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Method Article
This protocol describes a new intraoperative imaging technique that uses a ruthenium complex as a source of chemiluminescent light emission, thereby producing high signal-to-noise ratios during in vivo imaging. Intraoperative imaging is an expanding field that could revolutionize the way that surgical procedures are performed.
Intraoperative imaging techniques have the potential to make surgical interventions safer and more effective; for these reasons, such techniques are quickly moving into the operating room. Here, we present a new approach that utilizes a technique not yet explored for intraoperative imaging: chemiluminescent imaging. This method employs a ruthenium-based chemiluminescent reporter along with a custom-built nebulizing system to produce ex vivo or in vivo images with high signal-to-noise ratios. The ruthenium-based reporter produces light following exposure to an aqueous oxidizing solution and re-reduction within the surrounding tissue. This method has allowed us to detect reporter concentrations as low as 6.9 pmol/cm2. In this work, we present a visual guide to our proof-of-concept in vivo studies involving subdermal and intravenous injections in mice. The results suggest that this technology is a promising candidate for further preclinical research and might ultimately become a useful tool in the operating room.
In recent decades, imaging technologies have revolutionized the way that physicians diagnose and monitor disease. These imaging technologies, however, have been largely limited to whole body imaging systems, such as positron emission tomography (PET), single photon-emission computed tomography (SPECT), computed tomography (CT), and magnetic resonance imaging (MRI). Particular attention has been paid to cancer, and technological imaging breakthroughs have greatly improved the way that this disease is diagnosed and treated. Despite these advances, there is one place where these imaging technologies just don't fit: the operating room. While whole body imaging techniques can help in surgical planning, they typically lack spatial resolutions high enough to help physicians determine in real-time whether all of the tumor tissue has been removed or residual tumor tissue remains hidden at the surgical margins1. Making sure that no infiltrative tumor margins are left behind is one of the most important surgical goals, and surgeons must walk a tight-rope between rigorous and cautious tissue resection. If too much is removed, unwanted side effects for the patient are exacerbated; if too little is removed, recurrence rates are increased2,3. Therefore, it is crucial to delineate accurate tumor margins, and we believe that chemiluminescent intraoperative imaging can help to improve the accuracy of the identification of tumor margins by helping surgeons to visualize malignant tissue that could otherwise remain undetected with established techniques.
There are many imaging technologies currently being investigated for their possible utility as intraoperative imaging systems. These include β- and γ-radiation-emitting probes4, optical fluorescence5, Raman spectroscopy6,7, and Cherenkov luminescence8,9. To date, however, none of these have become established as standard clinical tools. Optical fluorescence imaging has so far proven to be the most promising of these techniques and is therefore the most explored. While it has already been shown to be a valuable tool for many applications, it is not without its limitations. Indeed, its principal drawback is the background fluorescence generated by inherently autofluorescent biological tissue. This background autofluorescent signal is a product of the excitation of the surrounding tissue, in addition to the fluorophore, by the external light source needed for the generation of a fluorescent signal. From a practical perspective, this autofluorescence can potentially lead to low signal-to-noise ratios, which can limit the utility of this technology in the operating room.
The principal advantage of chemiluminescence imaging over fluorescence imaging is that no excitation light is necessary. As a result, there is no background autofluorescence. In chemiluminescence imaging, the excitation energy is instead generated chemically. This process produces no unintended background signal and therefore can result in higher signal-to-noise ratios. This could ultimately result in the more precise and accurate detection of surgical margins. Somewhat surprisingly, the utility of this approach as an intraoperative imaging technique has remained unexplored10. Indeed, the closest example to this technique is the oxidation of luminol by myeloperoxidase in mice11,12,13. Chemiluminescent biomedical imaging is therefore a rather unexplored area of research that could offer the following advantages: (1) minimal autofluorescence resulting in a low background signal with higher signal-to-noise ratios; (2) tunable wavelengths of chemiluminescent emissions ranging from the visible to the near-infrared; and (3) functionalizable chemiluminescent complexes that, when combined with linker technologies and targeted biomolecules that already exist, provide access to whole libraries of targeted molecular imaging probes14.
This proof-of-principle study illustrates the potential utility of chemiluminescent imaging in the biomedical setting using a ruthenium-based imaging agent. The chemiluminescent properties of this compound are well studied, with investigations dating back to the mid-1960s15. Upon chemical activation, the agent produces light at around 600 nm16, which is well suited for medical imaging purposes. The activation energy is provided by a redox reaction that leads to an excited state-which has a lifetime of 650 ns in water17-followed by the generation of photons upon relaxation of this excited state. Through the use of a specially-designed remote nebulizer, we were able to detect the compound both ex vivo and in vivo. The results of initial experiments are very promising, suggesting further investigation of this technology.
