Despite the demonstrated potential as an accurate cancer diagnostic tool, Raman spectroscopy (RS) is yet to be adopted
by the clinic for histopathology reviews. The Stratified Medicine through Advanced Raman Technologies (SMART)
consortium has begun to address some of the hurdles in its adoption for cancer diagnosis. These hurdles include
awareness and acceptance of the technology, practicality of integration into the histopathology workflow, data
reproducibility and availability of transferrable models. We have formed a consortium, in joint efforts, to develop
optimised protocols for tissue sample preparation, data collection and analysis. These protocols will be supported by
provision of suitable hardware and software tools to allow statistically sound classification models to be built and
transferred for use on different systems. In addition, we are building a validated gastrointestinal (GI) cancers model,
which can be trialled as part of the histopathology workflow at hospitals, and a classification tool. At the end of the
project, we aim to deliver a robust Raman based diagnostic platform to enable clinical researchers to stage cancer, define
tumour margin, build cancer diagnostic models and discover novel disease bio markers.
Photodynamic therapy (PDT) that uses the second generation photosensitizer, verteporfin (VP), is a developing
therapy for pancreatic cancer. The optimal timing of light delivery related to VP uptake and distribution in pancreatic
tumors will be important information to obtain to improve treatment for this intractable disease. In this work we
examined uptake and distribution of VP in two orthotopic pancreatic tumors with different histological structure.
ASPC-1 (fast-growing) and Panc-1 (slower growing) tumors were implanted in SCID mice and studied when tumors
were approximately 100mm3. In a pilot study, these tumors had been shown to differ in uptake of VP using lightinduced
fluorescence spectroscopy (LIFS) in vivo and fluorescence imaging ex vivo and that work is extended here. In
vivo fluorescence mean readings of tumor and liver increased rapidly up to 15 minutes after photosensitizer injection
for both tumor types, and then continued to increase up to 60 minutes post injection to a higher level in ASPC-1 than in
Panc-1. There was variability among animals with the same tumor type, in both liver and tumor uptake and no
selectivity of tumor over liver. In this work we further examined VP uptake at multiple time points in relation to
microvascular density and perfusion, using DiOC7 (to mark blood vessels) and VP fluorescence in the same tissue
slices. Analysis of DiOC7 fluorescence indicates that AsPC-1 and Panc-1 have different vascular densities but AsPC-1
vasculature is more perfusive. Analysis of colocalized DiOC7 and VP fluorescence showed ASPC-1 with higher
accumulation of VP 3 hrs after injection and more VP at a distance from blood vessels compared to Panc-1. This work
shows the need for techniques to analyze photosensitizer distribution in order to optimize photodynamic therapy as an
effective treatment for pancreatic tumors.
Photodynamic therapy (PDT) mediated with verteporfin is currently being investigated to treat pancreatic cancer in
patients who are not surgical candidates. Clinically, interstitial light delivery is administered through a fiber, via
percutaneous needle implantation guided by ultrasound and/or verified by CT. Tumor response to PDT is based on
photosensitizer (PS) dose, light dose, light dose rate and the timing of light application following PS injection. However,
studies have shown that even when matching administered PDT treatment parameters such as drug dose and light level,
there can be significant inter-patient variation in tissue damage post-PDT, and this has been primarily attributed to
imprecise PS concentration at the target tissue site.
In order to achieve optimal tumor response from PDT without causing major damage to surrounding tissue, it would be
advantageous to measure the PS concentration in the target tissue just prior to light application. From these
measurements, the clinician can adapt the light application dose to the measured target tissue PS concentration (i.e.
insufficient target tissue PS concentrations compensated by higher light doses and vice versa.) in order to provide an
optimal light dose for each patient.
In animal studies, a spectrometer-based in-vivo fluorescence dosimetry system has been used to assess accumulated PS
levels (verteporfin) in situ. Measurements are taken from skin, leg muscle, buccal mucosa and tumor tissue locations one
hour after injection of the photosensitizer. Real-time spectral fitting, subtraction of background autofluorescence and
ratiometric analysis is performed on the raw data to extract out only the photosensitizer fluorescence and therefore
concentration. Using a pre-measured calibration data set of varying concentrations for verteporfin in tissue phantoms
composed of intralipid and whole blood, it was possible detect concentrations of the photosensitizer below 0.5nM.
