Nanoparticles synthesis: AGuIX® nanoparticles were prepared in diethylene glycol (DEG) according to Le Duc
et al 27 . AGuIX® nanoparticles (1500 µmol of Gd
3+) were dispersed in water at a pH of 7.4 (3 mL, [Gd
3+] = 500 mM). After 1 hour, the suspension was heated at 40°C and DEG (12 mL) already heated at 40°C was added. A solution of 5-(4-carboxyphenyl succinimide ester)-10,15,20-triphenylporphyrin (113.4 mg, 150 µmol, 10 Gd
3+ per TPP) in dimethyl sulfoxide (DMSO) (7.56 mL, [TPP] = 15mL/mL) was added drop by drop to the dispersion of nanoparticles under stirring. The mixture was stirred at 40°C for 12 hours in the dark.
Number of TPP per Gd quantification: Lyophilized nanoparticles were first dispersed in water for one hour at room temperature, [Gd
3+] =50 mM and pH=7.4. Then the solution was diluted in water to [Gd
3+] = 0.5 mM and absorbance measured at 520 nm, 555 nm, 590 nm and 650 nm (Q bands). The nanoparticles solution was diluted to [Gd
3+] = 27 µM in water and absorbance measured at 420 nm (Soret band). The average result gives 14 Gd
3+ per TPP.
Photophysical properties: Absorption spectra were recorded on a Perkin-Elmer (Lambda 2, Courtaboeuf, France) UV-visible spectrophotometer. Fluorescence spectra were recorded on a SPEX Fluorolog-3 spectrofluorimeter (Jobin Yvon, Longjumeau, France) equipped with a thermo stated cell compartment (25°C), using a 450 W Xenon lamp. Fluorescence quantum yields (Φ
f) were determined using a TPP solution as a fluorescence standard. For the direct determination of singlet oxygen quantum yield (F
D): excitation occurred with a Xe-arc, the light was separated in a SPEX 1680, 0.22 µm double monochromator. The detection at 1270 nm was done through a PTI S/N 1565 monochromator, and the emission was monitored by a liquid nitrogen-cooled Ge-detector model (EO-817L, North Coast Scientific Co).
Dynamic light scattering size and ζ-potential measurements: Direct measurements of the size distribution of the nanoparticles suspended in any medium were performed via Zetasizer NanoS DLS (Dynamic light scattering, laser He-Ne 633 nm) from Malvern Instrument. The ζ-potential of the nanoparticles was also performed
via a Zetasizer NanoS. Prior to the experiment, the nanoparticles were diluted in an aqueous solution containing 0.01 M NaCl and adjusted to pH 7.4.
U87 Glioblastoma cell culture: U87 glioblastoma cells (ATCC, Manassas, VA, USA) were maintained in monolayer culture (37°C, 5% CO
2, 95% O
2) in Dulbecco's modified eagle medium (DMEM) supplemented with 10% fetal bovine serum (PAN biotech, GmbH, Aidenbach, Germany), 5% penicillin and streptomycin, 1.25% sodium pyruvate, 1% essential amino acid, 0.5% non-essential amino acid, 0.4% vitamins, 1% L-glutamine, L-serine, L-asparagine (Gibco, invitrogen, Saint Aubin, France).
Animals and stereotactic xenograft implantation:Animal procedures were performed according to institutional and national guidelines. All experiments were performed in accordance with animal care guidelines (Directive 2010/63/EU) and carried out by competent and authorized persons (personal authorization number 54-89 issued by the Department of Vetenary Services) in a registered establishment (establishment number C-54-547-03 issued by the Department of Vetenary Services). Male athymic nude rats (Hsd:RH-Foxn1rnu) were chosen for this study (Envigo, Gannat, France). The rats were used for tumor implantation at age of 8 weeks (180-220 g). During microsurgery (implantation or treatment protocol) and all acquisitions with microimaging, rats were anesthetized with a mixture of air and isoflurane concentrate (1.5-2% depending on the breathing) under sterile conditions. The rats were placed into a Kopf stereotactic frame (900M Kopf Instruments, Tujunga, CA). A midline incision was done and a burr hole was drilled 0.5 mm anterior and 2.7 mm lateral to the bregma. A skull anchor (Patent N° 11 55596) was fixed. 5.10
4 U87 cells were suspended in 5 µL Hank's Buffered Salt Solution (HBSS, 1X) and were injected in 4.4 mm into the brain parenchyma with a flow of 0.2 µL/min using a 10 µL Hamilton syringe. After injection, the scalp incision was sutured (Suture 6.0 filament) and the surface was antiseptically cleaned.
