Coronary Plaque Vulnerability: Molecular and Cellular Mechanisms and Novel Imaging Modalities

Molecular Imaging Of Plaque Inflammation And Protease Activity

In the light of the well-recognized contribution of inflammation and proteolytic activity to plaque destabilization, novel imaging modalities visualizing molecular targets are increasingly appreciated for their potential to assess in vivo biological processes beyond the structural information that is obtained from traditional imaging modalities. While the feasibility and validation of these techniques have been tested at the pre-clinical level, the rapidly emerging strategy of optical and multimodality molecular imaging of inflammation and protease activity has shown promise for clinical translation. These techniques could provide a powerful tool to enhance our understanding of the pathophysiologic processes governing the progression towards high-risk plaque, enable the identification of rupture-prone plaques at earlier stages of their evolution, enable monitoring of novel therapeutic interventions, and allow for individualized therapeutic strategies. Near-infrared fluorescence (NIRF) is a particularly promising technique for the in vivo visualization of protease activity. Detection of the NIR fluorochromes can be performed either non-invasively by fluorescence molecular tomography (FMT), or invasively, using intravascular NIRF catheters.