Improved Discrimination of Tumors with Low and Heterogeneous EGFR Expression in Fluorescence-Guided Surgery Through Paired-Agent Protocols.

Purpose: The goal of fluorescence-guided surgery (FGS) in oncology is to improve the surgical therapeutic index by enhancing contrast between cancerous and healthy tissues. However, optimal discrimination between these tissues is complicated by the nonspecific uptake and retention of molecular targeted agents and the variance of fluorescence signal. Paired-agent imaging (PAI) employs co-administration of an untargeted imaging agent with a molecular targeted agent, providing a normalization factor to minimize nonspecific and varied signals.

Examining the Feasibility of Quantifying Receptor Availability Using Cross-Modality Paired-Agent Imaging.

Purpose: The ability to noninvasively quantify receptor availability (RA) in solid tumors is an aspirational goal of molecular imaging, often challenged by the influence of non-specific accumulation of the contrast agent. Paired-agent imaging (PAI) techniques aim to compensate for this effect by imaging the kinetics of a targeted agent and an untargeted isotype, often simultaneously, and comparing the kinetics of the two agents to estimate RA. This is usually accomplished using two spectrally distinct fluorescent agents, limiting the technique to superficial tissues and/or preclinical applications.

Prediction of optimal contrast times post-imaging agent administration to inform personalized fluorescence-guided surgery.

Significance: Fluorescence guidance in cancer surgery (FGS) using molecular-targeted contrast agents is accelerating, yet the influence of individual patients' physiology on the optimal time to perform surgery post-agent-injection is not fully understood.

Aim: Develop a mathematical framework and analytical expressions to estimate patient-specific time-to-maximum contrast after imaging agent administration for single- and paired-agent (coadministration of targeted and control agents) protocols.

Approach: The framework was validated in mouse subcutaneous xenograft studies for three classes of imaging agents: peptide, antibody mimetic, and antibody.

Noninvasive quantification of target availability during therapy using paired-agent fluorescence tomography.

Immuno-oncological treatment strategies that target abnormal receptor profiles of tumors are an increasingly important feature of cancer therapy. Yet, assessing receptor availability (RA) and drug-target engagement, important determinants of therapeutic efficacy, is challenging with current imaging strategies, largely due to the complex nonspecific uptake behavior of imaging agents in tumors. Herein, we evaluate whether a quantitative noninvasive imaging approach designed to compensate for nonspecific uptake, MRI-coupled paired-agent fluorescence tomography (MRI-PAFT), is capable of rapidly assessing the availability of epidermal growth factor receptor (EGFR) in response to one dose of anti-EGFR antibody therapy in orthotopic brain tumor models.

Topical dual-probe staining using quantum dot-labeled antibodies for identifying tumor biomarkers in fresh specimens.

Purpose: Rapid, intra-operative identification of tumor tissue in the margins of excised specimens has become an important focus in the pursuit of reducing re-excision rates, especially for breast conserving surgery. Dual-probe difference specimen imaging (DDSI) is an emerging approach that uses the difference in uptake/clearance kinetics between a pair of fluorescently-labeled stains, one targeted to a biomarker-of-interest and the other an untargeted isotype, to reveal receptor-specific images of the specimen. Previous studies using antibodies labeled with either enhanced Raman particles or organic fluorophores have shown promising tumor vs.

A paired-agent fluorescent molecular imaging strategy for quantifying antibody drug target engagement in window chamber xenograft models.

A paired-agent fluorescent molecular imaging strategy is presented as a method to measure drug target engagement in whole tumor imaging. The protocol involves dynamic imaging of a pair of targeted and control imaging agents prior to and following antibody therapy. Simulations demonstrated that antibody "drug target engagement" can be estimated within a 15%-error over a wide range of tumor physiology (blood flow, vascular permeability, target density) and antibody characteristics (affinity, binding rates).

Noninvasive imaging of dual-agent uptake in glioma and normal tissue using MRI-coupled fluorescence tomography.

As the role of immuno-oncological therapeutics expands, the capacity to noninvasively quantify molecular targets and drug-target engagement is increasingly critical to drug development efforts and treatment monitoring. Previously, we showed that MRI-coupled dual-agent fluorescence tomography (FMT) is capable of estimating the concentration of epidermal growth factor receptor (EGFR) in orthotopic glioma models noninvasively. This approach uses the dynamic information of two fluorescent agents (a targeted agent and untargeted isotype) to estimate tumor receptor concentration in vivo.

Effect of staining temperature on topical dual stain imaging of tissue specimens for tumor identification.

In the pursuit of reducing re-excision rates in breast conserving surgery, a dual probe specimen staining technique has emerged as a promising approach to identify positive margins during surgery. This approach generally involves staining the tissue with a fluorescent dye targeted to a biomarker of interest, such as a cell surface receptor, and an untargeted counterpart, imaging both dyes and using the two images together to compensate for instrumentation inhomogeneities and non-specific uptake. A growing body of literature suggests that this approach can effectively discriminate tumor and normal tissue in gross fresh specimens in reasonable timeframes.

