<p>The diagnosis and treatment of pulmonary diseases still rely on pulmonary function tests that offer archaic or insensitive biomarkers of lung structure and function. As a consequence, chronic obstructive pulmonary disease is the third leading cause of death in the US, and the hospitalization costs for asthma are on the order of $29 Billion. Pulmonary diseases have created a large and unsustainable economic burden, and hence there is still a dire need for biomarkers that can predict early changes in lung function. The work presented in this thesis looks to address this very issue, by taking advantage of the unique properties of hyperpolarized (HP) <super>129</super>Xe in conjunction with magnetic resonance imaging (MRI), to probe the fundamental function of the lung - gas-exchange. </p><p>While a bulk of the inhaled HP <super>129</super>Xe stays in the alveolar spaces, its moderate solubility in the pulmonary tissues causes a small fraction of this xenon in the alveolar spaces to diffuse into the pulmonary barrier tissue and plasma, and further into the red blood cells (RBC). Additionally, when in either of these compartments, xenon experiences a unique shift in its resonance frequency from the gas-phase (barrier - 198 ppm, RBC - 217 ppm). These unique resonances are collectively called the dissolved-phase of xenon. As the pathway taken by xenon to reach the RBCs is identical to that of oxygen, this dissolved-phase offers a non-invasive probe to study the oxygen transfer pathway, and imaging its distribution, to first order, would give us an image of gas-exchange in the lung.</p><p>Gas-exchange is controlled by ventilation, perfusion, and lastly diffusion of gases across the capillary membrane. This process of diffusion is dictated by Fick's first law of diffusion, and hence the volume of gas taken up by the capillary blood stream depends on the alveolar surface area, and the interstitial thickness. Interestingly, changes in these factors can be measured using the resonances of xenon. Changes in the alveolar surface area brought on by diseases like emphysema will increase the diffusion of xenon within the alveolus. Thus, by using diffusion-weighted imaging of the gas-phase of <super>129</super>Xe, which is the focus of chapter 3, one can extract the `apparent diffusion coefficient' (ADC) of xenon, that is sensitive to the changes in the alveolar surface area. The dissolved-phase on the other hand, while sensitive to the surface area, is also sensitive to subtle changes in the interstitial thickness. In fact, after the application of an RF pulse on the dissolved-phase, the recovery time for the xenon signal in the RBCs is significantly delayed by micron scale thickening of the interstitium. This delayed signal recovery can be used as a sensitive marker for diffusion impairment in the lung. </p><p>While direct imaging of the dissolved-phase was shown to be feasible, truly quantifying gas-exchange in the lung will require two additional technical advances - 1) As the gas-phase is the source magnetization for the dissolved-phase signal, it is imperative to acquire both the gas and dissolved-phase images in a single breath. The technical details of this achievement are discussed in chapters 4 and 5. 2) As the dissolved-phase consists of both the barrier and the RBC components, obtaining a fundamental image of gas-exchange in the lung will require creating independent images of <super>129</super>Xe in the barrier and <super>129</super>Xe in the RBCs. This goal first required creating a global metric of gas-transfer in the lung (chapter 6), which aided the implementation of the 1-point Dixon acquisition strategy to separate the components of the dissolved-phase. In conjunction with aim 1, it was finally possible to image all three resonances of <super>129</super>Xe in a single breath (chapter 7). These <super>129</super>Xe-RBC images were acquired in healthy volunteers and their efficacy was tested in subjects with idiopathic pulmonary fibrosis (IPF). These IPF subjects are known for their characteristic diffusion limitation, and in regions of fibrosis shown on their CT scans, the <super>129</super>Xe-RBC images showed gas-transfer defects. </p><p>Hyperpolarized <super>129</super>Xe MRI thus provides a non-invasive, ionizing radiation free method to probe ventilation, microstructural changes and most importantly, gas-exchange. These preliminary results indicate that xenon MRI has potential as a sensitive tool in therapeutic clinical trials to evaluate longitudinal changes in lung function.</p> / Dissertation