Nanoparticles preparation for in vivo studies:Nanoparticles were suspended in ultrapure water and NaCl 9% (20:80) to obtain an equivalent concentration of 2.5 mM TPP or 60 mM Gd. Each batch of nanoparticles was buffered in order to obtain an iso-osmolar solution and pH 7.4 and conserved at 5°C. Injected TPP amounted to 1.75 µmol/kg as previously described 26 (
link). The injection solution was prepared by dissolution in 9% NaCl to obtain an injection volume of 600 µL (e.g. 0.525 µmol of TPP or 12.7 µmol of Gd for a body weight of 300 g) and injected, following by 600 µL of 9% NaCl were injected during 1 min.
Interstitial Photodynamic Therapy: The treatment happens 10-12 days after the graft when the tumor reached approximately 2.5±0.5 mm of diameter. The animal was maintained under volatile anesthesia (EZ-7000, WPi, Sarasota, USA) consisting in a mixture of 2% isoflurane (IsoFlo; Axience, Pantin, France) and air during MRI monitoring and treatment. The rats' temperature was maintained at 37°C thanks to the heating bed. The blood oxygenation was monitored all along the longitudinal follow-up and did not go down 87%. One hour prior the irradiation, the nanoparticles preparation was injected by intravenous administration in the caudal vein. Then the treatment was performed at 50 mW in fiber output (UltraSil ULS 272; OFS, Norcross, USA), 26 J and 652±1 nm with a laser diode (Biolitec, Jena, Germany). Sham rats received an injection of nanoparticles without photosensitizer one hour prior to iPDT.
MRI-guided iPDT and light delivery: Light delivery fiber was inserted through the skull anchor into the tumor tissue. The fiber tip (272 nm diameter, ULS 272, OFS, Norcross, U.S.A.) delivered the light (652 nm, 50 mw, 8 min 40 s, 26 J). A T1 weighted imaging in the coronal plane (TURBO-RARE, TR/TE: 400/9ms, NEX: 2, FOV: 4x4 cm, matrix: 256x256, SI: 1 mm) as a reference image before the injection of the nanoparticles, and a second T1 weighted MRI in the coronal plane to confirm their presence and to measure the coordinates for the fiber placement were performed. Then a density proton weighted image (TR/TE: 5000/33ms, NEX: 2, FOV: 4x4 cm, matrix: 256x256, SI: 1 mm) was performed before iPDT in order to control the positioning of the optical fiber inside the brain.
MRI acquisition protocol: The MR experiments were performed on a small animal 7 Teslas magnet (Bruker, Biospec 70/20 USR, Ettlingen Germany). A transmit body coil and a receive head coil were used for all acquisition except for the proton density weighted acquisition where just a transmit/receive body coil was used. The software Paravision 5.1 (Bruker, Ettlingen, Germany) was used to analyze the data. The MRI acquisition protocol was repeated at the eight times of the follow-up: the pre-treatment and post-treatment days (t=0), 1, 2, 3, 4 and 7 days post-treatment. The MRI acquisition protocol was composed by six images sequences and lasts 1h40: T2 weighted imaging (TURBO-Rapid Acquisition with Relaxation Enhancement TR/TE: 5000/77ms, NEX: 2, FOV: 4x4 cm, matrix: 256x256, SI: 1 mm) in axial and coronal planes to visualize the tumor in hyperintense. Diffusion-Weighted Imaging (DWI) on the slice of interest (Spin Echo-Echo Planar Imaging, TR/TE: 3000/30ms, six b values (100, 200, 400, 600, 800 and 1000 s/mm²), FOV: 4x4 cm, matrix: 128x128, SI: 1mm) defined from the fiber positioning. Taking into account the exponential diffusion signal decay, six b values were selected for a better fitting of the exponential curve. This has all been possible as we were not constrained by the movements of the anaesthetized animals and the duration of the acquisition. An Apparent Diffusion Coefficient map was calculated from the SE-EPI acquisition. This sequence was used to observe the water diffusion of the tissue.
