Elucidating structure-function relationships from molecule-to-cell-to-tissue: from research modalities to clinical realities.

The National Academy of Engineering selected 'Imaging' as one of the greatest engineering achievements of the 20th century (Greatest Engineering Achievements of the 20th Century. 2009 (cited 2008, November 10); available from: http://www.greatachievements.org/). The combination of different imaging modalities and technologies for mapping bimolecular and/or biological processes within single cells or even whole organs has extraordinary potential for revolutionizing the diagnosis and treatment of pathophysiological disorders, and thus for mitigating the significant social and economic costs associated with the clinical management of disease. Such integrated imaging approaches will eventually lead to individualized programs for disease prevention through advanced diagnosis, risk stratification and targeted cell therapies resulting in more successful and efficient health care. The goal of this article is to provide readers with a current update of selected of state-of-the-art imaging modalities which would likely to lead to improved clinical outcomes if employed in an integrated approach, including use of ultramicrosensors to detect reactive oxygen/nitrogen species in a single cell, use of electron tomography to visualize and characterize cellular organization in three dimensions (3D), and molecular imaging strategies to assess naturally occurring and therapeutic peripheral and myocardial angiogenesis using targeted radiolabeled tracers.

Regional hypoxia correlates with the uptake of a radiolabeled targeted marker of angiogenesis in rat model of myocardial hypertrophy and ischemic injury.

BACKGROUND: Non-invasive imaging strategies play a critical role for assessment of the efficacy of angiogenesis therapies. Hypoxia resulting from deficient blood flow is a potent stimulator of angiogenesis which is marked by upregulated alphavbeta3 integrin receptor. METHODS AND RESULTS: The use of dual-isotope radiotracers targeted at alphavbeta3 and myocardial hypoxia has been demonstrated to non-invasively track hypoxia-induced angiogenesis in ischemic rat model of myocardial hypertrophy, which was induced by non-occlusive abdominal aortic banding followed by myocardial infarction at 6 weeks after the banding procedure. The pressure overload-induced myocardial hypertrophy was confirmed by 2D echocardiography. Two radiotracers; 111In-labeled agent targeted at the alphavbeta3 (RP748) and 99mTc-labeled nitroimidazole retained in hypoxic myocardium (BRU-5921) have been used. Gamma well counting analysis demonstrated an inverse linear relationship (R2=0.5) between BRU-5921 myocardial uptake and the degree of hypoperfusion assessed by 201Tl chloride. 111In-RP748 was found to be preferentially retained in hypoxic myocardium identified by increased BRU-5921 uptake and localized to anterior-lateral wall as assessed by dual-isotope microautoradiography. There was a significant (P<0.01) almost four-fold increase in RP748 uptake in myocardial segments with highest relative BRU-5921 retention (200-600% non-ischemic). Immunohistochemical staining confirmed that increased RP748 uptake is associated with an augmented alphav and beta3 integrin expression within infarcted myocardium. CONCLUSIONS: Angiogenesis in the rodent model of combined myocardial hypertrophy and infarction was successfully assessed with alphavbeta3-targeted agent in relation to tissue hypoxia measured with 99mTc -labeled nitroimidazole retained in hypoxic myocardium. Regional retention of RP748 correlated well with BRU-5921 retention, supporting the role of RP748 as a targeted marker of hypoxia-stimulated angiogenesis with a potential clinical use to track naturally occurring and therapeutic angiogenesis and to predict the left ventricular remodeling in patients following myocardial infarction.

Molecular imaging. A new approach to nuclear cardiology.

Nuclear cardiology has historically played an important role in detection of cardiovascular disease as well as risk stratification. With the growth of molecular biology have come new therapeutic interventions and the requirement for new diagnostic imaging approaches. Noninvasive targeted radiotracer based as well as transporter gene imaging strategies are evolving to meet these new needs, but require the development of an interdisciplinary approach which focuses on molecular processes, as well as the pathogenesis and progression of disease. This progress has been made possible with the availability of transgenic animal models along with many technological advances. Future adaptations of the developing experimental procedures and instrumentation will allow for the smooth translation and application to clinical practice. This review is intended as a brief overview on the subject molecular imaging. Basic concepts and historical perspective of molecular imaging will be reviewed first, followed by description of current technology, and concluding with current applications in cardiology. The emphasis will be on the use of both single photon emission computed tomography (SPECT) and positron emission tomography (PET) radiotracers, although other imaging modalities will be also briefly discussed. The specific approaches presented here will include receptor-based and reporter gene imaging of natural and therapeutic angiogenesis.

