Name: in vivo imaging and tracking of technetium-99m labeled bone marrow mesenchymal stem cells in equine tendinopathy
Uploaded: 2015-12-09T13:00:00
Description: Watch this Scientific Journal Video about In Vivo Imaging and Tracking of Technetium-99m Labeled Bone Marrow Mesenchymal Stem Cells in Equine Tendinopathy at JoVE.com

The authors would like to acknowledge funding from the Horserace Betting Levy Board U.K. (grant number 721) and VetCell BioScience Ltd, U.K. and by Consejer&#236;a de Innovaci&#242;n, Ciencia y Empresa, Junta de Andaluc&#236;a, Spain.

The cases described herein were performed following Ethical permission granted by the Animal Ethics and Welfare Committee of the Colegio de Veterinarios de Malaga, Spain, and the Royal Veterinary College, North Mymms, U.K. The procedures used on the horses are based on approved protocols that are used in clinic on horses receiving stem cell based therapies which includes sedation, bone-marrow aspiration, intra-tendinous injection, regional perfusion, intravenous injection, post-procedural treatment and pain management an...

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V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mesenchymal+stem+cells+and+insulin-like+growth+factor-I+gene-enhanced+mesenchymal+stem+cells+improve+structural+aspects+of+healing+in+equine+flexor+digitorum+superficialis+tendons.">Mesenchymal stem cells and insulin-like growth factor-I gene-enhanced mesenchymal stem cells improve structural aspects of healing in equine flexor digitorum superficialis tendons.</a> Journal of Orthopaedic Research. 27, 1392-1398 (2009).</li><li>Smith, R. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Beneficial+effects+of+autologous+bone+marrow-derived+mesenchymal+stem+cells+in+naturally+occurring+tendinopathy.">Beneficial effects of autologous bone marrow-derived mesenchymal stem cells in naturally occurring tendinopathy.</a> PloS one. 8, e75697 (2013).</li><li>Sole, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Distribution+and+persistence+of+technetium-99+hexamethyl+propylene+amine+oxime-labelled+bone+marrow-derived+mesenchymal+stem+cells+in+experimentally+induced+tendon+lesions+after+intratendinous+injection+and+regional+perfusion+of+the+equine+distal+limb.">Distribution and persistence of technetium-99 hexamethyl propylene amine oxime-labelled bone marrow-derived mesenchymal stem cells in experimentally induced tendon lesions after intratendinous injection and regional perfusion of the equine distal limb.</a> Equine Veterinary Journal. 45, 726-731 (2013).</li><li>Godwin, E. E., Young, N. J., Dudhia, J., Beamish, I. C., Smith, R. 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R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Equine+embryonic+stem-like+cells+and+mesenchymal+stromal+cells+have+different+survival+rates+and+migration+patterns+following+their+injection+into+damaged+superficial+digital+flexor+tendon.">Equine embryonic stem-like cells and mesenchymal stromal cells have different survival rates and migration patterns following their injection into damaged superficial digital flexor tendon.</a> Equine Veterinary Journal. 42, 636-642 (2010).</li><li>Sole, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Scintigraphic+evaluation+of+intra-arterial+and+intravenous+regional+limb+perfusion+of+allogeneic+bone+marrow-derived+mesenchymal+stem+cells+in+the+normal+equine+distal+limb+using+(99m)+Tc-HMPAO.">Scintigraphic evaluation of intra-arterial and intravenous regional limb perfusion of allogeneic bone marrow-derived mesenchymal stem cells in the normal equine distal limb using (99m) Tc-HMPAO.</a> Equine Veterinary Journal. 44, 594-599 (2012).</li><li>Carvalho, A. 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Inflammation/Infection Taskgroup of the European Association of Nuclear Medicine.</a> European Journal of Nuclear Medicine and Molecular Imaging. 37, 842-848 (2010).</li><li>Trela, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Scintigraphic+comparison+of+intra-arterial+injection+and+distal+intravenous+regional+limb+perfusion+for+administration+of+mesenchymal+stem+cells+to+the+equine+foot.">Scintigraphic comparison of intra-arterial injection and distal intravenous regional limb perfusion for administration of mesenchymal stem cells to the equine foot.</a> Equine Veterinary Journal. 46, 479-483 (2014).</li><li>Barbash, I. 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In addition to bone marrow, stem cells isolated from sources such as adipose tissue are suitable for labeling with this protocol. Furthermore, cells from a frozen state may be revived and expanded in culture to the desired numbers for labeling studies12.
A critical factor that determines the efficiency of labeling the BMMSC is the time between elution of the Tc-99m from the molybdenum generator at the radiopharmacy, preparation of Tc-99m-HMPAO and use of the radiopharmaceutical in t...

