Abstract
Transplanted stem cells can induce and enhance functional recovery in experimental stroke. Invasive analysis has been extensively used to provide detailed cellular and molecular characterization of the stroke pathology and engrafted stem cells. But post mortem analysis is not appropriate to reveal the time scale of the dynamic interplay between the cell graft, the ischemic lesion and the endogenous repair mechanisms. This review describes non-invasive imaging techniques which have been developed to provide complementary in vivo information. Recent advances were made in analyzing simultaneously different aspects of the cell graft (e.g., number of cells, viability state, and cell fate), the ischemic lesion (e.g., blood–brain-barrier consistency, hypoxic, and necrotic areas) and the neuronal and vascular network. We focus on optical methods, which permit simple animal preparation, repetitive experimental conditions, relatively medium-cost instrumentation and are performed under mild anesthesia, thus nearly under physiological conditions. A selection of recent examples of optical intrinsic imaging, fluorescence imaging and bioluminescence imaging to characterize the stroke pathology and engrafted stem cells are discussed. Special attention is paid to novel optimal reporter genes/probes for genetic labeling and tracking of stem cells and appropriate transgenic animal models. Requirements, advantages and limitations of these imaging platforms are critically discussed and placed into the context of other non-invasive techniques, e.g., magnetic resonance imaging and positron emission tomography, which can be joined with optical imaging in multimodal approaches.
INTRODUCTION
The stroke pathology and regeneration processes induced by endogenous mechanisms or engrafted stem cells have been studied extensively. Invasive studies – including immunohistochemistry, autoradiography, electrophysiology, and molecular biology – revealed the ischemic cascade of pathological and protective signaling events (Zhang and Chopp, 2009; ). New neurons are found in the rat striatum after experimental stroke (), but neurogenesis and functional neuronal integration seem alone not to be able to restore brain function. In this line, exogenous stem cells, e.g., neural stem cells (NSCs) derived from embryonic or induced-pluripotent stem cells, have been implanted in experimental rodent models of stroke and found to increase functional recovery in many studies (; Oki et al., 2012). However, the interplay of stem cells with the injured host tissue and the mode of action of engrafted cells in the longitudinal time profile of stroke regeneration have to be deciphered before clinical translation.
We review here optical imaging as one promising approach to shed new light on structural and functional components of stem cell therapy in stroke. We introduced fluorescence and bioluminescence imaging (FLI and BLI) which have been extensively developed in the last decade to meet the criteria of a highly sensitive and minimally invasive set-up (Figure 1). We provide a selection of recent publications related to stroke and/or stem cell transplantation in rodents, which we find appropriate to introduce current possibilities and constraints of optical neuroimaging. In addition, selected references – in line with most preclinical optical imaging studies – refer to mice or rats and exclude, e.g., stroke studies in non-human primates () or the zebrafish (Walcott and Peterson, 2014).
FIGURE 1
OPTICAL NEUROIMAGING
Molecular imaging aims to visualize cellular and molecular events – related to physiological or pathophysiological processes – in the living subject, e.g., by genetically linked imaging reporters (Massoud et al., 2008a). Based on the first non-invasive experiments with superficial sources, optical neuroimaging has been so far most effectively implemented for brain tumor studies (Massoud et al., 2008b) and less for neurological disease models or endogenous/exogenous NSCs in which sensitivity is essential. Compared to superficial sources, the brain appears to be a very difficult organ to be penetrated and explored by light. The natural multilayer barrier of blood, meninges, bone and skin covers all neural cells. Despite the extensive technical developments in optical imaging, major challenges of light absorption and scattering, autofluorescence, low spectral resolution and quantification still need to be considered (Shah and Weissleder, 2005; ; Sutton et al., 2008). Among these physical limitations, light absorption and scattering are the main cause that affects in vivo optical approaches. Absorption is mainly driven by pigments/chromophores (hemoglobin and bilirubin in the blood, myoglobin in the muscles, pheo- and eumelanin in the skin) and also by water and lipids (Figure 2). Brain tissue requires continuous blood supply, which implies strong light attenuation by absorption. Efficient light propagation through the brain is provided in a naturally existing window of low absorption in the near-infrared (NIR, ∼700–900 nm; ). Despite absorption effects, light is scattered at inter- and intracellular membrane boundaries due to differences in the refractive index n (ratio of the speed of light in vacuum and speed of light in the material), e.g., extracellular fluids (n= 1.335) and triglycerides (n= 1.491; Ross, 1967). The brain parenchyma is composed of many of these specific boundaries, most prominently white and gray matter, leading to light scatter. Improving the imaging set-up, e.g., by advanced technical devices or imaging reporters with higher sensitivity will certainly facilitate imaging in small animals. But it should be noted that the physical factors leading to light attenuation and scattering and the insertion of an imaging transgene definitely limit the application on small animals and preclude optical neuroimaging in humans. As this review is focused on recent optical imaging applications but not on the physical principles, we refer the interested reader to a technical review of Schulz and Semmler (2008) and the comprehensive book Molecular imaging: Principles and Practice edited by Weissleder and Gambhir (2010). The following two chapters introduce FLI and BLI techniques with a focus on optical neuroimaging, describe useful imaging reporters and recent studies. Finally, we discuss the importance of cell-specific imaging and the benefit of combining different imaging techniques.
