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Imagerie Moléculaire Hervé Trillaud, Chrit Moonen Laboratory for Molecular and Functional Imaging: from Physiology to Therapy CNRS/ University Victor Segalen Bordeaux Bordeaux, France Gene expression profile List of 210 genes with highest differences in expression profile between Prostate Cancer and Benign Prosthetic Hyperplasia Down regulation Up regulation Seeing genes in action Molecular Imaging: Spatio-temporal mapping of gene expression and its physiological consequences PET/SPECT MRI Optics Ultrasound Outline Improved diagnostics for (individualized) therapy Seeing genes in action:(trans)gene expression Seeing drugs in action Biomarkers Therapy guided by Molecular Imaging Combined diagnostic/therapeutic contrast agents Local drug delivery Spatio-temporal control of transgene expression Stem cell therapy Conclusion/Challenges ahead Outline Improved diagnostics for (individualized) therapy Seeing genes in action:(trans)gene expression Seeing drugs in action Biomarkers Therapy guided by Molecular Imaging Combined diagnostic/therapeutic contrast agents Local drug delivery Spatio-temporal control of transgene expression Stem cell therapy Conclusion/Challenges ahead Mapping transgene expression in gene therapy: adding a spy Cancer cells overexpressing luciferase CMV promotor Luciferase gene + luciferin Lowik et al Leiden, The Netherlands Photon emission Optical Imaging CCD Camera intensifier screen Image analysis photon emission 2000 Photon counting 1500 1000 500 i.p. luciferin Metastases of luciferase overexpressing cancer cells 0 0 5 10 15 days 20 25 30 Experimental bone metastasis 20 days after intra-cardiac injection (3x106 cells) A Vehicle Day 20 Day 23 Day 27 Day 30 Day 34 B Paclitaxel 15 mg/kg, iv, q.d. Days 20-24 Lassota et al., Novartis Optical Imaging Very powerful tool for rapid evaluation of drug efficacy Limited clinical use because of light penetration/scattering problems seeing drugs in action using molecular imaging Mapping gene expression: MRI As compared to PET and optical methods, MRI requires a higher concentration of contrast agent Need a spy with amplification of contrast Imaging gene expression: MRI Amplification required MR contrast agent is a weak relaxation agent until galactosidase has cleaved the galactose unit: inner sphere of Gd3+ becomes available to water Fluorescence image MRI Xenopus Laevis embryos: Galactosidase + Green Fluorescent Protein mRNA injection on right. Meade et al. Nature Biotech 2000 Imaging transgene expression: MRI Co-expression of transferrin receptor, probed with superparamagnetic particles Parametric DT2* map (color overlay proportional to DT2*) Control (no transferrin receptor) Tumor expressing transferrin receptor Weissleder et al., Nature Med. 6, 2000 Expression of endogenous genes of special interest in cancer General for almost all tumors Angiogenesis (VEGF receptor, Integrins) Proteases (Cathepsin, Matrix MetalloProtease) Apoptosis (Annexin V) Specific HER2/neu (overexpressed in 25% of breast cancers) P53 Need for specific contrast agent Specific contrast agent design for MRI Target specific part MAB (fragments) Peptides Aptamers (short DNA/RNA strings) Linkage Contrast agent (multiple) Gd Iron particle Imaging of the HER-2/neu receptor with MRI In vitro In vivo Non-HER expressing Tumor line HER expressing Tumor line Artemov et al. Cancer Research, 2003 Melanoma Angiogenesis: Detection With avb3 Integrin-Targeted Paramagnetic Nanoparticles Time course after injection of target specific contrast agent Wickline, Lanza et al St Louis Imaging biomarkers for cancer diagnosis and treatment Identification of unique signatures related to gene expression Early diagnosis and detection of metastases (PET FDG) Assessment of drug response Helpful in therapeutic decision: stratification Major field of impact for MRI Perfusion changes in validation of angiogenesis drugs Diffusion changes in drug