Regenerative strategies for the repair of diseased or damaged tissues are based on multipotent stem cells derived from a variety of tissue and implanted into the affected area. Recent advances in the application of autologous BMMSC for the treatment of tendon and ligament injuries in the horse have shown improved outcome measures in both experimental1-5 and clinical studies6. The horse is a particularly attractive model for assessing the efficacy of stem cell related treatments because it suffers from age and overstrain related injuries to the tendons of the distal forelimb, it is an athletic animal, and it is a large, facilitating bone marrow recovery and accurate implantation. Tendon injuries heal naturally with fibrosis but the healed tendon is functionally inferior7 and has a high risk of re-injury8. The superficial digital flexor tendon (SDFT) is most commonly affected as it has evolved to act as an elastic energy store and experiences high loading stresses to achieve energy efficient and high speed locomotion. Restoring function after injury is therefore critical. These injuries are similar to those affecting the Achilles tendon in humans which performs a similar function9. There are no good treatment options to treat or achieve good repair for such injuries, therefore cell-based regenerative strategies offer an attractive opportunity to improve outcomes and to reduce re-injury.
In most studies 5 &#8211; 20 million autologous BMMSC are injected directly into the lesion which usually occur within the core of the tendon body which therefore acts as a receptacle for the cells. The fate of the cells once injected is not clear and different cell labeling methods to track the cells have been described recently. Cells labeled with a fluorescence tag were shown to survive only in relatively small numbers (&#60;10%)10,11. Fluorescence labels necessitate tissue extraction and sectioning for histological analysis which is time consuming and does not readily facilitate temporal analysis in a large animal model or in clinical cases. In more recent work we have used the radioisotope 99mTc to label cells and follow their fate by gamma scintigraphy1. This method allows rapid comparisons to be made between different routes of cell delivery, including intralesional, intravenous via the jugular vein1 or regional perfusion via intra-arterial12 or intravenous1,12 injections. The persistence and distribution of cells can then be imaged by gamma scintigraphy of various organs. This has demonstrated that only 24% of the cells injected intralesionally remained in the lesion by 24 hr1 and this is supported by another study using experimentally created lesions and using the same radiolabel5. Furthermore, the cells show limited ability to home into tendon lesions when delivered by regional perfusion or intravenously but are dispersed into the lungs by the latter routes4.
BMMSC labeled with iron nanoparticles is an alternative method to track cells implanted into forelimb tendons13. Although iron nanoparticle labeled cells allow cell tracking in vivo by MRI, temporal studies in a large animal are limited by the number of times anesthesia can be administered at each time point for performing the MRI scans. Furthermore, iron nanoparticles are hypointense on MRI which limits the information on the migration of labeled cells into the tendon body. Other radioisotopes that can be used include Indium-111 but this suffers the disadvantage of a longer half-life than Tc-99m (2.8 days vs 6.0 hr) and higher gamma ray emission energy. In addition, cell viability has been reported to be reduced when labeled with Indium-11114. Tc-99m, on the other hand, is routinely used in both equine and human nuclear medicine to label peripheral blood mononuclear cells and follow their distribution in vivo by scintigraphy. It can be relatively easily taken up by cells using HMPAO as a linker molecule to bind the technetium, as Tc-99m-HMPAO, to cells. Tc-99m-HMPAO labeled BMMSC show good viability and can proliferate in vitro4. This protocol details the labeling and tracking of equine autologous BMMSC implanted into naturally occurring lesions in the forelimb SDFT.
It is important to note that the protocol is intended only to be used as a research tool. Its use as a clinical therapeutic modality is not recommended as the effect of the radiolabel on cellular phenotype has not been fully elucidated.

