Thore Dietrich

Angiotensin II Type 2 Receptor Stimulation A Novel Option of Therapeutic Interference With the Renin-Angiotensin System in Myocardial Infarction?

Background— This study is the first to examine the effect of direct angiotensin II type 2 (AT2) receptor stimulation on postinfarct cardiac function with the use of the novel nonpeptide AT2 receptor agonist compound 21 (C21). Methods and Results— Myocardial infarction (MI) was induced in Wistar rats by permanent ligation of the left coronary artery. Treatment with C21 (0.01, 0.03, 0.3 mg/kg per day IP) was started 24 hours after MI and was continued until euthanasia (7 days after MI). Infarct size was assessed by magnetic resonance imaging, and hemodynamic measurements were performed via transthoracic Doppler echocardiography and intracardiac Millar catheter. Cardiac tissues were analyzed for inflammation and apoptosis markers with immunoblotting and real-time reverse transcription polymerase chain reaction. C21 significantly improved systolic and diastolic ventricular function. Scar size was smallest in the C21-treated rats. In regard to underlying mechanisms, C21 diminished MI-induced Fas-ligand and caspase-3 expression in the peri-infarct zone, indicating an antiapoptotic effect. Phosphorylation of the p44/42 and p38 mitogen-activated protein kinases, both involved in the regulation of cell survival, was strongly reduced after MI but almost completely rescued by C21 treatment. Furthermore, C21 decreased MI-induced serum monocyte chemoattractant protein-1 and myeloperoxidase as well as cardiac interleukin-6, interleukin-1&bgr;, and interleukin-2 expression, suggesting an antiinflammatory effect. Conclusions— Direct AT2 receptor stimulation may be a novel therapeutic approach to improve post-MI systolic and diastolic function by antiapoptotic and antiinflammatory mechanisms.

Assessment of Diffuse Myocardial Fibrosis in Rats Using Small-Animal Look-Locker Inversion Recovery T1 Mapping

Background— The concentration of gadopentetate dimeglumine in myocardium and blood can be assessed from T1 measurements and can be used to calculate the extracellular volume (ECV) of the myocardium. We hypothesized that diffuse myocardial fibrosis in a small-animal model could be quantitatively assessed by measuring myocardial ECV using small-animal Look-Locker inversion recovery T1 mapping. Methods and Results— Sprague-Dawley rats (n=10) were subjected to continuous angiotensin-2 (AT2) infusion for 2 weeks via a subcutaneously implanted minipump system. Magnetic resonance imaging (MRI) was performed both before and after AT2 infusion. The MRI protocol included multislice cine imaging and before-and-after contrast small-animal Look-Locker inversion recovery T1 mapping and late gadolinium enhancement imaging. Myocardial ECV was calculated from hematocrit and T1 values of blood and myocardium. During the course of AT2 infusion, the mean±SD systolic blood pressure increased from 122±10.9 to 152±27.5 mm Hg (P=0.003). Normalized heart weight was significantly higher in AT2-treated animals than in control littermates (P=0.033). Cine MRI documented concentric left ventricular hypertrophy. Postcontrast myocardial T1 times were shortened after treatment (median [interquartile range], 712 [63] versus 820 [131] ms; P=0.002). Myocardial ECV increased from 17.2% (4.3%) before to 23.0% (6.2%) after AT2 treatment (P=0.031), which was accompanied by perivascular fibrosis and microscarring on myocardial histological analysis. There was a moderate level of correlation between ECV and collagen volume fraction, as assessed by histological analysis (r=0.69, P=0.013). Conclusions— In a small-animal model of left ventricular hypertrophy, contrast-enhanced T1 mapping can be used to detect diffuse myocardial fibrosis by quantification of myocardial ECV.

In Vivo Imaging of the Inflammatory Receptor CD40 After Cerebral Ischemia Using a Fluorescent Antibody

