Role of Imaging in Cardiac Stem Cell Therapy
Saskia L.M.A. Beeres, MD*,
Frank M. Bengel, MD ,
Jozef Bartunek, MD ,a,
Douwe E. Atsma, MD*,
Jonathan M. Hill, MD ,
Marc Vanderheyden, MD,a,
Martin Penicka, MD||,
Martin J. Schalij, MD*,
William Wijns, MD,a and
Jeroen J. Bax, MD*,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Cardiovascular Center Aalst, Aalst, Belgium
Department of Cardiovascular Diseases, King’s College, London, United Kingdom
|| CardioCenter, 3rd Medical School, Charles University and University Hospital, Prague, Czech Republic.
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Figure 1 Approaches for Cell Tracking by Noninvasive Imaging
Cells are labeled directly for magnetic resonance imaging (MRI), positron emission tomography (PET), single-photon emission computed tomography (SPECT), or with a reporter gene for subsequent reporter-gene imaging using either of the techniques. F18-FDG = fluorodeoxyglucose; HMPAO = exametazime; IFP = iron fluorescent particle; SPIO = super-paramagnetic iron oxide; Tc = technetium.
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Figure 2 Magnetic Resonance Imaging Labeling Using Combined Modality Imaging Agent
Fluorescent green component of iron-fluorophore-labeled porcine mesenchymal stem cells delivered by intramyocardial injection with nuclei stained blue (left). Same panel imaged using Nomarski optics (middle). Hemotoxylin/eosin stain of same panel with iron-labeled cells appearing brown (right). Magnetic resonance imaging long-axis slice of a porcine left ventricle after anteroapical intramyocardial injection of iron-fluorophore-labeled mesenchymal stem cells (bottom). The black area on the endomyocardial border (arrows) is the signal void created by the iron-labeled cells.
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Figure 3 Tracking of In-111–Labeled Endothelial Progenitor Cells in the Rat Heart
After experimental myocardial infarction, 106 indium (In)-111–labeled cells were injected intramyocardially (left) or intravenously (right). Shown are planar scintigraphic images of the whole animal, along with magnification of the cardiac area. Significant cardiac retention of cells in the heart is only identified after intramyocardial injection (arrow).
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Figure 4 Tracking of Genetically Labeled Progenitor Cells by Positron Emission Tomography
3 x 106 endothelial progenitor cells transfected with the sodiumiodide symporter gene were injected intramyocardially in a healthy rat. After injection of N-13 ammonia, homogeneous myocardial perfusion is shown in grayscale on the top. Perfusion images are overlayed with images of reporter-gene expression (bottom). obtained after injection of I-124 sodiumiodide (red/yellow). Regional accumulation of the reporter probe depicts presence of viable transplanted cells at the injection site in the lateral wall. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.
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Figure 5 Technetium-99m Tetrofosmin SPECT Polar Maps at Baseline and 3 and 12 Months After Cell Therapy
Technetium-99m tetrofosmin single-photon emission computed tomography polar maps of a patient with stress-induced ischemia in the inferolateral myocardium at baseline (left). Three months after intramyocardial injection of autologous bone-marrow-derived mononuclear cells there is a reduction in the extent of stress-induced ischemia (middle). The effect is sustained at 12 months follow-up (right). Reprinted from Beeres et al. (31), with permission.
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