Clinical HCM genetic testing provides a definitive molecular diagnosis for many patients and provides cost savings to families. Expanded gene panels have not substantively increased the clinical sensitivity of HCM testing, suggesting major additional causes of HCM still remain to be identified.

Nanoparticle-based delivery of simvastatin inhibits plaque macrophage proliferation in apolipoprotein E–deficient mice.

Immunological complexity in atherosclerosis warrants targeted treatment of specific inflammatory cells that aggravate the disease. With the initiation of large phase III trials investigating immunomodulatory drugs for atherosclerosis, cardiovascular disease treatment enters a new era. We here propose a radically different approach: implementing and evaluating in vivo a combinatorial library of nanoparticles with distinct physiochemical properties and differential immune cell specificities. The library's nanoparticles are based on endogenous high-density lipoprotein, which can preferentially deliver therapeutic compounds to pathological macrophages in atherosclerosis. Using the apolipoprotein E-deficient (Apoe −/− ) mouse model of atherosclerosis, we quantitatively evaluated the library's immune cell specificity by combining immunological techniques and in vivo positron emission tomography imaging. Based on this screen, we formulated a liver X receptor agonist (GW3965) and abolished its liver toxicity while still preserving its therapeutic function. Screening the immune cell specificity of nanoparticles can be used to develop tailored therapies for atherosclerosis and other inflammatory diseases.nanomedicine | drug delivery | immunotherapy | molecular imaging | atherosclerosis

BackgroundDisrupting the costimulatory CD40-CD40L dyad reduces atherosclerosis, but can result in immune suppression. The authors recently identified small molecule inhibitors that block the interaction between CD40 and tumor necrosis factor receptor-associated factor (TRAF) 6 (TRAF-STOPs), while leaving CD40-TRAF2/3/5 interactions intact, thereby preserving CD40-mediated immunity.ObjectivesThis study evaluates the potential of TRAF-STOP treatment in atherosclerosis.MethodsThe effects of TRAF-STOPs on atherosclerosis were investigated in apolipoprotein E deficient (Apoe−/−) mice. Recombinant high-density lipoprotein (rHDL) nanoparticles were used to target TRAF-STOPs to macrophages.ResultsTRAF-STOP treatment of young Apoe−/− mice reduced atherosclerosis by reducing CD40 and integrin expression in classical monocytes, thereby hampering monocyte recruitment. When Apoe−/− mice with established atherosclerosis were treated with TRAF-STOPs, plaque progression was halted, and plaques contained an increase in collagen, developed small necrotic cores, and contained only a few immune cells. TRAF-STOP treatment did not impair “classical” immune pathways of CD40, including T-cell proliferation and costimulation, Ig isotype switching, or germinal center formation, but reduced CD40 and β2-integrin expression in inflammatory monocytes. In vitro testing and transcriptional profiling showed that TRAF-STOPs are effective in reducing macrophage migration and activation, which could be attributed to reduced phosphorylation of signaling intermediates of the canonical NF-κB pathway. To target TRAF-STOPs specifically to macrophages, TRAF-STOP 6877002 was incorporated into rHDL nanoparticles. Six weeks of rHDL-6877002 treatment attenuated the initiation of atherosclerosis in Apoe−/− mice.ConclusionsTRAF-STOPs can overcome the current limitations of long-term CD40 inhibition in atherosclerosis and have the potential to become a future therapeutic for atherosclerosis.

OBJECTIVES This study sought to develop an integrative positron emission tomography (PET) with magnetic resonance imaging (MRI) procedure for accurate atherosclerotic plaque phenotyping, facilitated by clinically approved and nanobody radiotracers. BACKGROUND Noninvasive characterization of atherosclerosis remains a challenge in clinical practice. The limitations of current diagnostic methods demonstrate that, in addition to atherosclerotic plaque morphology and composition, disease activity needs to be evaluated. METHODS We screened 3 nanobody radiotracers targeted to different biomarkers of atherosclerosis progression, namely vascular cell adhesion molecule (VCAM)-1, lectin-like oxidized low-density lipoprotein receptor (LOX)-1, and macrophage mannose receptor (MMR). The nanobodies, initially radiolabeled with copper-64 ( 64 Cu), were extensively evaluated in Apoe –/– mice and atherosclerotic rabbits using a combination of in vivo PET/MRI readouts and ex vivo radioactivity counting, autoradiography, and histological analyses. RESULTS The 3 nanobody radiotracers accumulated in atherosclerotic plaques and displayed short circulation times due to fast renal clearance. The MMR nanobody was selected for labeling with gallium-68 ( 68 Ga), a short-lived radioisotope with high clinical relevance, and used in an ensuing atherosclerosis progression PET/MRI study. Macrophage burden was longitudinally studied by 68 Ga-MMR–PET, plaque burden by T2-weighted MRI, and neovascularization by dynamic contrast-enhanced (DCE) MRI. Additionally, inflammation and microcalcifications were evaluated by fluorine-18 ( 18 F)-labeled fluorodeoxyglucose ( 18 F-FDG) and 18 F-sodium fluoride ( 18 F-NaF) PET, respectively. We observed an increase in all the aforementioned measures as disease progressed, and the imaging signatures correlated with histopathological features. CONCLUSIONS We have evaluated nanobody-based radiotracers in rabbits and developed an integrative PET/MRI protocol that allows noninvasive assessment of different processes relevant to atherosclerosis progression. This approach allows the multiparametric study of atherosclerosis and can aid in early stage anti-atherosclerosis drug trials.

