Contrast-enhanced MRI of atherosclerosis can provide valuable additional information on a patient's disease state. As a result of the interactions of HDL with atherosclerotic plaque and the flexibility of its reconstitution, it is a versatile candidate for the delivery of contrast-generating materials to this pathogenic lesion. We herein discuss the reports of HDL modified with gadolinium to act as an MRI contrast agent for atherosclerosis. Furthermore, HDL has been modified with fluorophores and nanocrystals, allowing it to act as a contrast agent for fluorescent imaging techniques and for computed tomography. Such modified HDL has been found to be macrophage specific, and, therefore, can provide macrophage density information via noninvasive MRI. As such, modified HDL is currently a valuable contrast agent for probing preclinical atherosclerosis. Future developments may allow the application of this particle to further diseases and pathological or physiological processes in both preclinical models as well as in patients.
Keywords contrast agent; HDL; lipoproteins; medical imaging; MRI; nanoparticleThe noninvasive imaging of atherosclerotic plaques by MRI has obvious preclinical and clinical applications. In addition to diagnostic applications, noninvasive imaging would also allow the assessment of the responses to therapies [1]. In the preclinical setting, an immediate obstacle for MRI of atherosclerosis is the small size of the arteries of the most common model of the human disease, namely genetically engineered mice. The mice are made deficient in a lipoprotein clearance factor, such as ApoE or the LDL receptor, which results in elevated plasma levels of the atherogenic (non-HDL) lipoproteins. If the mice are placed on a cholesterol-and fat-enriched diet (the so-called 'Western diet'), plasma non-HDL levels are further elevated and atherosclerotic plaque progression accelerates [2]. In the mid-1990s, we were successful in demonstrating that noncontrast-enhanced MRI could detect mouse aortic atherosclerosis [3], which led to a series of papers demonstrating both practical applications [4] , further encouraging our strategy. Gadolinium is widely used to generate contrast for MRI and was available in a form in which it was chelated to a diethylene triamine pentaacetic acidphosphatidyl ethanolamine (DPTA-PE) molecule, which could be included in the phospholipids layer of HDL. Therefore, an integrated gadolinium-HDL particle was proposed as an initial MRI contrast agent for atherosclerosis.
First-generation HDL nanoparticlesThe first gadolinium-labeled HDL was formed by reconstituting human HDL with gadolinium (Gd)-DPTA-PE and also with a fluorescent dye, NBD, which would allow convenient ex vivo analyses of the distribution of the particle in the plaque [9]. The labeled HDL we termed Gd-HDL. The reconstitution procedure followed the classical cholate dialysis method, with the components used including phosphatidyl choline and ApoA-I to form the surface and cholesteryl ester to form the core [9]. These s...