Thesis (MScMedSc)--Stellenbosch University, 2010. / ENGLISH ABSTRACT: Radiolabelled compounds have been widely used as investigative tools for psychiatric disorders using positron emission tomography (PET) or single photon emission tomography (SPECT) of the brain. In particular 123I-5-IR91150, a serotonin (5-HT) 2a antagonist, has been used for imaging the serotonergic system. The current study developed optimal radiolabelling and purification methods in our laboratory with the objective that it can provide 123I- 5-I-R91150 in sufficient quantity and of acceptable pharmaceutical quality for human use. Unlabelled R91150 was obtained from Janssen Pharmaceutica (Beerse, Belgium). Carrier free [123I]Iodine was produced by iThemba LABS, South Africa, via the 127I(p,5n)123Xe-123I reaction, providing Na[123I] in 0.05 N sodium hydroxide with a specific activity of 4000-6000 MBq/ml. A direct electrophilic radioiodination method of labelling was used in this study for labelling 123-I-5-IR91150 in glacial acetic acid. After radiolabelling, the product was purified using two different methods, namely a high performance liquid chromatography (HPLC) purification method and a solid phase extraction (SPE) method. The analyses of the purified product for both methods were done using HPLC. Methods were tested to reduce the volume of the purified product using C8 or C18 solid phase extraction cartridges. The average labelling efficiencies for SPE and HPLC purification methods were 76% ± 13.6% and 52% ± 11.2% respectively. The yields of 123I-5-I-R91150 were about 80%. Sep-Pak C8 and C18 were both unable to concentrate the HPLC purified product. Products from both purification methods were sterile and pyrogen free. Both SPE and HPLC purification methods have been shown to provide products meeting most criteria set for this study. However, both methods have advantages and disadvantages. The SPE purification method provided higher labelling efficiency and a much lower product volume. The stability of this product is however of concern as some free iodide was detected. If this purification method is used, the product should therefore be administered as soon as possible after completion of analysis. After HPLC purification, the undiluted product remained stable up to 4.15 hours after production but the product volume was relatively high, and purification time-consuming. In order to obtain a useful patient dose, labelling would have to start with at least 740 MBq 123I and the labelled product should be collected in fractions of 5 ml or less in order to obtain a fraction of sufficiently high specific activity. It was concluded that radiolabeling R91150 is possible at our institution, but that an improved HPLC system would be of value for routine production of a pure and safe product. / AFRIKAANSE OPSOMMING: Radioaktief gemerkte verbindings word baie gebruik as ondersoekmiddel vir psigiatriese afwykings met behulp van positron emissive tomografie (PET) of enkelfoton emissie tomografie (SPECT) van die brein. Die verbinding 123I-5-IR91150, ‘n serotonien (5-HT) 2a antagonis, is beskryf vir beelding van die serotonerge sisteem. Die huidige studie het ondersoek ingestel na optimale metodes vir radioaktiewe merking en suiwering vir ons laboratorium met die doel om 123I-5-I-R91150 in genoegsame hoeveelhed en van aanvaarbare farmaseutiese gehalte geskik vir menslike gebruik te verskaf. R91150 is van Janssen Pharmaceutica (Beerse, België) verkry. Draervry [123I]jodium is deur iThemba LABS, Suid-Afrika, via die 127I(p,5n)123Xe-123I reaksie geproduseer, om Na[123I] in 0.05 N natriumhidroksied met spesifieke aktiwiteit van 4000-6000 MBq/ml te lewer. ‘n Direkte elektrofiliese radioiodineringsmetode is in hierdie studie gebruik om 123-I-5-I-R91150 in ysasynsuur te merk. Na radioaktiewe merking is die radioaktiewe produk deur twee verskillende metodes gesuiwer, naamlik ‘n HPLC metode en ‘n soliede fase ekstraksie (SPE) metode. Vir beide metodes is die produk deur middel van HPLC analiseer. Metodes is getoets om die volume van die gemerkte produk met C8 of C18 SPE kolommetjies te verminder. Die gemiddelde bindingsdoeltreffendheid vir die SPE en HPLC suiweringsmetodes was 76% ± 13.6% en 52% ± 11.2% onderskeidelik. Die opbrengs van 123I-5-I-R91150 was ongeveer 80%. Sep-Pak C8 en C18 kon beide nie gebruik word om die HPLC gesuiwerde produk te konsentreer nie. Produkte van beide suiweringsmetodes was steriel en pirogeenvry. Daar is getoon dat beide suiweringsmetodes produkte lewer wat aan die meeste kriteria wat in hierdie studie gestel is, voldoen. Beide metodes het egter voor- en nadele. Die SPE suiweringsmetdode het tot hoër bindingsdoeltreffendheid gelei, asook ‘n baie laer produkvolume. Daar is egter ‘n mate van kommer oor die stabiliteit van die produk aangesien vry radiojodied waargeneem is. Indien hierdie suiweringsmetode gebruik word, moet die produk dus so gou as moontlik na voltooiing van analise toegedien word. Na HPLC suiwering was die onverdunde produk tot 4.15 uur na produksie stabiel maar die produkvolume was relatief hoog en suiwering tydrowend. Om ‘n bruikbare pasiëntdosis te verkry moet merking met ten minste 740 MBq 123I begin en die gemerkte produk moet na suiwering in fraksies van 5 ml of minder versamel word om ‘n fraksie met geskikte spesifieke aktiwiteit te verkry. Die gevolgtrekking is gemaak dat radioaktiewe merking van R91150 by ons instelling moontlik is, maar dat ‘n verbeterde HPLC sisteem vir roetineproduksie van ‘n suiwer en veilige produk van waarde sou wees.