FIGURE 2
FLUORESCENCE IMAGING
In vivo FLI uses a set-up similar to fluorescence microscopy consisting of a light source, fluorescence filters and a sensitive charge-coupled device (CCD) camera. But in addition, the set-up is housed in a light-tight chamber to collect fluorescence emission exclusively from the anesthetized animal at the macroscopic level (Rao et al., 2007). To penetrate the mouse skull efficiently, excitation with NIR laser light either through the mouse head [transillumination fluorescence imaging (TFI)] or from top [fluorescence reflectance imaging (FRI)] is applied (
FLUORESCENCE PROTEINS
The discovery of the green FP (GFP) from the jellyfish Aequorea victoria paved the way for a universal marker for cell structures and cellular processes detectable by fluorescence microscopy (
FLUORESCENT DYES
Several chemical probes have proven long term labeling of stem cells, including chloromethylfluorescein diacetate (CMFDA or CellTracker) and long chain carbocyanine dyes (like DiI, DiO, DiD, and CM-DiI; Sutton et al., 2008; Mäkinen et al., 2013;
FIGURE 3

in vivo FLI of thromboembolic-stroke. Fibrin deposition is visualized with a near-infrared probe against the activated coagulation factor XIII (FXIIIa; A15) in a thromboembolic model of stroke. Scale bar 5 mm. Images adapted with permission from Zhang et al. (2012).
FLUORESCENCE NEUROIMAGING AT THE MICRO- AND MACROSCALE
Two-photon microscopy (2PM) is the method of choice to obtain detailed structural information of neural tissue in vivo [also referred to 2P laser scanning microscopy (2PLSM)]. A pulsed infrared laser is used to excite fluorophores by the combined power of two long-wavelength photons (Sigler and Murphy, 2010), which promotes better sample penetration, higher resolution, less light scatter, and less photo-damage compared to in vivo confocal microscopy (
A common way to measure neuronal activity indirectly in vivo is functional magnetic resonance imaging (MRI) on the basis of the hemodynamic response, thus the locally dynamic changes in oxy- and deoxyhemoglobin (HbO2 and HbR). Differences in absorption of HbO2 and HbR can be used by intrinsic imaging to record cortical activity on a sub-second time scale based on the changes in blood oxygenation (Ts’o et al., 1990). The exposed cortex is illuminated sequentially by light of different wavelengths (multi-spectral reflectance imaging). Images are recorded which are particularly sensitive to changes in HbO2 and HbR concentration. At wavelengths where HbO2 and HbR absorption is the same (isosbestic points), changes in total hemoglobin concentration can be measured (
Grinvald and colleagues paved the way for a direct method to optically record neuronal activity: voltage sensitive-dyes (VSDs; Orbach et al., 1985) and voltage sensitive-proteins (VSFPs; Sakai et al., 2001). Both, VSDs and VSFPs respond to changes in transmembrane voltage in the millisecond time scale, by changing their fluorescence properties [but resolving single action potentials is still limited (
FIGURE 4

VSD imaging detects macroscopic changes in functional networks after stroke and implantation of NSCs.(A) Changes of the functional representation of the forelimb (FL) cortex area toward the peri-infarct primary motor cortex M1 and hindlimb (HL) area appear 8 weeks upon photothrombotic stroke but not sham surgery. Reprinted by permission from MacMillan Publisher Ltd: Molecular Therapy (
BIOLUMINESCENCE IMAGING
In vivo BLI uses, similar to fluorescence imaging (FLI), a CCD camera housed in a light-tight chamber to collect photon emission from the anesthetized animal. But instead of an excitation source, photons are emitted when the intracellular enzyme luciferase oxidizes its substrate luciferin. As luciferase is only expressed in transgenic mammalian cells, there is only negligible BLI background signal and emitted photons can be detected with surpassing sensitivity through the intact skull (Keyaerts et al., 2012a) – even from freely moving awake animals (Keyaerts et al., 2012b). BLI is a high throughput technique, scalable from in vitro to in vivo, highly non-invasive and ease of use. Similar to FLI, the spatial resolution is limited to several mm (Massoud and Gambhir, 2003). Although the number of photons emitted is proportional to the number of luciferase molecules (
FIGURE 5

In vivo monitoring of endogenous and implanted stem cells.(A) The improved BLI protocol (300 mg/kg Luciferin pre Isofluran anaesthesia) promotes substantial higher photon emission compared to standard protocol (150 mg/kg Luciferin post anesthesia) and the lowers the detection limit to 3,000 engrafted NSCs in vivo. Signal-to-noise ratio (SNR) above 3 was defined as a limit for reliable cell graft detection. (B) Bioluminescence images of a 1 day and 2 month old doublecortin-luciferase mouse for in vivo imaging of endogenous neurogenesis (Insert shows neurogenesis in the spinal cord and the olfactory bulbs, respectively). Images modified with permission from