Multi Gradient Echo-T2* acquisition (TR: 1500ms, 12 TE: range from 4 to 60ms, FOV: 4x4 cm, matrix: 256x256, SI: 1 mm) was performed on the same slice of interest. A T2* relaxation map was calculated from the T2* acquisition. The Bruker t2vtr-fitting function (Paravision 5, Bruker) based on the equation below was applied to calculate T2* relaxation time as a function of signal intensity and TE values of each image:
With: A= absolute bias, C= signal intensity, T2*= spin-spin relaxation time All calculated T2* times were given in ms.
1H-MR spectroscopy PRESS-1H (Point RESolved Spectroscopy) sequence (TR/TE : 2500/20ms, NEX : 512, VOI : 2.5x2x3mm) combined with a water suppression sequence VAPOR (VAriable Power Optimized Relaxation delays) are used for acquiring in single voxel spectroscopy one spectrum from a voxel placed on the tumor and another one on the contralateral side. Before MRS and T2* weighted images, a second order shim was performed.
MRI monitoring: The tumor response to the treatment was monitored by MRI from the pre-treatment to 20 days after the treatment. Each MRI session included an anatomical MRI, a diffusion MRI, a T2* MRI and a MRS. MRI session were performed just before the treatment, just after the treatment and 1, 2, 3, 7 and 10 days after the treatment. All sequences of one MRI session were carried out consecutively without moving the animal.
Images analysis:The volume of the tumors was achieved with a segmentation software ITK-SNAP 3.0.0 28 (
link). Mean ADC value of the tumor comes from a ROI which circled the whole tumor on the T2 weighted images and which is then, replaced on the ADC map. The ADC ratios were calculated by dividing the tumor ADC value by the contralateral ADC value. Each ratio was then normalized to the pretreatment ratio. The VOI for MRS was drawn on the T2 weighted images, and included the whole initial tumor volume (7.2 ±3.1 mm
3) and also the brain adjacent to tumor. For the final stages, the whole tumor (63.1 ± 56.6 mm
3) was filling the VOI so that the voxel remains focused on tumor. Each brain tissue spectrum was analyzed using jMRUI software with a basis set of prior knowledge containing 17 peaks which correspond to 9 metabolites (Lipids/lactate (CH/CH2/CH3), N-Acetyl-Aspartate (NAA), glutamine, glutamate, glutamine-glutamate (GLX), creatine (Cr), choline (Cho), taurine, myo-inositol (MIn)) 29 (
link)
30 . The metabolites expression was determined using the water signal as a reference, and therefore all amplitudes were expressed semi quantitatively. AMARES algorithm is used for the quantitation 31 .
The proportion of hemorrhage and the proportion of the water compartment came from T2* map. The ROIs have always the same size and enclosed the tumor and its periphery, in order to assess the micro hemorrhages and the water content changes, induced by iPDT, in and around the tumor. An arbitrary threshold was defined to quantify the hemorrhage or the water content. The proportion of hemorrhage or water content was respectively defined as the ratio of the number of pixels under or upper the threshold divided by the total number of pixels.