response Choline metabolism Thermal dose assessment in tumor ablation Macrophage activity Prostate cancer: improved diagnostics using cell labeling: Detection of metastases in lymph nodes using USPIO (Sinerem, Combidex) Harisinghani, Barentsz et al. NEJM 2003 ? Outline Improved diagnostics for (individualized) therapy Seeing genes in action:(trans)gene expression Seeing drugs in action Biomarkers Therapy guided by Molecular Imaging Combined diagnostic/therapeutic contrast agents Local drug delivery Spatio-temporal control of transgene expression Stem cell therapy Conclusion/Challenges ahead Combined diagnostic/therapeutic contrast agents/drugs Radio-labelled drugs for detection (PET, SPECT) and radio-therapy Specific contrast agent used subsequently for (pro)drug delivery Modular contrast agents for MRI, US Combined MR contrast agents for imaging/therapy Target specific part MAB (fragments) Peptides Aptamers (short DNA/RNA strings) Linkage D Contrast agent (multiple) Gd Iron particle Drugs Rejection of Mouse Melanoma 7d after anb3Targeted Doxorubicin Nanoparticles Tumor 4x Tumor Inflammatory cells rejection anb3-DXR-NP Control viable Wickline, Lanza et al St Louis MRI guided FUS for spatio-temporal control of gene expression under control of a heat sensitive promoter FUS heating with automatic feedback MR temperature control f Fully automatic temp control in focal point: SD of 0.58 °C Guilhon et al, J. Gene Med, J. Mol. Imag. 2003 z x 1 cm Analysis of GFP gene Expression using Confocal Microscope Heated region Transmission Image Fluorescence Image Outline Improved diagnostics for (individualized) therapy Seeing genes in action:(trans)gene expression Seeing drugs in action Biomarkers Therapy guided by Molecular Imaging Combined diagnostic/therapeutic contrast agents Local drug delivery Spatio-temporal control of transgene expression Stem cell therapy Conclusion/Challenges ahead Issues in imaging research of stem cells When and how do stem cells migrate to their target tissue? When and how do stem cells differentiate in vivo? What is the timeframe of stem cell multiplication and functional recovery at the target site? Can we influence stem cell behavior/differentiation in vivo for gene therapy purposes? Transplantation of cells by intravascular injection (renal artery, rat): Bos et al. Radiology, 2004 reference Day 4 after stem cell inj <1hr after stem cell inj Day 2 after stem cell inj Day 7 after stem cell inj Day 7 after stem cell inj Ex vivo Transplantation of 5x106 cells by intravascular injection (portal vein): Bos et al. Radiology, 2004 reference Day 4 post stem cell Day 2 (CCl4) Day 8 post stem cell <1hr after stem cell inj Day 12 post stem cell Summary (1) Molecular imaging allows : the non-invasive spatio-temporal evaluation of gene expression the non-invasive characterization of disease processes on the molecular level in vivo the use of image biomarkers for therapy assessment the further evaluation of animal models for human disease the rapid development of new treatment strategies such as gene and (stem) cell-based therapies Summary (2) Molecular imaging will lead to : a need for specialists understanding molecular biology, imaging and chemistry blurring between diagnostics and treatment a new look at clinical imaging instruments with combined technologies: MRI/(focused)ultrasound; PET/CT; MRI/PET a large role for optical Molecular Imaging of mice a paradigm shift in health care towards early molecular diagnostics and image guided molecular therapy Ackowledgment Many thanks for contributions and discussions: Andreas Jacobs Ralph Weissleder Tobias Schäffter Alan Koretsky Chris Bakker Simon Cherry Nicolas Grenier Kullervo Hynynen Tom Meade Bertrand Tavitian Peter Lassota Silvio Aime Clemens Lowik Ronald Blasberg Sam Wickline Arend Heerschap Jim Basilion Dimitri Artemov Zaver Bhujwalla Jelle Barentsz Robert Muller Mark Bednarski King Li Michal Neeman Jeff Bulte Joe Frank Hervé Trillaud