Molecular imaging of spatio-temporal distribution of angiogenesis in hindlimb ischemia model and diabetic milieu

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Τσιουπινάκη, Κωνσταντία
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In the current thesis, spatio-temporal evaluation of the endogenous angiogenic response to ischemia was perfomed. After vascular occlusion, ischemic angiogenesis is an important reparative mechanism and can ameliorate the outcome of ischemic disease. Diabetic foot ulcers affect almost 15% of diabetic patients and are the leading cause of amputations worldwide (Yoon et al., 2005). Diminished blood flow because of atherosclerotic occlusive disease of the peripheral arteries of diabetic patients, in conjunction with anatomic and functional microcirculatory impairments contribute to development of trophic ulcerations, infections and gangrene of the lower extremities, frequently requiring amputation of the leg (Sasso et al., 2005). Numerous studies have confirmed the impaired post-ischemic angiogenesis in diabetes (Yoon et al., 2005; Sasso et al., 2005). Consequently, wound healing patterns are disturbed in diabetes mainly due to decreased ischemia-driven angiogenesis (Yoon et al., 2005). Integrin ανβ3 is a promising imaging target of angiogenic activity which is up-regulated on activated endothelial cells (ECs) but not on quiescent ones. Molecular imaging (MI) of ανβ3 integrin expression with the aid of a dedicated high resolution gamma camera, is a very sensitive imaging approach for the evaluation of angiogenesis in the rabbit hindlimb ischemia model. Furthermore, diabetes mellitus (DM) was induced, to study the effects of this pathology on the spatio-temporal distribution of angiogenesis. In order to evaluate the whole spectrum of endogenous process of collateralization after occlusion of an artery, Digital Subtraction Angiography (DSA) was also used for the visualization of larger collaterals. During the first part of the study DM experimental protocol was investigated in order to find the appropriate protocol for the induction of long-term diabetic animal model, as it is a methodology that has not yet been standardized. At the same time a cohort of animals underwent endovascular embolization for the establishment of hindlimb ischemia and were imaged with the aid of a MI radiotracer technique in order to deal with unresolved issues and establish the imaging protocol. The study included seven New Zealand White (NZW) rabbits that underwent unilateral percutaneous endovascular embolization of the femoral artery, for the establishment of hindlimb ischemia that triggers the endogenous process of collateralization. The contralateral limb was not embolized and served as a control. The employed radiotracer for angiogenesis imaging, was a 99mTc labeled cyclic RGD peptide [c RGDfk-His]-99mTc that binds specifically to ανβ3 integrin via the three amino acid sequence Arginine-Glycine-Aspartic acid or RGD. Image acquisition was performed with a high resolution gamma camera and all animals underwent molecular imaging on the 3rd and the 9th day post-embolization. In all animals DSA was performed on the 9th day post-embolization. The acquired images demonstrated that retention of the radiotracer at the ischemic tissue is remarkably increased compared to the non-ischemic hindlimb (normal limb) (16020 ± 2309 vs. 13139 ± 2493 on day 3; p=0.0014 and 21616 ± 2528 vs. 13362 ± 2529 on day 9; p<0.0001, respectively). In addition, radiotracer retention in normal limbs seems to be increased at day 9 in normal limbs compared to day 3 (p=0.0112). DSA at day 9, demonstrated that the mean vessel length detected was significantly superior in the normal compared to the ischemic limb (mean value 3680 ± 369.8 vs.2772 ± 267.7; p< 0.0001, respectively). Angiogenesis was successfully detected using a 99mTc labeled cyclic RGD peptide MI technique and was significantly more pronounced in the ischemic compared to normal limbs, both at day 3 and day 9 after embolization. The peak of the phenomenon was detected at day 9. Increased mean vessel length in the normal compared to the ischemic limb demonstrates that although angiogenesis is pronounced in day 9, arteriogenesis is not sufficiently pronounced and that the phenomenon of arteriogenesis has just initiated. The study of the angiogenic response to ischemia, has not yet been completed as MI of diabetic animals with hindlimb ischemia is underway and not completed due to many difficulties and delay in different phases of the experiment. With the conclusion of the MI of diabetic animals with hindlimb ischemia, the study will be completed and we expect to demonstrate the effect of DM on the spatio-temporal pattern of angiogenesis, providing a valuable tool in clinical practice for the precise and early diagnosis and therapy assessment of the ‘diabetic foot’.
Angiogenesis, Molecular imaging, Integrin αvβ3, 99mTc, SPECT