Central hypotensive action of clonidine requires nitric oxide.

Background- Clonidine has an antihypertensive effect by its action in the brain and, because we observed that the tonic production of nitric oxide (NO) in the brain is required to maintain blood pressure at its low, normotensive level, the current study was designed to determine whether the hypotensive action of clonidine resulted from its stimulation of excess NO in the brain. Methods and Results- Porphyritic microsensors were used to quantify NO concentration in the nucleus tractus solitarius (NTS) in vitro in brain slices and in vivo in the anesthetized rat. In both preparations, the basal production of NO in the NTS was 15+/-3 nmol/L. In vitro stimulation of the NTS with clonidine (50 nmol/L) resulted in an increase in the NO concentration to 84+/-7 nmol/L. In vivo, the intracerebroventricular (ICV) infusion of clonidine (0.03 microgram) caused an increase in NO concentration in the NTS to 128+/-17 nmol/L. This ICV injection of clonidine caused a fall in mean arterial pressure of -22+/-1 mm Hg and a decrease of heart rate of -18+/-2%. The blockade of NO production with N(G)-nitro-L-arginine-methyl ester (2 micromol; delivered ICV, 30 minutes before the clonidine) reduced responses to clonidine for both mean arterial pressure and heart rate (-3+/-1 mm Hg and -2+/-1% change, respectively). Conclusion- The stimulation of the release of NO in the brain by clonidine contributes to its central antihypertensive action.

Nitric oxide as a second messenger in parathyroid hormone-related protein signaling.

Parathyroid hormone (PTH)-related protein (PTHrP) is produced in smooth muscles and endothelial cells and is believed to participate in the local regulation of vascular tone. No direct evidence for the activation of endothelium-derived nitric oxide (NO) signaling pathway by PTHrP has been found despite attempts to identify it. Based on direct in situ measurements, it is reported here for the first time that the human PTH/PTHrP receptor analogs, hPTH(1--34) and hPTHrP(1--34), stimulate NO release from a single endothelial cell. A highly sensitive porphyrinic microsensor with a response time of 0.1 ms and a detection limit of 1 nmol/l was used for the measurement of NO. Both hPTH(1--34) and hPTHrP(1--34) stimulated NO release at nanomolar concentrations. The peak concentration of 0.1 micromol/l hPTH(1--34)- and 0.1 micromol/l hPTHrP(1--34)-stimulated NO release was 175+/-9 and 248+/-13 nmol/l respectively. This represents about 30%--40% of maximum NO concentration recorded in the presence of (0.1 micromol/l) calcium ionophore. Two competitive PTH/PTHrP receptor antagonists, 10 micromol/l [Leu(11),d -Trp(12)]-hPTHrP(7--34)amide and 10 micromol/l [Nle(8,18),Tyr(34)]-bPTH(3--34)amide, were equipotent in antagonizing hPTH(1--34)-stimulated NO release; [Leu(11),d -Trp(12)]-hPTHrP(7--34)amide was more potent than [Nle(8,18),Tyr(34)]-bPTH(3--34)amide in inhibiting hPTHrP(1--34)-stimulated NO release. The PKC inhibitor, H-7 (50 micromol/l), did not change hPTH(1--34)- and hPTHrP(1--34)-stimulated NO release, whereas the combined effect of 10 micromol/l of the cAMP antagonist, Rp-cAMPS, and 50 micromol/l of the calmodulin inhibitor, W-7, was additive. The present studies show that both hPTH(1--34) and hPTHrP(1--34) activate NO production in endothelial cells. The activation of NO release is through PTH/PTHrP receptors and is mediated via the calcium/calmodulin pathway.

Statin-stimulated nitric oxide release from endothelium.

