a revitalizing effect on quantitative intracellular protein receptor imaging, offering a potential means for quantifying intracellular drug target availability. We have developed a dynamic, fluorescence-based, three-compartment model termed intracellular paired-agent imaging that utilizes fluorophore labeled small molecule therapeutics as imaging agents to measure drug target availability in live cells and tissues.
Nerve damage ruins the lives of many patients post surgery, significantly affecting post-surgical quality of life. Intraoperative nerve detection is completed using anatomical knowledge and conventional white light visualization when possible. However, nerves can be difficult or impossible to identify by white light visualization and neuroanatomy is often varied between patients. We have developed nerve specific fluorescence guided surgery (FGS) contrast agents that provide real time direct visualization of nerves intraoperatively. These nerve-specific fluorophores represent the first of their kind and are capable of translation to clinical studies using existing clinical infrastructure of FGS systems. Work is underway to complete the preclinical pharmacology and toxicology testing required for a successful investigational new drug application to the FDA for first-in-human clinical trials and translation to surgical use should be feasible within the next five years.
Cranial and spinal nerve repair occurs at a very slow rate, and in most cases the iatrogenic injury can’t be fully repaired, leading to permanent motor or sensory disabilities as well as incurable neuropathies. The visualization and evaluation of tumor-involved nerves is extremely difficult during minimally invasive surgical procedures such as through at the skull base. Recently, our group developed a library of nerve-specific near infrared (NIR) oxazine scaffold dyes that have high specificity for cranial nerves, and the ability to permeate the Blood-Brain Barrier (BBB), which resulted in different degrees of the obtained cranial nerves SBR. These cranial nerve-specific fluorophores will significantly improve nerve visualization at depth, enhancing the ability to visualize and evaluate buried and tumor-involved cranial nerves. This could significantly decrease post-surgical morbidity rates and could solve the unmet clinical need for an intraoperative tool that enhances visualization.
Iatrogenic nerve injury is a major source of morbidity common to all surgical specialties. Prostate cancer, the second leading cause of cancer-related death among men in the U.S, is often treated surgically via prostatectomy. But visibility of the nerve plexus is extremely limited and nerve damage affects 60% of patients leading to post-surgical comorbidities.
We’ve developed a synthetic strategy to improve key properties of fluorophores with potential clinical translatability to generate an optimal 700 nm fluorophore to pair with a fluorescently labeled probe optimized for the 800 nm channel in FGS systems targeting PSMA via the EUK targeting sequence for use in two-color prostatectomy.
These new water-soluble, NIR, nerve-specific fluorophores show improved nerve specificity and in vivo brightness, require a lower dose to achieve contrast of superficial and buried nerve tissue and negate formulation development, improving safety profiles and lowering the cost of clinical translation.
Iatrogenic nerve injury is a common complication across all surgical specialties. Better nerve visualization and identification during surgery will improve outcomes and reduce nerve injuries. The Gibbs Laboratory at Oregon Health and Science University has developed a library of near-infrared, nerve-specific fluorophores to highlight nerves intraoperatively and aid surgeons in nerve identification and visualization; the current lead agent is LGW16-03. Prior to this study, testing of LGW16-03 was restricted to animal models; therefore, it was unknown how LGW16-03 performs in human tissue. To advance LGW16-03 to clinic, we sought to test this current lead agent in ex vivo human tissues from a cohort of patients and determine if the route of administration affects LGW16-03 fluorescence contrast between nerves and adjacent background tissues (muscle and adipose). LGW16-03 was applied to ex vivo human tissue from lower limb amputations via two strategies: (1) systemic administration of the fluorophore using our first-in-kind model for fluorophore testing, and (2) topical application of the fluorophore. Results showed no statistical difference between topical and systemic administration. However, in vivo human validation of these findings is required.
We have co-developed a first-in-kind model of fluorophore testing in freshly amputated human limbs. Ex vivo human tissue provides a unique opportunity for the testing of pre-clinical fluorescent agents, collection of imaging data, and histopathologic examination in human tissue prior to performing in vivo experiments. Existing pre-clinical fluorescent agent studies rely primarily on animal models, which do not directly predict fluorophore performance in humans and can result in wasted resources and time if an agent proves ineffective in early human trials. Because fluorophores have no desired therapeutic effect, their clinical utility is based solely on their safety and ability to highlight tissues of interest. Advancing to human trials even via the FDA’s phase 0/microdose pathway still requires substantial resources, single-species pharmacokinetic testing, and toxicity testing. In a recently concluded study using amputated human lower limbs, we were able to test successfully a nerve-specific fluorophore in pre-clinical development. This study used systemic administration via vascular cannulization and a cardiac perfusion pump. We envision that this model may assist with early lead agent testing selection for fluorophores with various targets and mechanisms.