<table>
	<tbody>
		<tr>
			<td>Technetium99m&#160;</td>
			<td></td>
			<td></td>
			<td>Please enquire with local ionisation radiation supplier in accordance with legal requirements.&#160; The isotope must be used within 2 h of elution from the molybdenum-99 generator</td>
		</tr>
		<tr>
			<td>Ceretec - Hexamethylpropyleneamine oxime (HMPAO)&#160;</td>
			<td>GE HealthCare</td>
			<td></td>
			<td>Please enquire directly with GE HealthCare</td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Microfuge, Minispin/Minispin Plus</td>
			<td>Ependorf</td>
			<td>22620100</td>
			<td></td>
		</tr>
		<tr>
			<td>18G and 19G Needles</td>
			<td>Terumo Medical</td>
			<td>NN-1838R (18G);&#160;&#160;&#160;&#160;&#160;&#160;&#160;&#160; NN1938R (19G)</td>
			<td></td>
		</tr>
		<tr>
			<td>Syringes 1 mL and 2 mL</td>
			<td>Scientific Laboratory Supplies Ltd</td>
			<td>SYR6200 (1 mL); SYR6003 (2 mL)</td>
			<td></td>
		</tr>
		<tr>
			<td>Microcentrifuge tubes 1.5 mL</td>
			<td>Greiner Bio-One Ltd</td>
			<td>616201</td>
			<td></td>
		</tr>
		<tr>
			<td>PBS - Phosphate-Buffered Saline</td>
			<td>LifeTechnologies</td>
			<td>14190</td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile Gauze Swabs</td>
			<td>Shermond Ltd</td>
			<td>UNG602</td>
			<td></td>
		</tr>
		<tr>
			<td>CoflexVet self adhering bandage</td>
			<td>Andover Healthcare, Inc.</td>
			<td>3540RB-018</td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasound imaging software</td>
			<td>Scion Image, Scion Corporation, USA</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>MicasXplus Scintigram processing software</td>
			<td>Bartec Technologies Ltd</td>
			<td></td>
			<td>http://www.bartectechnologies.com/veterinaryscintigraphy.html</td>
		</tr>
		<tr>
			<td>Field isotope counter for monitoring isotope</td>
			<td>John Caunt U.K.</td>
			<td>GMS1800a</td>
			<td>http://www.johncaunt.com/</td>
		</tr>
		<tr>
			<td>Well counter for isotope measurements, dose calibrator</td>
			<td>Capintec Southern Scientific</td>
			<td>CRC-25R</td>
			<td></td>
		</tr>
	</tbody>
</table>

in vivo imaging and tracking of technetium-99m labeled bone marrow mesenchymal stem cells in equine tendinopathy

Recent advances in the application of bone marrow mesenchymal stem cells (BMMSC) for the treatment of tendon and ligament injuries in the horse suggest improved outcome measures in both experimental and clinical studies. Although the BMMSC are implanted into the tendon lesion in large numbers (usually 10 - 20 million cells), only a relatively small number survive (&#60;10%) although these can persist for up to 5 months after implantation. This appears to be a common observation in other species where BMMSC have been implanted into other tissues and it is important to understand when this loss occurs, how many survive the initial implantation process and whether the cells are cleared into other organs. Tracking the fate of the cells can be achieved by radiolabeling the BMMSC prior to implantation which allows non-invasive in vivo imaging of cell location and quantification of cell numbers.
This protocol describes a cell labeling procedure that uses Technetium-99m (Tc-99m), and tracking of these cells following implantation into injured flexor tendons in horses. Tc-99m is a short-lived (t1/2 of 6.01 hr) isotope that emits gamma rays and can be internalized by cells in the presence of the lipophilic compound hexamethylpropyleneamine oxime (HMPAO). These properties make it ideal for use in nuclear medicine clinics for the diagnosis of many different diseases. The fate of the labeled cells can be followed in the short term (up to 36 hr) by gamma scintigraphy to quantify both the number of cells retained in the lesion and distribution of the cells into lungs, thyroid and other organs. This technique is adapted from the labeling of blood leukocytes and could be utilized to image implanted BMMSC in other organs.

Tc-99m-HMPAO incorporation into BMMSs does not adversely affect their ability to adhere to tissue culture plastic and while they show proliferation ability to form monolayers (Figure 1) we have not fully determined whether proliferation rates or other cellular phenotypes are affected. Their morphology is similar to unlabeled cells with a typical spindle shape. The cellular labeling efficiency (i.e., uptake of label) typically varies from about 1.5% to 25%. The main reason for the low labeling ef...

Watch this Scientific Journal Video about In Vivo Imaging and Tracking of Technetium-99m Labeled Bone Marrow Mesenchymal Stem Cells in Equine Tendinopathy at JoVE.com

In Vivo Imaging and Tracking of Technetium-99m Labeled Bone Marrow Mesenchymal Stem Cells in Equine Tendinopathy

This protocol describes the radiolabeling of equine mesenchymal stem cells and their implantation into tendon injuries in the horse in order to determine cell survival and tissue distribution using gamma scintigraphy.

In Vivo Imaging and Tracking of Technetium-99m Labeled Bone Marrow Mesenchymal Stem Cells in Equine Tendinopathy

Recent advances in the application of bone marrow mesenchymal stem cells (BMMSC) for the treatment of tendon and ligament injuries in the horse suggest ...

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