Background and Purpose— Brain inflammation is a hallmark of stroke, where it has been implicated in tissue damage as well as in repair. Imaging technologies that specifically visualize these processes are highly desirable. In this study, we explored whether the inflammatory receptor CD40 can be noninvasively and specifically visualized in mice after cerebral ischemia using a fluorescent monoclonal antibody, which we labeled with the near-infrared fluorescence dye Cy5.5 (Cy5.5-CD40MAb). Methods— Wild-type and CD40-deficient mice were subjected to transient middle cerebral artery occlusion. Mice were either intravenously injected with Cy5.5-CD40MAb or control Cy5.5-IgGMAb. Noninvasive and ex vivo near-infrared fluorescence imaging was performed after injection of the compounds. Probe distribution and specificity was further assessed with single-plane illumination microscopy, immunohistochemistry, and confocal microscopy. Results— Significantly higher fluorescence intensities over the stroke-affected hemisphere, compared to the contralateral side, were only detected noninvasively in wild-type mice that received Cy5.5-CD40MAb, but not in CD40-deficient mice injected with Cy5.5-CD40MAb or in wild-type mice that were injected with Cy5.5-IgGMAb. Ex vivo near-infrared fluorescence showed an intense fluorescence within the ischemic territory only in wild-type mice injected with Cy5.5-CD40MAb. In the brains of these mice, single-plane illumination microscopy demonstrated vascular and parenchymal distribution, and confocal microscopy revealed a partial colocalization of parenchymal fluorescence from the injected Cy5.5-CD40MAb with activated microglia and blood-derived cells in the ischemic region. Conclusions— The study demonstrates that a CD40-targeted fluorescent antibody enables specific noninvasive detection of the inflammatory receptor CD40 after cerebral ischemia using optical techniques.

Small animal Look-Locker inversion recovery (SALLI) for simultaneous generation of cardiac T1 maps and cine and inversion recovery-prepared images at high heart rates: initial experience.

PURPOSE To develop a single magnetic resonance (MR) imaging approach for comprehensive assessment of cardiac function and tissue properties in small animals with high heart rates. MATERIALS AND METHODS All animal studies were approved by the local animal care committee. Small animal Look-Locker inversion recovery (SALLI) was implemented on a clinical 3.0-T MR unit equipped with a 70-mm solenoid coil. SALLI combines a segmented, electrocardiographically gated, inversion recovery-prepared Look-Locker-type pulse sequence with a multimodal reconstruction framework. Temporal undersampling and radial nonbalanced steady-state free precession enabled acceleration of data acquisition and reduction of motion artifacts, respectively. Nine agarose gel phantoms were used to investigate different sequence settings. For in vivo studies, 10 Sprague-Dawley rats were evaluated to establish normal T1 values before and after injection of gadopentetate dimeglumine. Seven rats with surgically induced acute myocardial infarction were examined to test the feasibility of detecting myocardial injury. In vitro T1 behavior was studied with linear regression analysis, and in vivo T1 differences between infarcted and remote areas were tested by using the Wilcoxon signed rank test. RESULTS Phantom studies demonstrated systematic behavior of the T1 measurements, and T1 error could be reduced to 1.3% ± 7.4 by using a simple linear correction algorithm. The pre- and postcontrast T1 of myocardium and blood showed narrow normal ranges. In the area of infarction, SALLI demonstrated hypokinesia (on cine images), myocardial edema (on precontrast T1 maps), and myocardial necrosis (on postcontrast T1 maps and late gadolinium enhancement images). CONCLUSION An MR imaging method enabling simultaneous generation of cardiac T1 maps and cine and inversion recovery-prepared images at high heart rates is presented. SALLI allows for simultaneous and time-efficient assessment of cardiac T1 behavior, function, and late gadolinium enhancement at high heart rates.

Monitoring therapeutical intervention with ezetimibe using targeted near-infrared fluorescence imaging in experimental atherosclerosis.

Ezetimibe (EZE), an inhibitor of cholesterol absorption, reduces atherosclerosis in apolipoprotein E–deficient (apo–/–) mice. The matrix protein ED-B fibronectin (ED-B) is upregulated in atherosclerotic lesions. Using a novel conjugate for near-infrared fluorescence (NIRF) imaging targeting ED-B, we studied the effect of EZE on plaque lesion formation in apoE–/– mice. ApoE–/– mice received EZE (5 μg/kg/d) or chow up to the age of 4, 6, and 8 months. NIRF imaging of aortic lesions was performed 24 hours after intravenous application ex vivo and in vivo. Plaque lesion formation was analyzed by histology and immunohistochemistry. Aortic lesion formation detected by Sudan staining and NIRF imaging was significantly reduced at 6 and 8 months (p < .001). Plaque areas determined by NIRF imaging significantly correlated with Sudan staining (p < .001). EZE treatment resulted in a significant reduction in plaque macrophage and ED-B immunoreactivity (both p < .05) in brachiocephalic lesions. There was a significant reduction in plaque size in brachiocephalic arteries in 8-month-old mice treated with EZE compared with mice during short-term treatment (p < .05), indicating EZE plaque regression. Targeted NIRF imaging showed a correlation to histologic lesion extension during therapeutical intervention in experimental atherosclerosis.