<p>Optical coherence tomography (OCT) is a non-invasive imaging modality that uses low coherence interferometry to generate three-dimensional datasets of a sample's structure. OCT has found tremendous clinical applications in imaging the retina and has demonstrated great utility in the diagnosis of various retinal diseases. However, such diagnoses rely upon the ability to observe abnormalities in the structure of the retina caused by pathology. By the time an ocular disease has progressed to the point of affecting the morphology of the retina, irreversible vision loss in the eye may already occur. Changes in the functionality of the tissue often precede changes to the structure. Thus, if imaging methods are developed to provide additional functional information about the behavior and response of the retinal tissue and vasculature, earlier treatment for disease may be prescribed, thus preserving vision for the patient. </p><p>Within the last decade, significant technological advances in OCT systems have enabled high-speed and high sensitivity image acquisition using either spectral domain OCT (SDOCT) or swept-source OCT (SSOCT) configurations. Such systems use Fourier processing to extract structural information of a sample from interferometric principles. But such systems also have access to the optical phase information, which allows for functional analysis of sample dynamics. This dissertation details the development and application of methods using both intensity and phase information as a tool for studying interesting biological phenomena. The goal of this work is an extension of techniques to image the vasculature in the retina and enhance the clinical utility of OCT.</p><p>I first outline basic theory necessary for understanding the principles of OCT. I then describe OCT phase imaging in cellular applications as a demonstration of the ability of OCT to provide functional information on biological dynamics. Phase imaging methods suffer from an artifact known as phase wrapping, and I have developed a software technique to overcome this problem in OCT, thus extending its usefulness in providing quantitative information. I characterize the limitations in measuring moving scatterers with Doppler OCT in both SDOCT and SSOCT system. I also show the ability to image the vasculature in the retina using variance imaging with a high-speed retinal imaging system and software based methods to correct for patient motion and create a widefield mosaic in an automated manner. Finally, future directions for this work are discussed.</p> / Dissertation

Modern medicine has become reliant on medical imaging. Multiple modalities, e. g. magnetic resonance imaging (MRI), computed tomography (CT), etc. , are used to provide as much information about the patient as possible. The problem of geometrically aligning the resulting images is called image registration. Mutual information, an information theoretic similarity measure, allows for automated intermodal image registration algorithms. <br /><br /> In applications such as cancer therapy, diagnosticians are more concerned with the alignment of images over a region of interest such as a cancerous lesion, than over an entire image set. Attempts to register only the regions of interest, defined manually by diagnosticians, fail due to inaccurate mutual information estimation over the region of overlap of these small regions. <br /><br /> This thesis examines the region of union as an alternative to the region of overlap. We demonstrate that the region of union improves the accuracy and reliability of mutual information estimation over small regions. <br /><br /> We also present two new mutual information based similarity measures which allow for localized image registration by combining local and global image information. The new similarity measures are based on convex combinations of the information contained in the regions of interest and the information contained in the global images. <br /><br /> Preliminary results indicate that the proposed similarity measures are capable of localizing image registration. Experiments using medical images from computer tomography and positron emission tomography demonstrate the initial success of these measures. <br /><br /> Finally, in other applications, auto-detection of regions of interest may prove useful and would allow for fully automated localized image registration. We examine methods to automatically detect potential regions of interest based on local activity level and present some encouraging results.