SignificanceThis first-in-kind, perfused, and amputated human limb model allows for the collection of human data in preclinical selection of lead fluorescent agents. The model facilitates more accurate selection and testing of fluorophores with human-specific physiology, such as differential uptake and signal in fat between animal and human models with zero risk to human patients. Preclinical testing using this approach may also allow for the determination of tissue toxicity, clearance time of fluorophores, and the production of harmful metabolites.AimThis study was conducted to determine the fluorescence intensity values and tissue specificity of a preclinical, nerve tissue targeted fluorophore, as well as the capacity of this first-in-kind model to be used for lead fluorescent agent selection in the future.ApproachFreshly amputated human limbs were perfused for 30 min prior to in situ and ex vivo imaging of nerves with both open-field and closed-field commercial fluorescence imaging systems.ResultsIn situ, open-field imaging demonstrated a signal-to-background ratio (SBR) of 4.7 when comparing the nerve with adjacent muscle tissue. Closed-field imaging demonstrated an SBR of 3.8 when the nerve was compared with adipose tissue and 4.8 when the nerve was compared with muscle.ConclusionsThis model demonstrates an opportunity for preclinical testing, evaluation, and selection of fluorophores for use in clinical trials as well as an opportunity to study peripheral pathologies in a controlled environment.
This Conference Presentation, “Utilization of near infrared nerve-specific fluorescent contrast agents as an intraoperative assessment methodology for nerve damage,” was recorded for Photonics West BiOS 2022 On-Demand.
Iatrogenic nerve injury remains one of the most common surgical complications, often resulting in permanent disabilities that severely impact patient quality of life following surgery. Current means of intraoperative nerve identification are limited beyond white light visualization and neuroanatomical knowledge but include ultrasound and the gold standard electromyography (EMG). However, nerve identification in the surgical field of view often remains inadequate. Though fluorophores like rhodamine, cyanine, and others have found extensive and diverse uses in the life sciences, in the realm of fluorescence-guided surgery (FGS), fluorophores that absorb and emit in the NIR region (650-900 nm) have the highest potential for clinical translation. Combining the structural characteristics of a long wavelength emitting fluorophore cyanine like indocyanine green (ICG) with those of a topically nerve-specific fluorophore, like rhodamine B, could offer a strategy for generating NIR-emissive and nerve-specific fluorophores. This study investigated whether the topical nerve-affinity observed in rhodamines extends to systemic administration and whether the structural hybridization strategy used in the previously published Changsha dyes could prove useful in generating long-wavelength nerve-specific contrast agents for use in FGS.
Accidental damage of vital nerve structures remains a significant surgical morbidity. Patient-to-patient neuroanatomical variability requires considerable dependence on a surgeon’s first-hand experiences that primarily rely on proximal features for orientation, which can be further complicated in patients with nerve damage. As such, enhanced nerve visualization proves to be a vital avenue for advancing surgical precision and patient outcomes. Fluorescence guided surgery (FGS) has the potential to improve surgical guidance, but there are no current nerve-specific fluorophores approved for clinical use. Previous work has identified the oxazine scaffold as a promising avenue for nerve-specific contrast agent development, due to its sufficiently low molecular weight to cross the blood-nerve-barrier (BNB), tunable photophysical properties, and high nerve specificity. Herein we report our efforts to investigate the structure-function relationship of Oxazine-4 through fine-tuned terminal alkylamino modifications, both based on optical and physicochemical properties as well as their affected nerve specificities.
Intracellular drug target validation and target engagement quantification have proven to be challenging, and all drugs have some degree of non-specific accumulation due to variable drug affinity, biodistribution, pharmacokinetics, and metabolism. Quantification of available drug targets necessitates accounting for both the drug that binds to its target as well as the drug that accumulates in the cells and tissues in a non-specific manner. We have developed a dynamic, fluorescence-based, three-compartment model termed intracellular paired-agent imaging that utilizes fluorophore labeled small molecule therapeutics as imaging agents to measure drug target availability in live cells and tissues.