Light propagation Simulation: The simulation of photon propagation in the tumor volume and healthy tissues was made with Molecular Optical Simulation Environment (MOSE), a simulation platform for optical molecular imaging research co-developed by Xidian University, Institute of Automation, Chinese Academy of Sciences, China and Virginia Tech-Wake Forest University School of Biomedical Engineering & Sciences, USA. The parameters of the simulation were a sphere of the corresponding diameter for the tumor, a cube of 4 mm side for the healthy brain, a flat cylindrical light source at 652 nm (
Figure 7c and d). The characterization of optical coefficients in various biological tissues of different species exists in the literature. However, there are very few studies evaluating these coefficients
in vivo, and let alone in presence of nanoparticles. We used a method developed by our group to estimate the
in vivo optical parameters. The
in vivo values of the optical coefficients (absorption and scattering µa and µs, respectively) of subcutaneous U87MG tumors grafted in nude mice with and without AGuIX® nanoparticles were estimated by solving the inverse problem using fast Monte Carlo simulation and experimental spatially resolved diffuse reflectance spectra 32 .
Immunohistochemistry:The brains were kept in formol® (CARLO ERBA Reagents S.A.S, Val de Reuil, France) during 10 days. The tissue samples were dehydrated in successive ethanol baths from 70° to 100° to finish in toluene. They were conserved as 5 µm thick slice in paraffine. Immunohistophatology was performed on deparaffined slices. The unmasking step was performed at 110°C/5min in citrate buffer. To detect tumor cellular proliferation, sections were incubated for one night at room temperature with the primary antibody (rabbit monoclonal antibody anti-Ki67, 1:200 dilution buffer; SP6, RM-9106-S0, S1, NeoMarkers, Labvision). After washing, the slides were incubated for 1 hour with the secondary goat polyclonal antibody anti-rat biotinylated IgG (1:400 dilution in PBS-Tween E0432, Dakocytomation, Denmark). The revelation of secondary biotinylated antibodies was performed with a streptavidin-horseradish peroxidase complex (1 h at room temperature, diluted 1:400 in PBS-Tween, Dakocytomation, Denmark) and the peroxidase substrate (5 min, Vector® NovoRedTM Substrate Kit for peroxidase, HistoGreen, Vector Laboratories, Paris). A hematoxylin counterstaining was performed to visualize the section by optical microscopy (Eclipse E600, Nikon France S.A, Champigny sur Marne, France). ImageJ was used to perform counting. KI67 index is the number of nuclei stained on the number of nuclei unstained, counting on 3 different images, x40 magnification.
In vivo PDT response variables: Following PDT, tumor volume was measured by segmentation on T2 weighted images. For the statistical analysis, we used an innovative approach developed by Bastogne
et al. and based on the mixed-effect modeling of the tumor responses 33 . Its main advantage is to account for all the tumor kinetics and not only a specific end-point, which allows to significantly enhancing the statistical power of the tests. This method firstly required to define a parametric model of the kinetic response and secondly to determine the values of the model parameters with a maximum likelihood estimator. For the modeling step, originality was also to consider the equivalent diameter instead of the tumor volume. The diameter response generally showed a linear trend and therefore a simpler model 34
35 . As previously described, an exponential-linear model structure was used:
where
x is the tumor diameter (D),
t is the time variable,
k1, T, k2, τ are the model parameters to be estimated from the experimental data 33 . This model was implemented in the computational environment Matlab
© with the toolbox Monolix
©. Three groups of animals were deduced from this model, a non-treated group (control), a partially treated group (non-responder) and completely treated group (responder). The growth rate
k2 decreased of about 30%
versus 57% for the non-responder and responder animals, respectively.
Toussaint M., Pinel S., Auger F., Durieux N., Thomassin M., Thomas E., Moussaron A., Meng D., Plénat F., Amouroux M., Bastogne T., Frochot C., Tillement O., Lux F, & Barberi-Heyob M. (2017). Proton MR Spectroscopy and Diffusion MR Imaging Monitoring to Predict Tumor Response to Interstitial Photodynamic Therapy for Glioblastoma. Theranostics, 7(2), 436-451.