Development of Molecular Magnetic Resonance Imaging Tools for Risk Stratification of Carotid Atherosclerotic Disease Using Dual-Targeted Microparticles of Iron Oxide

• Published in: Translational stroke research Vol. 13; no. 2; pp. 245 - 256
• Main Authors: Chan, Joyce M. S., Jin, Park Sung, Ng, Michael, Garnell, Joanne, Ying, Chan Wan, Tec, Chong Tze, Bhakoo, Kishore
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2022; Springer Nature B.V
• Subjects: Animals; Apolipoproteins; Asymptomatic; Atherosclerosis; Biomedical and Life Sciences; Biomedicine; Cardiology; Carotid arteries; Carotid Arteries - diagnostic imaging; Carotid Arteries - pathology; Carotid Artery Diseases - diagnostic imaging; Contrast agents; Endothelium; Ferric Compounds; Humans; Inflammation; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Mice; Neurology; Neurosciences; Neurosurgery; Original; Original Article; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - pathology; Risk Assessment; Shear stress; Statistical analysis; Stroke; Stroke - pathology; Thromboembolism; Vascular Surgery; Veins & arteries; Vulnerable carotid plaques; Stroke; Inflammation; Iron oxide particles; Atherosclerosis; Risk stratification
• ISSN: 1868-4483; 1868-601X
• DOI: 10.1007/s12975-021-00931-3

Identification of patients with high-risk asymptomatic carotid plaques remains a challenging but crucial step in stroke prevention. Inflammation is the key factor that drives plaque instability. Currently, there is no imaging tool in routine clinical practice to assess the inflammatory status within atherosclerotic plaques. We have developed a molecular magnetic resonance imaging (MRI) tool to quantitatively report the inflammatory activity in atherosclerosis using dual-targeted microparticles of iron oxide (DT-MPIO) against P-selectin and VCAM-1 as a smart MRI probe. A periarterial cuff was used to generate plaques with varying degree of phenotypes, inflammation and risk levels at specific locations along the same single carotid artery in an Apolipoprotein-E-deficient mouse model. Using this platform, we demonstrated that in vivo DT-MPIO-enhanced MRI can (i) target high-risk vulnerable plaques, (ii) differentiate the heterogeneity (i.e. high vs intermediate vs low-risk plaques) within the asymptomatic plaque population and (iii) quantitatively report the inflammatory activity of local plaques in carotid artery. This novel molecular MRI tool may allow characterisation of plaque vulnerability and quantitative reporting of inflammatory status in atherosclerosis. This would permit accurate risk stratification by identifying high-risk asymptomatic individual patients for prophylactic carotid intervention, expediting early stroke prevention and paving the way for personalised management of carotid atherosclerotic disease.