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Research ArticleInflammation/Infection

In Vivo Hypoxia PET Imaging Quantifies the Severity of Arthritic Joint Inflammation in Line with Overexpression of Hypoxia-Inducible Factor and Enhanced Reactive Oxygen Species Generation

Kerstin Fuchs, Anna Kuehn, Moritz Mahling, Philipp Guenthoer, Andreas Hector, Johannes Schwenck, Dominik Hartl, Stefan Laufer, Ursula Kohlhofer, Leticia Quintanilla-Martinez, Gerald Reischl, Martin Röcken, Bernd J. Pichler and Manfred Kneilling
Journal of Nuclear Medicine May 2017, 58 (5) 853-860; DOI: https://doi.org/10.2967/jnumed.116.185934
Kerstin Fuchs
1Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Anna Kuehn
1Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Moritz Mahling
1Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Philipp Guenthoer
1Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Andreas Hector
2Children’s Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
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Johannes Schwenck
1Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
3Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University, Tuebingen, Tuebingen, Germany
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Dominik Hartl
2Children’s Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
4Immunology, Inflammation and Infectious Diseases Discovery and Translational Area, Roche Pharma Research & Early Development (pRED), Roche Innovation Center Basel, Basel, Switzerland
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Stefan Laufer
5Department of Pharmacy & Biochemistry, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Ursula Kohlhofer
6Institute of Pathology and Neuropathology, Eberhard Karls University Tuebingen and Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany; and
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Leticia Quintanilla-Martinez
6Institute of Pathology and Neuropathology, Eberhard Karls University Tuebingen and Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany; and
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Gerald Reischl
1Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Martin Röcken
7Department of Dermatology, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Bernd J. Pichler
1Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Manfred Kneilling
1Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
7Department of Dermatology, Eberhard Karls University Tuebingen, Tuebingen, Germany
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    FIGURE 1.

    (A) pO2 values in arthritic and healthy ankles (left box plot) and the contralateral muscle issues (right box plot) on day 6 after GPI (n = 5) or control serum (n = 4) injection. (B) We correlated ankle swelling (mm) and pO2 values from arthritic and healthy ankles.

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    FIGURE 2.

    Representative 18F-FMISO (A; first column) and 18F-FAZA PET (B; first column) images from arthritic (black column) and healthy control (white column) mice on day 6 after GPI or control serum injection (representative slices of 90-min datasets). Ninety-minute 18F-FMISO (GPI, n = 2; control, n = 1) (A; second column) and 18F-FAZA (GPI, n = 2; control, n = 1) (B; second column) time–activity curves on day 6 after GPI or control serum application. Quantification of pooled static 18F-FMISO (GPI, n = 8; control, n = 5) (A; third column) and 18F-FAZA PET (GPI, n = 8; control, n = 4) (B; third column) of arthritic and healthy ankles presented as mean of %ID/g ± SD. (C) Quantification of pooled static 18F-FMISO PET scans presented as mean of %ID/g in arthritic and healthy ankles on day 1 (GPI, n = 3; control, n = 2), day 3 (GPI, n = 2; control, n = 2), and day 6 (GPI, n = 8; control, n = 4) after serum transfer (left bars). We correlated ankle swelling (mm) with %ID/g values from arthritic ankles on days 1, 3, and 6 after serum transfer (right). Mean ± SD; **P < 0.001.

  • FIGURE 3.
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    FIGURE 3.

    Localization of exact 18F-FMISO uptake sites in arthritic and control ankles, using PET/MRI. Representative healthy mouse after control serum injection exhibited no signs of hypoxia.

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    FIGURE 4.

    (A) Representative 18F-FAZA autoradiography analysis of slices from arthritic ankles on day 6 after GPI serum transfer (left) and healthy ankles after control serum application (right) confirming in vivo 18F-FAZA PET results. (B) Pimonidazole immunohistochemistry from arthritic ankles 6 d after GPI serum transfer (right), indicating areas of enhanced hypoxia compared with healthy ankles (left, *).

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    FIGURE 5.

    (A) Representative hematoxylin and eosin–stained slides from GPI arthritic ankles (n = 2) on day 6 after GPI serum transfer are shown (upper images). HIF-1α (630×) staining (n = 2) demonstrated increased number of hypoxic cells comprising predominantly neutrophils and synoviocytes (lower images). Control ankles (n = 2) exhibited no positive staining. (B) HIF-1α and HIF-2α WB analyses of arthritic (n = 2) and healthy ankles (n = 2) 6 d after GPI or control serum transfer revealed strongly enhanced HIF-1α and HIF-2α protein expressions. Control β-actin staining was performed as indicated at 40 kDa. (C) RT-PCR was performed with ankle tissue from mice 6 (black column) and 12 h (white column) after single GPI or control serum injection and with mouse ankle tissue from day 2 after first and 6 and 12 h after second GPI or control serum injection. We detected highest relative expressions of HIF-1α, HIF-2α, IL-1β, and TNF, 6 h after second GPI serum transfer. c = cytosolic fraction; h = hours; n = nuclear fraction; p.i. = after injection.

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    FIGURE 6.

    (A) L-012 chemiluminescence imaging in mice after GPI or control serum injection using OI. Arthritic ankles exhibited high levels of L-012 expression compared with control ankles (left). Quantitative analysis confirmed a significantly greater L-012 signal on days 3 (80,544 p/s/cm2/sr, n = 8) and 6 (165,639 p/s/cm2/sr, n = 8) after GPI serum injection in arthritic compared with healthy ankles (2,904 p/s/cm2/sr) (n = 9) (right). (B) We correlated ankle swelling (mm) with average (avg) radiance (p/s/cm2/sr) of L-012 in arthritic and healthy ankles at days 3 and 6 after GPI or control serum injection. (C) DHR-FACS analyses of cells gained from lavage of arthritic and healthy ankles revealed significantly greater ROS levels in arthritic ankles than control ankles. Mean value ± SD; **P < 0.0001.

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Journal of Nuclear Medicine: 58 (5)
Journal of Nuclear Medicine
Vol. 58, Issue 5
May 1, 2017
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In Vivo Hypoxia PET Imaging Quantifies the Severity of Arthritic Joint Inflammation in Line with Overexpression of Hypoxia-Inducible Factor and Enhanced Reactive Oxygen Species Generation
Kerstin Fuchs, Anna Kuehn, Moritz Mahling, Philipp Guenthoer, Andreas Hector, Johannes Schwenck, Dominik Hartl, Stefan Laufer, Ursula Kohlhofer, Leticia Quintanilla-Martinez, Gerald Reischl, Martin Röcken, Bernd J. Pichler, Manfred Kneilling
Journal of Nuclear Medicine May 2017, 58 (5) 853-860; DOI: 10.2967/jnumed.116.185934

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In Vivo Hypoxia PET Imaging Quantifies the Severity of Arthritic Joint Inflammation in Line with Overexpression of Hypoxia-Inducible Factor and Enhanced Reactive Oxygen Species Generation
Kerstin Fuchs, Anna Kuehn, Moritz Mahling, Philipp Guenthoer, Andreas Hector, Johannes Schwenck, Dominik Hartl, Stefan Laufer, Ursula Kohlhofer, Leticia Quintanilla-Martinez, Gerald Reischl, Martin Röcken, Bernd J. Pichler, Manfred Kneilling
Journal of Nuclear Medicine May 2017, 58 (5) 853-860; DOI: 10.2967/jnumed.116.185934
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