Head and neck squamous cell carcinomas (HNSCCs) have high levels of chromosomal instability and epidermal growth factor receptor (EGFR) overexpression, both of which drive their tumorigenesis. While drug treatment targeting the extracellular domain of EGFR has shown some success, mutations and alternate intracellular pathways contribute to therapeutic resistance. Therefore, a dynamic in vivo method to monitor binding and downstream cell signaling is warranted. Previous work has demonstrated that paired-agent imaging (PAI) is a powerful tool to quantify extracellular EGFR, and so this work extends the same principles to quantify intracellular protein target engagement. Here, in ovo models were used to grow human HNSCC xenografts – eggs were windowed to reveal the chorioallantoic membrane (CAM) of chicken embryos and tumors were implanted on its surface. A fluorescent cocktail of both intracellular and extracellular, targeted and untargeted agents (four agents total) was intravenously injected and multispectral imaging was performed over two hours. To isolate the relative quantities of each agent, a spectral fitting procedure was employed that accounted for the linear contributions of each fluorescent agent and autofluorescence, and the non-linear absorbing contributions of oxy- and deoxyhemoglobin. This unmixing was performed on a pixel-by-pixel basis to generate distribution maps of each individual dye, and then motion correction was done, followed by a convolution correction to account for delivery differences. Results demonstrated successful unmixing of individual fluorophores such that a ratiometric calculation could be applied to extract both intracellular and extracellular binding potential (BP), which is proportional to EGFR concentration.
Fluorescence-guided surgery (FGS) to aid in the precise visualization of vital nerve structures in real-time intraoperatively could greatly improve patient outcomes. We took a medicinal chemistry approach that facilitated the design of our first-in-class NIR nerve-binding small molecule fluorophore libraries with excitation and emission profiles compatible with the “700-” and “800-” nm fluorescence imaging channels in the clinical grade FGS systems. Molecular engineering of the lead candidates allowed for the development of water-soluble nerve-specific contrast agents with improved safety profile that has great potential for clinical translation in the near future.
Intracellular paired-agent imaging (iPAI) utilizes fluorescent-labeled small molecule therapeutics to measure drug target engagement. Our new water-soluble, cell-permeant fluorophores termed Sulfo-Rh and Sulfo-SiRh show substantially improved optical stability against solvent polarity changes over tetramethylrhodamine (TMR) and silicon-substituted TMR, respectively, while retaining the desirable photophysical properties of the base compounds, including brightness, to facilitate stable biological imaging.
Targeted and untargeted versions of an EGFR tyrosine kinase inhibitor labeled with these fluorophores, demonstrated similarity to the parent drug in competitive binding and cytotoxicity assays. Utilizing iPAI to visualize drug target engagement enables quantitative small molecule imaging in living systems.
Personalized molecularly targeted therapy has largely not lived up to its promise of providing curative therapies due to a lack of durable therapeutic response driven by a lack of drug target engagement (i.e. sublethal drug delivery to the tumor) and cell signaling reprogramming as a mechanism of acquired resistance. To simultaneously measure both of these factors, we have developed and optimized a fluorescence imaging platform, Therapeutic Response Imaging through Proteomic and Optical Drug Distribution (TRIPODD), resulting in the only methodology capable of simultaneous quantification of single-cell DTE and protein expression with preserved spatial context within a tumor.
Nerve damage plagues surgical outcomes, significantly affecting post-surgical quality of life. Intraoperative nerve detection is difficult since neuroanatomy is varilable between patients, and nerves are typically protected deep within the tissue. Fluorescence-guided surgery (FGS) offers a potential means for enhanced intraoperative nerve identification and preservation. We have developed the first near infrared (NIR) nerve-specific fluorophores for use during FGS. Lead optimization has yielded water soluble derivatives with excellent safety and pharmacology parameters. Work is underway to plan and execute preclinical toxicity testing to enable first-in-human clincial trials.