Ethics statement: All of the in vivo animal experiments described were performed according to an approved protocol and under the ethical guidelines of the Memorial Sloan Kettering Cancer Center (MSK) Institutional Animal Care and Use Committee (IACUC).
1. Construction of a Nebulizing Device
2. Sensitivity Determination of the Method
3. In Vivo Imaging After Systemic Intravenous Injection
4. In Vivo Imaging of Lymph Nodes
The nebulizer system described in protocol section 1 can be constructed from easily-available materials at a low cost. It is intended to be an inset for remote-triggered spraying of the reducing/oxidizing agent inside a bioluminescent reader (Figure 1). Our design allows for the safe operation of the nebulizer within the bioluminescence reader at a 14 cm distance from the lens. No fogging or blurring of the lens was observed during the operation. We selected the commercia...
Here, we have presented a technology that is capable of optically delineating tissue via the emission of photons created by a chemiluminescent reporter. In contrast to other, more established, technologies4,5,6,7,8,9, this chemiluminescent reporter system employs an imaging probe that is non-radioactive and facilitates detect...
The authors have nothing to disclose.
The authors thank Prof. Jan Grimm and Mr. Travis Shaffer for their helpful discussions and Mr. David Gregory for editing the manuscript. Technical services provided by the MSK Animal Imaging Core Facility, supported in part by NIH Cancer Center Support Grant P30CA008748-48, are gratefully acknowledged. The authors thank the NIH (K25 EB016673 and R21 CA191679, T.R. and 4R00CA178205-02, B.M.Z.), the MSK Center for Molecular Imaging and Nanotechnology (T.R.), the Tow Foundation (B.C.), and the National Science Foundation Integrative Graduate Education and Research Traineeship (IGERT 0965983 at Hunter College for B.C. and T.M.S.) for their generous support. The research reported in this publication was supported by funding from the King Abdullah University of Science and Technology.
Name | Company | Catalog Number | Comments |
Wood part A (12.5 × 2.5 × 1.8 cm) | Woodcraft | 131404 | Cut from a 3/4” x 24” x 30” birch plywood sheet |
Wood part B (12.7 × 10.7 × 1.8 cm) | Woodcraft | 131404 | Cut from a 3/4” x 24” x 30” birch plywood sheet |
Wood part C (11 × 2.5 × 1.8 cm) | Woodcraft | 131404 | Cut from a 3/4” x 24” x 30” birch plywood sheet |
Screws (4 × 25 mm) | Screwfix | 79939 | |
Harmon Face Values 3 oz mini sprayer | Bed, Bath and Beyond | ||
stainless steel rod (10 cm of 1/16” steel) | Metals Depot Int. Inc. | 2192 | |
Pencil Classic HB | Papermate | 58592 | |
Paper clip | Office Depot | 221720 | |
speaker cable | RCA Inc. | AH1650SN | |
Energizer 9V alkaline battery | Energizer Holdings Inc. | EN22 | |
Hitech HS-82MG Micro Servo Motor, 3.4 kg/cm output torque @ 6V | Hitech RCD USA Inc. | 32082S | |
Name | Company | Catalog Number | Comments |
28 cm plastic cable ties | General Electric Inc. | 50725 | |
Duct tape | 3M Inc. | 3939 | |
littleBits w1 wire | littleBits Inc. | w1 wire | |
littleBits p1 power | littleBits Inc. | p1 power | |
littleBits i2 toggle switch | littleBits Inc. | i2 toggle switch | |
littleBits 011 servo | littleBits Inc. | 011 servo | |
20 cm plastic covered wire twist ties | Four Star Plastics | 71TIE8000 | |
Tris(2,2′-bipyridyl)dichlororuthenium(II) hexahydrate | Sigma-Aldrich Inc. | 224758 | |
Ammonium cerium(IV) nitrate | Sigma-Aldrich Inc. | 22249 | |
Isofluorane | Baxter Healthcare | 1001936060 | |
PBS | Sigma-Aldrich | PBS1 | |
Ethanol | Sigma-Aldrich | 2854 | |
Triethylamine | Sigma-Aldrich Inc. | T0886 | |
Water | Water was purified using a Milipore Mili-Q (R ≥ 18 MΩ) | ||
Female nude (outbred) mice | Jackson Laboratories | 1929 | age 5 - 6 weeks |
Strain C57BL/6J | |||
NU/J male mice at | Jackson Laboratories | 2019 | age 6 – 8 weeks |
IVIS 200 bioluminescence reader | Caliper Live Science | ||
Live Image 4.2 software | Perkin-Elmer | 128165 | |
Microscope slides | ThermoScientific | 4951PLUS4 |
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