BACKGROUND: There is increasing evidence that loss of endothelium-derived NO is a major factor in cardiovascular complication events, and that NO might exert antiatherosclerotic actions. The beneficial effects of HMG CoA reductase inhibitors (statins) therapy in atherosclerosis outweigh those expected from simply lowering low-density lipoprotein (LDL) cholesterol, and may be related to the direct action in the endothelium. Based on these concepts, in the studies described here, the effect of new statin derivatives on nitric oxide (NO) and superoxide (O2-) release in bovine endothelial cells was tested. MATERIAL AND METHODS: Highly sensitive electrochemical NO and O2--microsensors were placed near the surface of endothelial cells, and the concurrent kinetics of NO and O2-- release were measured in situ. RESULTS: All tested statins stimulated NO release. The peak concentration of NO after stimulation with 1 Kmol/l Lovastatin, 1 Kmol/l Atorvastatin, 1 Kmol/l Pravastatin, or 1 Kmol/l Simvastatin was about 77%, 73%, 72%, and 44% lower, respectively, as compared with the NO peak concentration after stimulation with 1 Kmol/l calcium ionophore A23187 (receptor-independent agonist). The tested statins stimulated NO release in a modest way, which resulted in diminishing O2- generation during activation of nitric oxide synthase. Moreover, the kinetics of O2- release after administration of the statins suggested that these compounds may also scavenge O2-. The NO/O2- peak concentration ratio after the NOS agonists administration was as follows: 7.51 for CaI, 6.56 for Lovastatin, 6.00 for Atorvastatin, 4.17 for Pravastatin and 6.25 for Simvastatin. CONCLUSIONS: The tested statins, i.e. Lovastatin, Atorvastatin, Pravastatin and Simvastatin demonstrate variable potency to enhance the NO/O2- concentration ratio after stimulation of NOS, resulting in an increase of NO bioavailability in endothelial cells.

Nitric oxide measurements during endotoxemia.

BACKGROUND: Excessive continuous NO release from inducible NO synthase over prolonged periods under pathological conditions, such as endotoxemia, contributes significantly to circulatory failure, hypotension, and septic shock. This NO production during endotoxemia is accompanied by superoxide release, which contributes to the fast decay of NO. Therefore, the amount of NO that diffuses to target sites may be much lower than the total amount released under pathological conditions. METHODS: We performed in vivo and ex vivo measurements of NO (electrochemical) and ex vivo in situ measurements of superoxide, peroxynitrite (chemiluminescence), and nitrite and nitrate (ultraviolet-visible spectroscopy). We determined the effect of lipopolysaccharide administration (20 mg/kg) on diffusible NO, total NO (diffusible plus consumed in chemical reactions), and superoxide and peroxynitrite release in the pulmonary arteries of rats. RESULTS: An increase in diffusible NO generated by constitutive NO synthase was observed immediately after administration of lipopolysaccharide, reaching a plateau (145 +/- 18 nmol/L) after 540 +/- 25 s. The plateau was followed by a decrease in NO concentration and its subsequent gradual increase after 45 min because of NO production by inducible NO synthase. The concentration of superoxide increased from 16 +/- 2 nmol/L to 30 +/- 3 nmol/L after 1 h and reached a plateau of 41 +/- 4 nmol/L after 6 h. In contrast to the periodic changes in the concentration of diffusible NO, the total concentration of NO measured as a sum of nitrite and nitrate increased steadily during the entire period of endotoxemia, from 2.8 +/- 0.2 micromol/L to 10 +/- 1.8 micromol/L. CONCLUSIONS: The direct measurement of NO concentrations in the rat pulmonary artery demonstrates dynamic changes throughout endotoxemia, which are related to the production of superoxide and the subsequent increase in peroxynitrite. Monitoring endotoxemia with total nitrate plus nitrite is not sensitive to these fluctuations in NO concentration.

Nitric oxide deficiency contributes to large cerebral infarct size.