Intracellular Paired-Agent Imaging (iPAI) quantifies intracellular drug targets using fluorescently-labeled small molecule imaging agents. iPAI has the potential to predict therapeutic response for individual patients but requires a patient derived xenograft (PDX) model that accurately mimics in vivo tumor heterogeneity yet is easily accessible for intravenous drug administration and rapid image collection. The chicken embryo chorioallantoic membrane (CAM) provides an intermediate, cost-effective model that provides vascularized, in vivo tumors in a matter of days (typically ~72 h) from implantation. Here, we investigate the implantation of thin (< 1 mm) cross-sectional slices (1-2 cm) of freshly excised tumor tissues from mouse xenografts. Multispectral iPAI will be performed to quantify the distribution and heterogeneity of drug targets within the tumor cross-section.
Accidental nerve damage or transection of vital nerve structures remains an unfortunate reality that is often associated with surgery. Despite the existence of nerve-sparing techniques, the success of such procedures is not only complicated by anatomical variance across patients but is also highly dependent on a surgeon’s first-hand experience that is acquired over numerous procedures through trial and error, often with highly variable success rates. Fluorescent small molecules, such as rhodamines and fluoresceins have proven incredibly useful for biological imaging in the life sciences, and they appeared to have potential in illuminating vital nerve structures during surgical procedures. In order to make use of the current clinically relevant imaging systems and to provide surgeons with fluorescent contrast largely free from the interference of hemoglobin and water, it was first necessary to spectrally tune known fluorescent scaffolds towards near infrared (NIR) wavelengths. To determine whether the well-documented Si-substitution strategy could be applied towards developing a NIR fluorophore that retained nerve-specific properties of candidate molecules, an in vivo comparison was made between two compounds previously shown to highlight nervous structures – TMR and Rhodamine B – and their Si-substituted derivatives.
Small molecule kinase inhibitors (SMKIs) drugs have the potential to offer exquisite specificity in controlling aberrant intracellular signaling pathways in cancer and other disease states. However, while nearly 50 SMKIs have been FDA-approved, patient responses have been variable, and sensitive populations not easy to identify. For instance, in non-small-cell lung cancer, only 30% of patients respond to the epidermal growth factor receptor (EGFR) targeted SMKI, erlotinib, yet the level of erlotinib uptake is a poor indicator of treatment efficacy. The development of fluorescently-labeled SMKIs that maintain their viability as drugs has facilitated the use of paired-agent molecular imaging protocols that are able to discriminate, in vivo, between imaging agent uptake and binding. Here we present a mathematical framework of SMKI transport and binding, in vivo, and derive a kinetic model for extracting SMKI binding potential (BP) from kinetic fluorescent-SMKI imaging data-proposed as a more effective indicator of potential therapeutic response than SMKI uptake alone. The accuracy and precision of the SMKI BP kinetic model was demonstrated in simulation studies and in an in ovo xenograft experiment. In simulation, the SMKI BP estimates were within 20 5% of expected values over a large range of physiologically relevant blood flow, vascular permeability and cell permeability; and over a range of SMKI affinity, cell membrane permeability, and blood plasma pharmacokinetics. The in ovo experiment bolstered the simulation findings, demonstrating a statistically significant spatial correlation (r > 0.9, p < 0.01) between EGFR concentration measured by a validated extracellular approach and the SMKI BP approach.
Targeting the aberrant epidermal growth factor receptor (EGFR) signaling pathway is an attractive choice for many cancers (e.g., non-small cell lung carcinoma (NSCLC) and head and neck squamous cell carcinoma (HNSCC)). Despite the development of promising therapeutics, incomplete target engagement and acquired resistance (e.g., mutagenesis and intracellular signaling pathway rewiring) ensure that curative options still elude patients. To address limitations posed by standard drug evaluation assays (e.g., western blot, bulk plasma monitoring, immunohistochemistry), we have developed a novel dynamic, fluorescence-based platform termed intracellular paired agent imaging (iPAI). iPAI quantifies intracellular protein target engagement using two matched small-molecule, cell membrane-permeable agents: one targeted to the protein of interest and one untargeted, which accounts for non-specific therapeutic uptake. Currently, our iPAI panel includes successfully characterized tyrosine kinase inhibitors targeting the kinase binding domain of numerous proteins in the EGFR pathway, including erlotinib (EGFR). Here, we present a pharmacokinetic uptake study using our novel iPAI erlotinib reagents: a targeted erlotinib probed conjugated to silicon tetramethylrhodamine (Erl- SiTMR-T) and an untargeted reagent conjugated to tetramethylrhodaime (Erl-TMR-UT). An initial uptake study in a cell derived xenograft (CDX) model of NSCLC was performed by administering the Erl iPAI reagents systemically via tail vein injection, where drug uptake was quantified in the tumor over time. Excitingly, evidence of heterogeneous uptake was observed in the iPAI injected cohort, displaying distinct drug-uptake within a single tumor. Characterization of additional iPAI agents targeting downstream effectors (e.g., AKT, PI3K, MEK and ERK) is ongoing and will allow us to visualize complex drug-target interactions and quantify their downstream signaling partners during treatment regimens for NSCLC and other cancers. Together, we anticipate these iPAI probes will improve understanding of current limitations in personalized cancer therapy.
