Rationale: Inflammation plays a pivotal role in the pathogenesis of the acute coronary syndrome. Detecting plaques with high inflammatory activity and specifically treating those lesions can be crucial to prevent life-threatening cardiovascular events. Methods: Here, we developed a macrophage mannose receptor (MMR)-targeted theranostic nanodrug (mannose-polyethylene glycol-glycol chitosan-deoxycholic acid-cyanine 7-lobeglitazone; MMR-Lobe-Cy) designed to identify inflammatory activity as well as to deliver peroxisome proliferator-activated gamma (PPARγ) agonist, lobeglitazone, specifically to high-risk plaques based on the high mannose receptor specificity. The MMR-Lobe-Cy was intravenously injected into balloon-injured atheromatous rabbits and serial in vivo optical coherence tomography (OCT)-near-infrared fluorescence (NIRF) structural-molecular imaging was performed. Results: One week after MMR-Lobe-Cy administration, the inflammatory NIRF signals in the plaques notably decreased compared to the baseline whereas the signals in saline controls even increased over time. In accordance with in vivo imaging findings, ex vivo NIRF signals on fluorescence reflectance imaging (FRI) and plaque inflammation by immunostainings significantly decreased compared to oral lobeglitazone group or saline controls. The anti-inflammatory effect of MMR-Lobe-Cy was mediated by inhibition of TLR4/NF-κB pathway. Furthermore, acute resolution of inflammation altered the inflamed plaque into a stable phenotype with less macrophages and collagen-rich matrix. Conclusion: Macrophage targeted PPARγ activator labeled with NIRF rapidly stabilized the inflamed plaques in coronary sized artery, which could be quantitatively assessed using intravascular OCT-NIRF imaging. This novel theranostic approach provides a promising theranostic strategy for high-risk coronary plaques.

Background Photoactivation targeting macrophages has emerged as a therapeutic strategy for atherosclerosis, but limited targetable ability of photosensitizers to the lesions hinders its applications. Moreover, the molecular mechanistic insight to its phototherapeutic effects on atheroma is still lacking. Herein, we developed a macrophage targetable near-infrared fluorescence (NIRF) emitting phototheranostic agent by conjugating dextran sulfate (DS) to chlorin e6 (Ce6) and estimated its phototherapeutic feasibility in murine atheroma. Also, the phototherapeutic mechanisms of DS-Ce6 on atherosclerosis were investigated. Results The phototheranostic agent DS-Ce6 efficiently internalized into the activated macrophages and foam cells via scavenger receptor-A (SR-A) mediated endocytosis. Customized serial optical imaging-guided photoactivation of DS-Ce6 by light illumination reduced both atheroma burden and inflammation in murine models. Immuno-fluorescence and -histochemical analyses revealed that the photoactivation of DS-Ce6 produced a prominent increase in macrophage-associated apoptotic bodies 1 week after laser irradiation and induced autophagy with Mer tyrosine-protein kinase expression as early as day 1, indicative of an enhanced efferocytosis in atheroma. Conclusion Imaging-guided DS-Ce6 photoactivation was able to in vivo detect inflammatory activity in atheroma as well as to simultaneously reduce both plaque burden and inflammation by harmonic contribution of apoptosis, autophagy, and lesional efferocytosis. These results suggest that macrophage targetable phototheranostic nanoagents will be a promising theranostic strategy for high-risk atheroma. Graphical abstract

Imaging the Eustachian tube is challenging because of its complex anatomy and limited accessibility. This study fabricated a fiber-based optical coherence tomography (OCT) catheter and investigated its potential for assessing the Eustachian tube anatomy. A customized OCT system and an imaging catheter, termed the Eustachian OCT, were developed for visualizing the Eustachian tube. Three male swine cadaver heads were used to study OCT image acquisition and for subsequent histologic correlation. The imaging catheter was introduced through the nasopharyngeal opening and reached toward the middle ear. The OCT images were acquired from the superior to the nasopharyngeal opening before and after Eustachian tube balloon dilatation. The histological anatomy of the Eustachian tube was compared with corresponding OCT images, The new, Eustachian OCT catheter was successfully inserted in the tubal lumen without damage. Cross-sectional images of the tube were successfully obtained, and the margins of the anatomical structures including cartilage, mucosa lining, and fat could be successfully delineated. After balloon dilatation, the expansion of the cross-sectional area could be identified from the OCT images. Using the OCT technique to assess the Eustachian tube anatomy was shown to be feasible, and the fabricated OCT image catheter was determined to be suitable for Eustachian tube assessment.

In endoscopic optical coherence tomography, a transparent protective sheath is used to protect the optics and tissue. However, the sheath causes astigmatism, which degrades transverse resolution and signal-to-noise ratio due to the cylindrical lens effect. Generally used methods for correcting this astigmatism are complex, difficult to control precisely, high-cost, and increase the dimensions of the imaging probe. To overcome these problems, we have developed an astigmatism-corrected imaging probe with an epoxy window. The astigmatism is precisely and cost-effectively adjusted controlling the curvature radius of the epoxy window, which is produced by soft lithography. Using the fiber optic fusion splicing, the fabrication process is simple. The fabricated imaging probe is almost monolithic, so its diameter is similar to that of a standard single-mode fiber. We demonstrate its astigmatism-correcting performance using focal spot analysis, imaging micro-beads and a biological sample.

Backgrounds: Atherosclerosis is a chronic inflammatory disease causing a fatal plaque rupture and its key aspect is a failure to resolve inflammation. We hypothesized that macrophage targeted near-infrared fluorescence (NIRF) emitting photoactivation could simultaneously in vivo assess the inflamed high-risk plaques and facilitate the inflammation resolution. Method and results: We newly synthesized a Dectin-1 targeted photoactivatable theranostic agent by the chemical conjugation of photosensitizer chlorin e6 (Ce6) and Dectin-1 ligand laminarin (LAM-Ce6). Intravascular photoactivation through a customized fiber-based diffuser effectively reduced inflammation in the targeted plaques 4 weeks after LAM-Ce6 administration as serially assessed by dual-modal optical coherence tomography (OCT)-NIRF catheter imaging. The number of TUNEL-positive apoptotic macrophages peaked at 1 day after laser irradiation, and then resolved until 4 weeks. One hour after the light therapy, autophagy was strongly augmented with the formation of autophagolysosomes revealed by co-localization of enhanced microtubule-associated protein light-chain 3 (LC3) and lysosome-associated membrane protein 2 (LAMP2) expressions in the plaques (Figure). LAM-Ce6 photoactivation increased the TUNEL/RAM11- and MerTK-positive cells in the plaques, suggestive of enhanced efferocytosis. In line with inflammation resolution, photoactivation reduced the plaque burden with collagen-rich fibrotic replacement via TGF-β pathway confirmed by corroborative immunostainings ( p <0.01). Conclusions: OCT-NIRF imaging-guided macrophage Dectin-1 targetable photoactivation could stabilize the inflamed high-risk plaques by autophagy-mediated inflammation resolution and TGF-β dependent fibrotic replacement. This novel targeted photoactivation will offer new opportunity for the catheter based theranostic strategy.