LUCIFERASES FOR IN VIVO IMAGING
Luciferase enzymes occur naturally in numerous luminous species, such as the North American firefly [firefly luciferase (Fluc)], click beetles [click beetle luciferase (CBR)], the sea pansy Renilla reniformis [Renilla luciferase (Rluc)], and the copepod Gaussia princeps [Gaussia luciferase (Gluc); Mezzanotte et al., 2013]. There are species-specific changes in the substrate, co-factors and emitted wavelength. Gluc and Rluc emit in the blue spectrum and therefore are not optimal for in vivo use, as it gets strongly absorbed when traveling through tissue (see Figure 1). Fluc and CBR, on the other hand, have a strong component above 600 nm (Figure 6) resulting in less absorption (Zhao et al., 2005). Changes in one single amino acid of the luciferase can already result in wavelength shifts. Extensive mutagenesis was performed to create red and green shifts and improve pH-tolerance and thermostability (Miloud et al., 2011;
FIGURE 6

In vivo emission spectra of bioluminescent reporters. Emission spectra from luciferase expression in skin, lung, and liver are compared with those from labeled cells in culture showing tissue-induced light attenuation in the blue spectrum. Photon fluxes are normalized to the values at 680 nm for beetle luciferases and 640 nm for Renilla luciferase (indicated at green arrow), where absorption is minimal. Hemoglobin absorption curves are plotted as background (shaded in gray). hRLuc, Renilla reniformis; CBGr68, click beetle green; CBRed, click beetle red; Fluc+, Firefly luciferase. Reproduced with permission from Zhao et al. (2005).
BIOLUMINE SCENE IMAGING OF ENDOGENOUS AND EXOGENOUS STEM CELLS FOR STROKE REPAIR
Stem cell therapy has already been proven beneficial for stroke recovery (
The second source of stem cells for stroke repair is the pool of endogenous stem cells, e.g., within the subventricular zone. These cells can be either targeted by in vivo transduction with a viral vector to express Fluc (Reumers et al., 2008), or by designing a neural progenitor-specific reporter mouse, in which Fluc expression is controlled by the doublecortin (DCX) promotor (
FUTURE DIRECTIONS
CELL FATE IMAGING
Besides the possibility to track the viability of transplanted NSCs by BLI, luciferases have been linked to neural cell specific promoters to monitor differentiation. Such system was successfully used to trace the in vivo activation of neuronal differentiation by coupling Fluc to the NeuroD promoter which is active in neuronal precursor cells (Oh et al., 2013). Weak cell specific promoters can be enhanced by coupling them to a two-step transcriptional amplification (TSTA;
COMBINATION OF NON-INVASIVE IMAGING TECHNIQUES
Optical imaging provides best sensitivity of 10-15–10-17 mol/l for visualization of stem cell therapy in stroke (Massoud and Gambhir, 2003). Among many recent technical developments, optoacoustic (photoacoustic) imaging holds great potential to visualize both, the stem cell graft location (
We believe that the application of the non-invasive imaging tools presented here will be essential to fully understand stroke regeneration and the potential of engrafted stem cells in pre-clinical trials – the prerequisite of an effective clinical therapy.
Statements
Author contributions
Markus Aswendt, Joanna Adamczak and Annette Tennstaedt wrote the manuscript.
Acknowledgments
We thank Markus Gramer (MPI) for comments on parts of the manuscript. This work was financially supported by the EU-FP7 program TargetBraIn (HEALTH-F2-2012-279017) and Brainpath (PIAPP-GA-2013-612360).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Summary
Keywords
optical neuroimaging, non-invasive, stem cell therapy, stroke, bioluminescence imaging, fluorescence imaging
Citation
Aswendt M, Adamczak J and Tennstaedt A (2014) A review of novel optical imaging strategies of the stroke pathology and stem cell therapy in stroke. Front. Cell. Neurosci. 8:226. doi: 10.3389/fncel.2014.00226
Received
22 May 2014
Accepted
22 July 2014
Published
14 August 2014
Volume
8 - 2014
Edited by
Thorsten Doeppner, University of Duisburg-Essen, Germany
Reviewed by
Raluca Reitmeir, University Hospital Bern, Switzerland; Bert Bosche, University of Toronto, Canada
Copyright
© 2014 Aswendt, Adamczak and Tennstaedt.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Annette Tennstaedt, In-vivo-NMR Laboratory, Max Planck Institute for Neurological Research, Gleuelerstrasse 50, D-50931 Köln, Germany e-mail: annette.tennstaedt@nf.mpg.de
This article was submitted to the journal Frontiers in Cellular Neuroscience.
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