Biomedical study researchers using animals to model disease and treatment need fast, deep, noninvasive, and inexpensive multi-channel imaging methods. Traditional fluorescence microscopy meets those criteria to an extent. Specifically, two-photon and confocal microscopy, the two most commonly used methods, are limited in penetration depth, cost, resolution, and field of view. In addition, two-photon microscopy has limited ability in multi-channel imaging. Light sheet microscopy, a fast developing 3D fluorescence imaging method, offers attractive advantages over traditional two-photon and confocal microscopy. Light sheet microscopy is much more applicable for in vivo 3D time-lapsed imaging, owing to its selective illumination of tissue layer, superior speed, low light exposure, high penetration depth, and low levels of photobleaching. However, standard light sheet microscopy using Gaussian beam excitation has two main disadvantages: 1) the field of view (FOV) of light sheet microscopy is limited by the depth of focus of the Gaussian beam. 2) Light-sheet images can be degraded by scattering, which limits the penetration of the excitation beam and blurs emission images in deep tissue layers. While two-sided sheet illumination, which doubles the field of view by illuminating the sample from opposite sides, offers a potential solution, the technique adds complexity and cost to the imaging system. We investigate a new technique to address these limitations: Bessel light sheet microscopy in combination with incoherent nonlinear Structured Illumination Microscopy (SIM). Results demonstrate that, at visible wavelengths, Bessel excitation penetrates up to 250 microns deep in the scattering media with single-side illumination. Bessel light sheet microscope achieves confocal level resolution at a lateral resolution of 0.3 micron and an axial resolution of 1 micron. Incoherent nonlinear SIM further reduces the diffused background in Bessel light sheet images, resulting in confocal quality images in thick tissue. The technique was applied to live transgenic zebra fish tg(kdrl:GFP), and the sub-cellular structure of fish vasculature genetically labeled with GFP was captured in 3D. The superior speed of the microscope enables us to acquire signal from 200 layers of a thick sample in 4 minutes. The compact microscope uses exclusively off-the-shelf components and offers a low-cost imaging solution for studying small animal models or tissue samples.

<p>Optical coherence tomography (OCT) is a noninvasive three-dimensional interferometric imaging technique capable of achieving micrometer scale resolution. It is now a standard of care in ophthalmology, where it is used to improve the accuracy of early diagnosis, to better understand the source of pathophysiology, and to monitor disease progression and response to therapy. In particular, retinal imaging has been the most prevalent clinical application of OCT, but researchers and companies alike are developing OCT systems for cardiology, dermatology, dentistry, and many other medical and industrial applications. </p><p>Adaptive optics (AO) is a technique used to reduce monochromatic aberrations in optical instruments. It is used in astronomical telescopes, laser communications, high-power lasers, retinal imaging, optical fabrication and microscopy to improve system performance. Scanning laser ophthalmoscopy (SLO) is a noninvasive confocal imaging technique that produces high contrast two-dimensional retinal images. AO is combined with SLO (AOSLO) to compensate for the wavefront distortions caused by the optics of the eye, providing the ability to visualize the living retina with cellular resolution. AOSLO has shown great promise to advance the understanding of the etiology of retinal diseases on a cellular level.</p><p>Broadly, we endeavor to enhance the vision outcome of ophthalmic patients through improved diagnostics and personalized therapy. Toward this end, the objective of the work presented herein was the development of advanced techniques for increasing the imaging speed, reducing the form factor, and broadening the versatility of OCT and AOSLO. Despite our focus on applications in ophthalmology, the techniques developed could be applied to other medical and industrial applications. In this dissertation, a technique to quadruple the imaging speed of OCT was developed. This technique was demonstrated by imaging the retinas of healthy human subjects. A handheld, dual depth OCT system was developed. This system enabled sequential imaging of the anterior segment and retina of human eyes. Finally, handheld SLO/OCT systems were developed, culminating in the design of a handheld AOSLO system. This system has the potential to provide cellular level imaging of the human retina, resolving even the most densely packed foveal cones.</p> / Dissertation