Objectives Our aim was to develop and validate a non-invasive imaging tool to visualize HDL’s in vivo behavior by positron emission tomography (PET), with an emphasis on its plaque targeting abilities. Background High-density lipoprotein (HDL) is a natural nanoparticle that interacts with atherosclerotic plaque macrophages to facilitate reverse cholesterol transport. HDL-cholesterol concentration in blood is inversely associated with risk of coronary heart disease and remains one of the strongest independent predictors of incident cardiovascular events. Methods Discoidal HDL nanoparticles were prepared by reconstitution of its components apolipoprotein A-I (APOA1) and the phospholipid DMPC. For radiolabeling with Zirconium-89 (89Zr), the chelator DFO was introduced by conjugation to APOA1 or as a phospholipid-chelator (DSPE-DFO). Radiolabeled HDL’s biodistribution and plaque targeting was studied in established murine, rabbit and porcine atherosclerosis models by PET combined with computed tomography (PET/CT) or with magnetic resonance imaging (PET/MRI). Ex vivo validation was conducted by radioactivity counting, autoradiography and near infrared fluorescence imaging. Flow cytometric assessment of cellular specificity in different tissues was performed in the murine model. Results We observed distinct pharmacokinetic profiles for the two 89Zr-HDL nanoparticles. Both APOA1- and phospholipid-labeled HDL mainly accumulated in kidneys, liver and spleen with some marked quantitative differences in radioactivity uptake values. Radioactivity concentrations in rabbit atherosclerotic aortas were 3–4-fold higher than in controls at 5 days p.i. for both 89Zr-HDL nanoparticles. In the porcine model, we observed increased accumulation of radioactivity in lesions by in vivo PET imaging. Irrespective of the radiolabel’s location we found HDL nanoparticles to preferentially target plaque macrophages and monocytes. Conclusions 89Zr labeling of HDL allows studying its in vivo behavior by non-invasive PET imaging, including visualization of its accumulation in advanced atherosclerotic lesions. The different labeling strategies provide insight on the pharmacokinetics and biodistribution of HDL’s main components, i.e. phospholipids and APOA1.

Hogstad et al. show that the somatic BRAFV600E mutation in myeloid dendritic cell precursors in Langerhans cell histiocytosis promotes lesion formation through impaired dendritic cell migration and resistance to apoptosis, which can be rescued with targeted MAPK pathway inhibition.

Purpose-Genetic tests for the most commonly mutated genes in dilated cardiomyopathy (DCM) can confirm a clinical diagnosis in the proband and inform family management. Presymptomatic family members can be identified, allowing for targeted clinical monitoring to minimize adverse outcomes. However, the marked locus and allelic heterogeneity associated with DCM have made clinical genetic testing challenging. Novel sequencing platforms have now opened up avenues for more comprehensive diagnostic testing while simultaneously decreasing test cost and turn around time.Methods-By using a custom design based on triplicate resequencing and separate genotyping of known disease-causing variants, we developed the DCM CardioChip for efficient analysis of 19 genes previously implicated in causing DCM.Results-The chip's analytical sensitivity for known and novel substitution variants is 100% and 98%, respectively. In screening 73 previously tested DCM patients who did not carry clinically significant variants in 10 genes, 7 variants of likely clinical significance were identified in the remaining 9 genes included on the chip. Compared with traditional Sanger-based sequencing, test cost and turn around time were reduced by ~50%. . 3). Because of the high cost of dideoxy sequencing, most previous multigene studies have screened only a subset of genes or tested a small number of patients.4 -12 Therefore, accurate mutation detection rates for any of these genes are difficult to define. Clinical genetic testing laboratories must attempt a balance between maximizing clinical sensitivity (i.e., the number of genes tested) and minimizing test price and turn around time (TAT). For disorders that are characterized by a high degree of locus and allelic heterogeneity, genes with low variant detection rates are, therefore, often not included in a clinical testing panel. Conclusions-TheBecause of the availability of novel sequencing platforms, it is now possible to screen a much larger number of genes simultaneously and, thereby, improve clinical sensitivity. One of these novel sequencing platforms is the Affymetrix Gene-Chip® Resequencing Array, a customizable high-density oligo-nucleotide microarray. This platform has been used successfully to sequence mitochondrial, bacterial, or small eukaryotic genomes and selected genes for specific diseases, such as retinitis pigmentosa, congenital myasthenic syndromes, and HCM. [13][14][15][16][17][18] Although initial studies showed high false negative and positive rates, improvements including redundant tiling and custom bioinformatics algorithms have enabled adaptation into clinical services at a reasonable analytical sensitivity. 19 Parallel processing of a large number of genes can result in a gain in labor, time, and cost efficiency as outlined for an HCM resequencing array. 14 However, it is important to point out that this effect needs to be confirmed for every new test because individual parameters can vary greatly depending on the selected genes and/or the laboratory performing the...