In the clinical studies being performed at UCL Hospital in which verteporfin-PDT treatment is being given to patients
with pancreatic cancer, the dosimetry system is being used to assess PS concentration the pancreatic tumor tissue prior to
interstitial light dose treatment. The goal of the work here is to determine whether the dosimetry system can accurately
and efficiently be used clinically by evaluating the measured local tissue PS concentration to treatment outcome (area of
necrosis established). The results of this study will partially determine the need for fluorescence dosimetry to
individualize PDT treatment for patients based on local tissue PS concentration.
Biophysical changes such as inflammation and necrosis occur immediately following PDT and may be used to
assess the treatment response to PDT treatment in-vivo. This study uses localized reflectance measurements to quantify
the scatter changes in tumor tissue occurring in response to verteporfin-based PDT treatment in xenograft pancreas
tumors. Nude mice were implanted with subcutaneous AsPC-1 pancreatic tumors cells in matrigel, and allowed to
establish solid tumors near 100mm3 volume. The mice were sensitized with 1mg/kg of the active component of
verteporfin (benzoporphryin derivative, BPD), one hour before light delivery. The optical irradiation was performed
using a 1 cm cylindrical interstitial diffusing tip fiber with 20J of red light (690nm). Tumor tissue was excised
progressively and imaged, from 1 day to 4 weeks, after PDT treatment. The tissue sections were stained and analyzed by
an expert veterinary pathologist, who provided information on tissue regions of interest. This information was correlated
with variations in scattering and absorption parameters elucidated from the spectral images and the degree of necrosis
and inflammation involvement was identified.
Areas of necrosis and dead cells exhibited the lowest average scatter irradiance signature (3.78 and 4.07
respectively) compared to areas of viable pancreatic tumor cells and areas of inflammation (5.81 and 7.19 respectively).
Bilirubin absorbance parameters also showed a lower absorbance value in necrotic tissue and areas of dead cells (0.05
and 0.1 respectively) compared to tissue areas for viable pancreatic tumor cells and areas of inflammation (0.28 and
0.35). These results demonstrate that localized reflectance spectroscopy is an imaging modality that can be used to
identify tissue features associated with PDT treatment (e.g. necrosis and inflammation) that can be correlated with
histopathologically-reviewed H&E stained slides. Further study of this technique may provide means for automated
discrimination of tissue features based on scatter and absorbance maps elucidated from reflectance spectral datasets and
provide a valuable tool for treatment response monitoring during PDT and enabling more effective treatment planning.
These results are relevant to verteporfin-based PDT trial for treatment pancreatic cancer in non-surgical
candidate cases (VERTPAC-1 University College London, PI Pereira), where individualized assessment of damage and
response could be beneficial, if this study is proven to be a well-controlled imaging tool.
Photodynamic therapy (PDT) is a light activated chemotherapy that is dependent on three parameters: photosensitizer
(PS) concentration; oxygen concentration; and light dosage. Due to highly variable treatment response, the development
of an accurate dosimeter to optimize PDT treatment outcome is an important requirement for practical applications.
Singlet oxygen is an active species in PDT, and we are developing two instruments, an ultra-sensitive singlet oxygen
point sensor and a 2D imager, with the goal of a real-time dosimeter for PDT researchers. The 2D imaging system can
visualize spatial maps of both the singlet oxygen production and the location of the PS in a tumor during PDT. We have
detected the production of singlet oxygen during PDT treatments with both in-vitro and in-vivo studies. Effects of
photobleaching have also been observed. These results are promising for the development of the sensor as a real-time
dosimeter for PDT which would be a valuable tool for PDT research and could lead to more effective treatment outcome.
We summarize recent results in this paper.
Photodynamic therapy (PDT) mediated with Verteporfin is being investigated as a pancreatic cancer treatment in the
cases for non-surgical candidates. Tissue response to PDT is based on a number of parameters including photosensitizer
(PS) dose, light dose and time interval between light application and PS injection.