<p>A tenet of modern radiotherapy (RT) is to identify the treatment target accurately, following which the high-dose treatment volume may be expanded into the surrounding tissues in order to create the clinical and planning target volumes. Respiratory motion can induce errors in target volume delineation and dose delivery in radiation therapy for thoracic and abdominal cancers. Historically, radiotherapy treatment planning in the thoracic and abdominal regions has used 2D or 3D images acquired under uncoached free-breathing conditions, irrespective of whether the target tumor is moving or not. Once the gross target volume has been delineated, standard margins are commonly added in order to account for motion. However, the generic margins do not usually take the target motion trajectory into consideration. That may lead to under- or over-estimate motion with subsequent risk of missing the target during treatment or irradiating excessive normal tissue. That introduces systematic errors into treatment planning and delivery. In clinical practice, four-dimensional (4D) imaging has been popular in For RT motion management. It provides temporal information about tumor and organ at risk motion, and it permits patient-specific treatment planning. The most common contemporary imaging technique for identifying tumor motion is 4D computed tomography (4D-CT). However, CT has poor soft tissue contrast and it induce ionizing radiation hazard. In the last decade, 4D magnetic resonance imaging (4D-MRI) has become an emerging tool to image respiratory motion, especially in the abdomen, because of the superior soft-tissue contrast. Recently, several 4D-MRI techniques have been proposed, including prospective and retrospective approaches. Nevertheless, 4D-MRI techniques are faced with several challenges: 1) suboptimal and inconsistent tumor contrast with large inter-patient variation; 2) relatively low temporal-spatial resolution; 3) it lacks a reliable respiratory surrogate. In this research work, novel 4D-MRI techniques applying MRI weightings that was not used in existing 4D-MRI techniques, including T2/T1-weighted, T2-weighted and Diffusion-weighted MRI were investigated. A result-driven phase retrospective sorting method was proposed, and it was applied to image space as well as k-space of MR imaging. Novel image-based respiratory surrogates were developed, improved and evaluated.</p> / Dissertation

SAMMANFATTNING   Bakgrund: Den medicinska diagnostiken revolutionerades efter Wilhelm Conrad Röntgens upptäckt av de strålar som kunde tränga igenom material och projicera bild på film. Skadliga effekter av den joniserande röntgenstrålningen visade sig dock snart på både patienter och röntgenpersonal, trots kunskapen om strålningens skadliga verkan visar tidigare studier på brister gällande patientstrålskydd.   Syfte: Syftet med detta arbete var att studera röntgensjuksköterskans tillämpning av patientstrålskydd, anledningar till att patientstrålskydd inte tillämpas samt om röntgensjuksköterskan hade egna förslag och/eller uppfattningar till hur användandet av patientstrålskydd kunde ökas.   Metod: Studien är en kvantitativ deskriptiv enkätstudie, där tre tillfrågade sjukhus har deltagit. Enkäten bestod av frågor med slutna svarsalternativ samt lämnades plats för egna kommentarer. Totalt analyserades 32 enkäter.   Resultat: Resultatet visade att fertila kvinnor i hög utsträckning tillfrågades om graviditet på samtliga sjukhus samt angav majoriteten av respondenterna att de alltid eller oftast tillämpade gonadskydd som patientstrålskydd. Gällande kompression och PA-positionering skilde sig sjukhusen från varandra i tillämpningen av patientstrålskydd. Vid jämförelse mellan sjukhusen framkom signifikanta skillnader i samtliga frågeställningar. Avseende förbättringsmöjligheter analyserades respondenternas egna kommentarer och fyra huvudgrupper framträdde; tillgänglighet, tradition/kultur på arbetsplatsen, radiologernas roll samt utbildning.   Slutsats: Det finns kunskaper hos röntgensjuksköterskan angående fördelarna med att tillämpa patientstrålskydd, trots dessa kunskaper finns det plats för förbättring gällande de rutiner och krav som styrs av röntgenverksamheten på de medverkande sjukhusen.