The purpose of this study was to examine the role played by a deficit in nitric oxide (NO) in contributing to the large cerebral infarcts seen in hypertension. Cerebral infarction was produced in rats by occlusion of the middle cerebral artery (MCA). Studies were performed in Sprague-Dawley (SD) rats subjected to NO synthase blockade (N(G)-nitro-L-arginine [L-NNA], 20 mg x kg(-1) x d(-1) in drinking water) and in spontaneously hypertensive stroke-prone rats (SHRSP). NO released in the brain in response to MCA occlusion was monitored with a porphyrinic microsensor in Wistar-Kyoto rats. The increment in NO released with MCA occlusion was 1.31+/-0.05 micromol/L in L-NNA-treated rats, 1.25+/-0.04 micromol/L in SHRSP, 2. 24+/-0.07 micromol/L in control SD rats, and 2.25+/-0.06 micromol/L in Wistar-Kyoto rats (P<0.0001 for control versus the other groups). Infarct sizes in the L-NNA-treated and control SD rats were 8.50+/-0. 8% and 5.22+/-0.7% of the brain weights, respectively (P<0.05). The basilar arterial wall was significantly thicker in L-NNA-treated rats compared with their controls. We conclude that both the deficit in NO and the greater wall thickness contribute to the larger infarct size resulting from MCA occlusion in SHRSP and in L-NNA-treated rats compared with their respective controls.

The protective role of nitric oxide in the brain ischemia.

A role of nitric oxide in ischemia/reperfusion (I/R) injury of brain in normotensive (Sprague-Dowley rats, SD) and stroke-prone spontaneously hypertensive rats (SHR-SP) was studied. Cerebral ischemia was produced in rats by occlusion of the middle cerebral artery (MCA). NO and O2- releases in the brain in response to MCA occlusion followed by reperfusion were simultaneously monitored (2h) using electrochemical microsensors. The size of infarct was evaluated in the course of I/R from images of brain slices stained with 2,3,5-triphenyltetrazolium chloride. Similar patterns of NO and O2- releases were exhibited for SD and SHR-SP rats in the entire course of the experiments. However, the concentration of NO release was significantly lower during I/R in SHR-SP than in SD rats (the maximal NO concentration was 2.61 +/- 0.22 micromol/L for SD and 1.51 +/- 0.16 micromol/L for SHR-SP rats; *P < 0.01). In contrast, the concentration of O2- release during cerebral ischemia was significantly higher in SHR-SP than SD rats (the maximal increase was 122 +/- 24 nmol/L for SD and 220 +/- 44 nmol/L for SHR-SP rats; *P<0.01). The infarct sizes revealed in the course of I/R were larger in SHR-SP than SD rats (1.8 +/- 0.4% vs. 1.1 +/- 0.4% at 30 min., 2.84 +/- 0.8% vs. 2.21 +/- 0.6% at 100 min. and 9.20 +/- 1.1% vs. 5.8 +/- 0.6% at 180 min. ofthe brain weights, respectively; *P < 0.01 for each time-point). These studies indicate that nitric oxide plays a protective role during I/R and deficiency of NO in SHR-SP rats is due to excess of O2- production. The deficiency in NO concentration correlates positively with the increase of cerebral I/R injury.

Nitric oxide release from normal and dysfunctional endothelium.

The endothelium plays a critical role in maintaining vascular tone by releasing vasoconstrictor and vasodilator substances. Endothelium - derived nitric oxide (NO) is a vasodilator rapidly inactivated by superoxide (O2-) found in significant quantities. The porphyrinic sensor (0.5-8 microm diameter) and chemiluminescence methods were used to measure NO and (O2-) respectively. Effects of hypertension, low density lipoprotein (LDL), and heart preservation on the release of NO and O2- were delineated. In the single endothelial cell (rat aorta) NO concentration was the highest in the cell membrane decreasing exponentially with distance from cell, and becoming undetectable beyond 50 microm and 25 microm for normotensive (WKY) and hypertensive (SHR) rats respectively. The endothelium of SHR released 40% less NO (300+/-25 nmol L(-1)) than that of normotensive rats (500+20 nmol L(-1)), due to the higher production of O2- in SHR rats. An exponentially decreasing NO production (from 1.20 +/- 0.15 to 0.16 +/- 0.05 micromol (L-1)) and concomitant increase of O2- generation (from 10 +/- 0.3 to 300 +/- 25 nmol L(-1) were observed in left ventricle of stored (eight hours) rabbit heart. Native and oxidized low density lipoproteins (nLDL and oxLDL) inhibited NO generation and increased O2- production. The local depletion of the L-arginine substrate may disarrange the nitric oxide synthase, leading to production of O2- from oxygen.