In this study, PS uptake and distribution in animal leg muscle, oral cavity tissues, pancreas and tumor was measured
in vivo using light-induced fluorescence spectroscopy (LIFS) via an Aurora Optics Inc. PDT fluorescence dosimeter. An
orthotopic pancreatic cancer model (AsPC-1) was implanted in SCID mice and treated with the PS. Probe measurements
were made using a surface probe and an interstitial needle probe before and up to one hour after intravenous tail vein
injection of the PS.
The study demonstrated that it is possible to correlate in-vivo LIFS measurements of the PS uptake in the pancreas
with measurements taken from the oral cavity indicating that light dosimetry of PDT of the pancreas can be ascertained
from the LIFS measurements in the oral cavity. These results emphasize the importance of light dosimetry in improving
the therapeutic outcome of PDT through light dose adaptation to the relative in situ tissue PS concentration.
Verteporfin photodynamic therapy (PDT) is a promising adjuvant therapy for pancreas cancer and investigations for its use are currently underway in both orthotopic xenograft mouse models and in human clinical trials. The mouse models have been studied extensively using magnetic resonance (MR) imaging as a measure of surrogate response to verteporfin PDT and it was found that tumor lines with different levels of aggression respond with varying levels to PDT. MR imaging was successful in determining the necrotic volume caused by PDT but there was difficultly in distinguishing
inflamed tissues and regions of surviving tumor. In order to understand the molecular changes within the tumor immediately post-PDT we propose the implementation of MR-guided fluorescence molecular tomography (FMT) in conjunction with an exogenously administered fluorescently labeled epidermal growth factor (EGF-IRDye800CW, LI-COR Biosciences). We have previously shown that MR-guided FMT is feasible in the mouse abdomen when multiple
regions of fluorescence are considered from contributing internal organs. In this case the highly aggressive AsPC-1 (+EGFR) orthotopic tumor was implanted in SCID mice, interstitial verteporfin PDT (1mg/kg, 20J/cm) was performed when the tumor reached ~60mm3 and both tumor volume and EGF binding were followed with MR-guided FMT.
In this work, a novel technique for rapid image analysis of Fourier transform infrared (FTIR) data obtained from human lymph nodes is explored. It uses the mathematical principle of orthogonality as a method to quickly and efficiently obtain tissue and pathology information from a spectral image cube. It requires less computational power and time compared to most forms of cluster analysis. The values obtained from different tissue and pathology types allows for discrimination of noncancerous from cancerous lymph nodes. It involves the calculation of the dot product between reference spectra and individual spectra from across the tissue image. These provide a measure of the correlation between individual spectra and the reference spectra, and each spectrum or pixel in the image is given a color representing the reference most closely correlating with it. The correlation maps are validated with the tissue and pathology features identified by an expert pathologist from corresponding hematoxylin and eosin stained tissue sections. Although this novel technique requires further study to properly test and validate this tool, with inclusion of more lymph node hyperspectral datasets (containing a greater variety of tissue states), it demonstrates significant clinical potential for pathology diagnosis.
Prostate cancer is now the most commonly diagnosed male cancer in Europe. Histopathology, the current
gold standard for diagnosing prostate pathology is subjective and limited by intra and inter-observer
variation. Fourier transform infrared spectroscopy (FTIR) enables objective tissue analysis on the basis of
biochemical and structural tissue components. This study examined FTIR's ability to discriminate between
benign, premalignant and malignant prostate pathologies. Biochemical fitting using non negative least
squares was performed on the spectral datasets of individual prostate pathologies. This novel technique was
applied to estimate the relative concentrations of the dominant components in prostate tissue from different
prostate pathologies. Preliminary results of the biochemical fitting were promising and gave an early
insight into possible biomarkers which could be used in the future to classify stages of the carcinogenesis
process. The Principal Component Analysis fed Linear Discriminant Analysis enabled good separation of
the pathologies with sensitivities and specificities comparable with the gold standard histopathology.
Further work will develop the biochemical fitting technique and increase sample size.
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