Bakgrund: Många patienter som genomgår en DT-colonundersökning upplever att både förberedelser och själva undersökningen är krävande och ansträngande. Genom väl formulerad och tydlig förhandsinformation samt att undersökande personal har ett gott bemötande och individanpassar kommunikationen kan leda till en positiv patientupplevelse. Syfte: Syftet med studien är att ta reda på hur patienten upplever förhandsinformationen och personalens information från två olika sjukhus samt att jämföra resultaten med varandra. Metod: Studien är en kvantitativ studie där patienter som utfört DT-colonundersökningar har blivit tillfrågade att anonymt fylla i en enkät efter undersökningens slut. Ett strategiskt urval har gjorts där inklusions- och exklusionskriterier har tillämpats. Enkätens resultat har analyserats i statistikprogrammet SPSS. Resultat: Patienterna var överlag nöjda med förhandsinformationen, en viss procentuell skillnad visar att patienterna från sjukhus B var mer nöjda än sjukhus A. Patienterna från båda sjukhusen upplevde att informationen från personalen var bra och patienterna var nöjda. Inga signifikanta skillnader mellan de två sjukhusen kan påvisas i denna studie. Slutsats: Överlag var studiens deltagare nöjda med både förhandsinformationen samt personalens information. Trots att det inte fanns någon signifikant skillnad visade resultatet att deltagarna på sjukhus B var nöjdare, procentuellt sett, än sjukhus A gällande både förhandsinformation och personalens information. / Background: Many patients who participate in CT-colonography find the preparations and the examination itself to be hard. A plain and well written information letter, as well as good communication and patient-centered care from the hospital staff could make the patient experience better. Aim: The aim of the study is to investigate how patients from two different hospitals perceive both the information letter and the oral information from the staff and compare to each other. Method: The study is a qualitative study. Patients have been asked to fill out a survey at the end of their examination. The patients have been strategically selected, inclusion- and exclusion criterias have been adapted. The result of the survey has been analyzed in SPSS. Results: In general the patients were pleased with the information letter. The patients at hospital B were to some extent more satisfied than the patients at hospital A. The majority of the patients from both hospitals were satisfied with the information from the hospital staff. Although the result showed some percentage difference between the hospitals, no significant difference was shown.   Conclusion: Overall the participants of the study were satisfied with both the information letter and the information from the hospital staff. Although there were no significant differences, the result showed that the patients from hospital B were more satisfied than the patients from hospital A in all senses.

<p>There is a critical need to target tumor hypoxia as patients with hypoxic tumors have worse prognosis due to aggressive phenotypes and resistance to radiotherapy and chemotherapy. The overall goal of this work is to improve response to conventional cancer therapies by targeting tumor hypoxia. This has been carried out and evaluated through the use of polymersome-encapsulated myoglobin (PEMs) with the hypothesis that O2-releasing PEMs will increase tumor oxygenation, and thereby improve response to radiotherapy. Mb was chosen as an O2 carrying protein to deliver to tumors because it has a strong association to O2, providing a mechanism to deliver O2 only within the hypoxic regions of the tumor. Mb was loaded within nanoscale polymeric vesicles that were expected to accumulate within solid tumors due to the enhanced permeability and retention (EPR) effect. This hypothesis has been tested through the following aims:</p><p>1. Develop NIR imaging techniques for studying the biodistribution and pharmacokinetics of polymersomes</p><p>2. Establish the effects of Mb-containing polymersomes on tumor physiology</p><p>3. Modify tumor growth through delivery of Mb polymersomes in combination with a cytotoxic therapy specific to aerobic tumors</p><p>These aims have been evaluated through numerous in vivo studies. First, polymersomes of various polymer formulations and diameters ranging from 110-550 nm were prepared with a near-infrared (NIR) -emissive fluorophore. Using live animal fluorescence imaging, I was able to study the biodistribution of the polymersomes following i.v. administration, demonstrating significant polymersome accumulation in orthotopic 4T1 mammary carcinomas. In addition, a novel method for measuring pharmacokinetics was developed, using serial small volume blood draws from individual mice. The plasma fluorescence in microcapillary tubes was used to quantify polymersome concentrations, demonstrating long circulation half-lives that varied from 6-23 h. Toxicity of various polymersome formulations were also studied in vitro and in vivo, revealing negligible toxicities.