On the use of fluorescein-based contrast agents as analogs to MRI-gadolinium agents for imaging brain tumors.

Magnetic resonance imaging (MRI) of gadolinium (Gd)-based contrast agents plays a central role in managing the treatment of intracranial tumors. These images are involved in diagnosis, surgical planning, surgical navigation, and postoperative assessment of extent of resection. Replicating the information from Gd-MRI in the visual surgical field using fluorescent agents that behave similar to gadolinium in vivo would represent a major advance for surgical intervention of these tumors, and could provide robust compensation information to update pre-operative MRI images during surgery.

Estimating drug delivery using hybrid system for simultaneous dynamic MRI and fluorescence tomography.

Optical tomography is often coupled with high resolution imaging modality like MRI to provide functional information associated with specific anatomical structure noninvasively. MRI-coupled paired agent fluorescence molecular tomography (MRI-PAFT) is a hybrid imaging modality capable of noninvasively quantifying drug-target engagement in vivo utilizing a targeted and an untargeted fluorescence agent. This study compares the uptake kinetics of MRI contrast agent and fluorescence agents in tumor and normal tissue, and demonstrates the potential of utilizing MRI contrast agent kinetic and targeted fluorescence agent kinetics to quantify targeted tumor receptor concentration in glioma tumor model.

Profiling the Stromal and Vascular Heterogeneity in Patient-derived Xenograft Models of Head and Neck Cancer: Impact on Therapeutic Response.

Head and neck squamous cell carcinomas (HNSCC) represent a group of epithelial neoplasms that exhibit considerable heterogeneity in clinical behavior. Here, we examined the stromal and vascular heterogeneity in a panel of patient-derived xenograft (PDX) models of HNSCC and the impact on therapeutic response. Tumor sections from established tumors were stained for p16 (surrogate for human papillomavirus (HPV) infection), stromal (Masson's trichrome) and vascular (CD31) markers.

Characterizing short-wave infrared fluorescence of conventional near-infrared fluorophores.

The observed behavior of short-wave infrared (SWIR) light in tissue, characterized by relatively low scatter and subdiffuse photon transport, has generated considerable interest for the potential of SWIR imaging to produce high-resolution, subsurface images of fluorescence activity in vivo. These properties have important implications for fluorescence-guided surgery and preclinical biomedical research. Until recently, translational efforts have been impeded by the conventional understanding that fluorescence molecular imaging in the SWIR regime requires custom molecular probes that do not yet have proven safety profiles in humans.

Elucidating the kinetics of sodium fluorescein for fluorescence-guided surgery of glioma.

Objective: The use of the optical contrast agent sodium fluorescein (NaFl) to guide resection of gliomas has been under investigation for decades. Although this imaging strategy assumes the agent remains confined to the vasculature except in regions of blood-brain barrier (BBB) disruption, clinical studies have reported significant NaFl signal in normal brain tissue, limiting tumor-to-normal contrast. A possible explanation arises from earlier studies, which reported that NaFl exists in both pure and protein-bound forms in the blood, the former being small enough to cross the BBB.

Bioluminescence and MR Imaging of the Safety and Efficacy of Vascular Disruption in Gliomas.

Purpose: The goal of the present study was to examine the safety and efficacy of the vascular disrupting agent (VDA) EPC2407 (Crolibulin™) in experimental glioma models using bioluminescence imaging (BLI) and magnetic resonance imaging (MRI).

Procedures: Experimental imaging studies were performed in subcutaneous human U87 glioma xenografts and orthotopic murine gliomas established by intracranial implantation of luciferase-transfected glioma cells (GL261-luc). Correlative histopathology and long-term survival analysis was also performed.

Preclinical Activity of the Vascular Disrupting Agent OXi4503 against Head and Neck Cancer.

Vascular disrupting agents (VDAs) represent a relatively distinct class of agents that target established blood vessels in tumors. In this study, we examined the preclinical activity of the second-generation VDA OXi4503 against human head and neck squamous cell carcinoma (HNSCC). Studies were performed in subcutaneous and orthotopic FaDu-luc HNSCC xenografts established in immunodeficient mice.

Multimodal imaging guided preclinical trials of vascular targeting in prostate cancer.

The high mortality rate associated with castration-resistant prostate cancer (CRPC) underscores the need for improving therapeutic options for this patient population. The purpose of this study was to examine the potential of vascular targeting in prostate cancer. Experimental studies were carried out in subcutaneous and orthotopic Myc-CaP prostate tumors implanted into male FVB mice to examine the efficacy of a novel microtubule targeted vascular disrupting agent (VDA), EPC2407 (Crolibulin™).

Vascular priming enhances chemotherapeutic efficacy against head and neck cancer.

Purpose: The need to improve chemotherapeutic efficacy against head and neck squamous cell carcinomas (HNSCC) is well recognized. In this study, we investigated the potential of targeting the established tumor vasculature in combination with chemotherapy in head and neck cancer.

Methods: Experimental studies were carried out in multiple human HNSCC xenograft models to examine the activity of the vascular disrupting agent (VDA) 5,6-dimethylxanthenone-4-acetic acid (DMXAA) in combination with chemotherapy.