Accidental nerve transection or injury is a significant morbidity associated with many surgical interventions, resulting in persistent postsurgical numbness, chronic pain, and/or paralysis. Nervesparing can be a difficult task due to patient-to-patient variability and the difficulty of nerve visualization in the operating room. Fluorescence image-guided surgery to aid in the precise visualization of vital nerve structures in real time during surgery could greatly improve patient outcomes. To date, all nerve-specific contrast agents emit in the visible range. Developing a nearinfrared (NIR) nerve-specific fluorophore is poised to be a challenging task, as a NIR fluorophore must have enough “double-bonds” to reach the NIR imaging window, contradicting the requirement that a nerve-specific agent must have a relatively low molecular weight to cross the blood-nervebarrier (BNB). Herein we report our efforts to investigate the molecular characteristics for the nervespecific oxazine fluorophores, as well as their structurally analogous rhodamine fluorophores. Specifically, optical properties, physicochemical properties and their in vivo nerve specificity were evaluated herein.
Quantification of protein concentrations is often a static and tissue destructive technique. Paired-agent imaging (PAI) using matched targeted and untargeted agents has been established as a dynamic method for quantifying the extracellular domain of epidermal growth factor receptor (EGFR) in vivo in a variety of tumor lines. Here we extend the PAI model to simultaneously quantify the extracellular and intracellular regions of EGFR using novel cell membrane permeable fluorescent small molecules, TRITC-erlotinib (targeted) and BODIPY-N-erlotinib (non-binding control isoform) synthesized in house. An EGFR overexpressing squamous cell carcinoma cell xenograft tumor, A431, was implanted on the chorioallantoic membrane (CAM) of the embryonated chicken egg. In total six fluorescent molecules were administered and monitored over 1 h using multi-spectral imaging. EGFR concentrations were determined using both extracellular and intracellular PAI methods. The fluorescent molecules used for extracellular PAI were ABY-029, an anti- EGFR Affibody molecule conjugated to IRDye 800CW, and a Control Imaging Agent Affibody molecule conjugated to IRDye 680RD. The intracellular PAI (iPAI) fluorescent molecules were cell membrane penetrating TRITC-erlotinib, BODIPY-N-erlotinb, and BODIPY TR carboxylate, as well as cell membrane impermeant control agent, Alexa Fluor 647 carboxylate. Results from simultaneous imaging of both the extracellular and intracellular binding domains of EGFR indicate that concentrations of intracellular EGFR are higher than extracellular. This is anticipated as EGFR exists in two distinct populations in cells, cell membrane bound and internalized, activated protein. iPAI is a promising new method for quantifying intracellular proteins in a rapid tumor model on the chicken CAM.
Tools for rapid therapeutic selection for pancreatic ductal adenocarcinoma (PDAC) patients are vital to improved survival as PDAC is the third leading cause of cancer death, with an average life expectancy of 5-7 months post diagnosis. Treatment options are limited to surgery and chemotherapy, where Gemcitabine has been the cornerstone of therapy since 1997. However, Gemcitabine resistance prevents PDAC cure and mechanisms of resistance are not fully understood. Yet, with average survival times still <1 year, improved treatment selection and early assessment of response are urgently needed. Our group has recently developed a promising imaging based technology that will improve patient specific treatment selection and provide a platform for assessment of newly developed therapeutics with improved efficacy prediction compared to drug distribution alone. We have established a spatially-resolved, quantitative imaging methodology termed paired agent imaging (PAI), that enables quantification of drug target sites at the single cell level, allowing direct visualization of drug target availability (DTA) in situ, a parameter directly related to therapeutic efficacy. Using PAI, we examined the mechanisms of cancer therapy resistance on a cell-by-cell basis with the goal of utilizing explants for rapid, patient-specific therapy selection as they can predict treatment response in <5 days. As proof of concept we have studied Erlotinib, synthesizing paired targeted and untargeted fluorescently labeled derivatives. Overall, we anticipate that our spatially resolved maps of DTA will be predictive of therapeutic efficacy in patient PDAC explants, providing a platform technology for patient specific therapy selection <1 week after resection or biopsy.
