Objective: Pulmonary embolism (PE) is a common condition that urgently needs novel diagnostic and therapeutic strategies. Here, we investigated PE-induced inflammation via longitudinal imaging of transcription factor NF-kappaB (NFkB) activation signals in murine PE. Understanding the temporal activation of inflammatory mediators, such as NFkB, in PE may lead to future medical interventions or better patient stratification. Methods: NFkB activation was assessed using male, 12-16w old, NFkB-GFP-luciferase (NGL) reporter mice (n=20 PE animals). Stasis venous thrombosis (VT) was induced in the femoral veins of donor mice on day 0. On day 1, the thrombus was resected and intravenously injected into recipient mice to create the PE model. PE animals underwent bioluminescence imaging on days -1, 1, 4, and 7. Regions-of-interest (ROI) areas were kept constant and placed over areas of PE as verified in other modalities. Lung and PE morphometrics were imaged by fluorescence-mediated tomography and computed tomography using a fibrin-specific molecular imaging agent, FTP11 (i.v. 150nmol/kg). Cardiac function pre- and post-PE was assessed by ultrasound and pulmonary arterial pressure measurements. Mouse cohorts were sacrificed 1, 4, and 7 days following stasis-VT embolization and underwent histological analysis of the PE. Results: The mean volume of the femoral stasis-VT was 1.21±0.25 mm 3 . The bioluminescence signal plateau was found at 4-8 minutes post-intravenous injection of D-luciferin in PE animals. The six-minute post-injection image was utilized in comparing longitudinal images. Bioluminescence from the activation of NFkB in the PE ROI showed a maximal signal in the day 1 PE with a 55.0% (334 to 151RU) decrease in signal from day 1 to day 7(p<0.05). Histological and protein assays validated the activation and localization of NFkB. In PE animals, immunohistochemistry of infiltrating CD45-positive cells showed increased cell numbers from day 1 to day 7 (p<0.05). Since PE is confided spatially to a lung lobe, contralateral PE-negative lobes also showed increased infiltrating cells compared to sham animals. Conclusions: Quantitative serial imaging pre- and post-PE demonstrates an inflammatory timeline in PE-induced NFkB activation.
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