Magnetic Resonance Imaging of Cardiovascular Fibrosis and Inflammation: From Clinical Practice to Animal Studies and Back

Late gadolinium enhancement is the technique of choice for detecting myocardial fibrosis. Although this technique is used in a wide range of cardiovascular pathologies, ischemic cardiomyopathy and the workup for myocarditis and other cardiomyopathies make up a significant proportion of the total indications. Multiple studies during the last decade have demonstrated its utility to adequately characterize myocardial tissue and offer diagnostic and prognostic information. Recent T1 mapping techniques aim to overcome the limitations of late gadolinium enhancement to assess diffuse fibrosis. 19F magnetic resonance has recently emerged as a promising technique for the assessment of inflammation. In the following review we will discuss the basic aspects of fibrosis assessment with MR and its utility for diagnostic and prognostic evaluation. We will also address the topic of cardiovascular inflammation imaging with 19F as a potential new development that may broaden the indications for MR in the future.

Aortic Stiffness, Impaired Fasting Glucose, and Aging

The arterial wall is subject to a continuous process of structural, cellular, and molecular modifications that involve cellular growth processes, apoptosis, cell migration, inflammation, and fibrosis, resulting in changes of wall structure and dimension, as well as contractile and elastic properties. Physiological remodeling is an adaptive response to hemodynamic changes in the sense of repair or adjustment. Cardiovascular (CV) diseases, such as diabetes mellitus (DM) and hypertension, as well as aging, lead to enhancement of vascular maladaptive processes and the formation of atherosclerotic lesions and calcifications. One essential consequence of these maladaptive processes is the change of the arterial wall structure and the loss of the elastic properties of the conduit arteries, which is of growing clinical relevance. This phenomenon is termed “arterial stiffening.” This process leads to increased pulse wave velocities and an increase of systolic and pulse pressures attributable to an alteration in the timing of reflected waves.1 Various studies using a variety of indices have established that arterial stiffness is increased with CV risk factors for atherosclerosis, is higher in women, and increases with age even in the absence of vascular disease or risk factors.2,3 Elevated blood pressure related to peripheral vasoconstriction increases aortic stiffness, which is an independent predictor of primary coronary events in patients with essential hypertension.4,5 The relevance of arterial stiffness, carotid pulse pressure, and augmentation index, as independent predictors for CV events, comes from epidemiological studies. The largest amount of evidence has been given for aortic stiffness, measured through carotid-femoral pulse wave velocity (PWV), as >10 000 subjects have been included in studies.1 DM is associated with a high risk for CV morbidity and mortality, including myocardial infarction, left ventricular (LV) hypertrophy, heart failure (HF), and stroke.6 DM leads to abnormal stiffening of the aorta and the large …

T1 mapping allows the study of the development of oedema in a small animal model of Ischemia-Reperfusion

Background Ischemic cell death is characterised by cellular oedema. Reperfusion may be expected to increase myocardial oedema via hyperaemia and osmotic changes. Cardiovascular magnetic resonance (CMR) can be used to detect oedema using T2 weighted imaging, but this technique does not allow the study of possible changes in oedema with reperfusion. The purpose of this study was to examine the development of oedema in a small animal model of Ischemia-Reperfusion using serial T1 mapping.

Assessment of cardiac function and myocardial morphology using small animal Look-Locker inversion recovery (SALLI) MRI in rats.

Small animal magnetic resonance imaging is an important tool to study cardiac function and changes in myocardial tissue. The high heart rates of small animals (200 to 600 beats/min) have previously limited the role of CMR imaging. Small animal Look-Locker inversion recovery (SALLI) is a T1 mapping sequence for small animals to overcome this problem. T1 maps provide quantitative information about tissue alterations and contrast agent kinetics. It is also possible to detect diffuse myocardial processes such as interstitial fibrosis or edema. Furthermore, from a single set of image data, it is possible to examine heart function and myocardial scarring by generating cine and inversion recovery-prepared late gadolinium enhancement-type MR images. The presented video shows step-by-step the procedures to perform small animal CMR imaging. Here it is presented with a healthy Sprague-Dawley rat, however naturally it can be extended to different cardiac small animal models.

Small animal look-locker inversion recovery (SALLI)

Cardiac T1 mapping allows for quantitative analysis of myocardial tissue properties. Pulse sequences for human applications are not suitable for in-vivo studies in small animals.The aim of this study was to develop a single magnetic resonance imaging (MRI) approach for comprehensive assessment of cardiac function and tissue properties in small animals with high heart rates.