Nerve damage plagues surgical outcomes, significantly affecting post-surgical quality of life. Surprisingly, no method exists to enhance direct nerve visualization in the operating room, and nerve detection is completed through a combination of palpation and visualization when possible. Fluorescence image-guided surgery offers a potential means of enhanced nerve identification and preservation, however a clinically approved nerve-specific contrast agent does not yet exist. Several classes of nerve-specific fluorophores have recently been demonstrated including the distyrylbenzenes (DSB), select oxazines (oxazine 4 perchlorate), and certain cyanines (3,3’-diethylthiatricarbocyanine iodine), which could provide intraoperative guidance. The nerve-sparing radical prostatectomy is a surgical procedure that could benefit from fluorescence image-guided nerve identification. Although the nerve-sparing surgical technique was developed over 30 years ago, nerve damage following radical prostatectomy is reported in some form in up to 60% of patients one to two years post-surgery. To facilitate clinical translation of fluorescence image guided surgery to the nerve sparing prostatectomy, a direct administration methodology was developed that allows selective nerve highlighting with a significantly lower fluorophore dose than systemic administration, where large animal studies have confirmed the technique’s translatability. Tissue penetration will be critical for clinical feasibility of the direct administration methodology and novel formulation strategies have been explored to enhance tissue penetration for identifying buried nerves. In addition, several biomolecular targets of Oxazine 4, a promising candidate for nerve-specific fluorophore development into a near-infrared (NIR) agent, have been identified, providing insight into the mechanism of nerve-specificity. Fluorophore development has made progress towards the goal of creating a NIR nerve-specific fluorophore and determining the structure-activity relationship responsible for nerve binding.
Pancreatic ductal adenocarcinoma (PDAC) has the poorest five-year survival rate of any cancer. Surgical resection is the only curative treatment but, is only possible in 15-20% of cases. Systemic therapies that demonstrate some efficacy are limited to chemotherapeutics, such as Gemcitabine, Abraxane (nab-Paclitaxel) and FOLFIRINOX, a multidrug chemotherapy regimen. Numerous studies have tried to apply multi-agent therapies to advance standard of care for metastatic PDAC. However, consistent improvement in survival remains poor. Of broader interest, there is an urgent need for improved treatment selection and early assessment of therapeutic responses as mean survival time following diagnosis is less than one year. Paired agent imaging (PAI) is a spatially-resolved, quantitative imaging methodology, which enables quantification of bound and unbound drugs on a cell by cell basis, using a targeted and control (untargeted) imaging agent. PAI has the potential to provide a spatially resolved map of drug engagement and treatment efficacy for PDAC. Herein, we have developed fluorescently labeled, paired targeted and control Gemcitabine, which have been characterized for their similarity to the parent Gemcitabine using competitive binding, liquid chromatography mass spectroscopy based uptake and pharmacokinetic studies, and cytotoxicity assays. Using our validated targeted and control agents, we have generated maps of targeted and untargeted Gemcitabine in murine models of PDAC, demonstrating that therapeutic efficacy is correlated to the bound drug fractions. We anticipate that PAI using fluorescently labeled targeted and control drug derivatives will be useful for future studies to prediction therapy combinations for personalized PDAC therapy.
Access to the requested content is limited to institutions that have purchased or subscribe to SPIE eBooks.
You are receiving this notice because your organization may not have SPIE eBooks access.*
*Shibboleth/Open Athens users─please
sign in
to access your institution's subscriptions.
To obtain this item, you may purchase the complete book in print or electronic format on
SPIE.org.
INSTITUTIONAL Select your institution to access the SPIE Digital Library.
PERSONAL Sign in with your SPIE account to access your personal subscriptions or to use specific features such as save to my library, sign up for alerts, save searches, etc.