</p><p>For the second aim, PEMs were administered i.v. in tumor-bearing mice. Unexpectedly, we observed a dramatic gross tumor effect within hours of treatment in both orthotopic 4T1 tumors and flank Renca renal cell carcinomas. Histological analysis revealed endothelial cell apoptosis as early as 1 h following treatment, with scattered tumor cell death throughout the tumor by 4 h. Hematoxylin and eosin staining showed significant necrosis 24 h following PEM treatment. Vascular effects and polymersome distribution were studied in 4T1 window chamber tumors. Following i.v. treatment with PEMs, intravital microscopy was used to image polymersome fluorescence, brightfield transmission was imaged for vessel morphology and blood flow, and a tunable filter was used for determining hemoglobin (Hb) oxygen saturation. Tumor hemorrhaging was observed within hours of PEM treatment, which was not seen with empty polymersomes. This was consistent with the gross tumor effects observed initially. Hb saturation decreased in both the PEM and empty polymersome groups, but not in saline-treated mice. While we expected to observe an increase in tumor oxygenation by using Mb as an oxygen carrier, we actually observed hemorrhage, decreased oxygenation, and central tumor necrosis. In vitro studies using human endothelial cells demonstrated dramatic changes in cell morphology and increased permeability due to Mb and PEM treatments, which appear to be enhanced in an oxidative environment. These in vitro and in vivo observations are similar to what is seen with tumor vascular disrupting agents.</p><p>For the third aim, I combined radiotherapy (RT) and PEM treatment with a new hypothesis. I originally expected the PEMs to increase tumor oxygenation, thus making the tumor more susceptible to RT. However, considering the results from the second aim, this hypothesis was modified: the PEMs would result in necrosis of the tumor core, while RT would target the more oxygenated rim of the tumor, thus leading to improved tumor growth delay compared with PEM or RT alone. This hypothesis was tested in both orthotopic, syngeneic 4T1 tumors as well as flank FaDu xenografts. 4T1 tumor cells were surgically implanted within the dorsal mammary fat pad of mice and grown until ~200 mm3. A CT microirradiator with a square collimator was used in order to locate and specifically irradiate the tumor. Within 1 h following RT, the PEMs were administered i.v.. Mice receiving PEMs with no RT showed a significant decrease in tumor growth compared with saline-treated mice (p = 0.0001 for time to 3x original tumor volume). In addition, the combination of RT plus PEMs reduced tumor growth compared with RT alone (p = 0.0144 for time to 3x original tumor volume). However, this effect was not seen with FaDu tumors. This may have been due to excessive radiation dose or other compounding factors: the timing between RT and PEM treatment was not optimized, and the number of mice per group was small (3-4). </p><p>Thus, the conclusions for each aim are as follows:</p><p>1. Develop NIR imaging techniques for studying the biodistribution and pharmacokinetics of polymersomes</p><p>NIR imaging techniques were optimized for studying polymersomes, demonstrating long plasma circulation times and accumulation within tumors.</p><p>2. Establish the effects of Mb-containing polymersomes on tumor physiology</p><p>While the hypothesis was that PEMs would accumulate within hypoxic tumors and subsequently increase O2 tension, we observed a rapid decrease in tumor oxygenation followed by a dramatic hemorrhagic effect of Mb polymersomes, which appear to be due to both endothelial cell apoptosis and morphological changes, resulting in central tumor necrosis.</p><p>3. Modify tumor growth through delivery of Mb polymersomes in combination with a cytotoxic therapy specific to aerobic tumors</p><p>Combination therapy of PEMs with RT results in enhanced tumor growth delay in aggressive 4T1 mammary carcinomas compared with RT or PEMs alone.</p><p>These studies have led to a proposed mechanism for the PEM anti-tumor effect in combination with RT. Prior to PEM administration, RT is administered, resulting in tumor cell kill of the well-oxygenated tumor periphery. Mb polymersomes are then injected i.v. and begin to accumulate within tumors due to the EPR effect. As shown in Aim 1, this accumulation occurs over a short time scale. Within 30 min of PEM treatment, the Mb is believed to act on tumor vessels, resulting in morphological changes and apoptosis of endothelial cells. These effects are expected to increase permeability of the vessels and expose the basement membrane, which leads to clotting and decreased blood flow. Both decreased perfusion and increased permeability are believed to have a catastrophic effect on interior tumor vessels. Hemorrhage results as the endothelial cells die, resulting in tumor core necrosis. Therefore, the result is tumor cell kill at the periphery due to RT and central tumor necrosis due to PEM treatment.</p><p>PEMs have potential in cancer therapy as a new class of VDAs. While the mechanism requires further investigation, this work has demonstrated that PEM treatment results in tumor vessel destruction and central necrosis. PEMs accumulate within tumors, thus minimizing the systemic toxicity of treatment commonly seen with VDAs. By combining PEMs with a therapy that kills the better perfused tumor periphery, PEMs show promise in improving tumor response. Future mechanistic studies will be needed in order to maximize vessel damage and optimize combination dosing schedules to improve outcome.</p> / Dissertation