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A Bright NIR-II Fluorescence Probe for Vascular and Tumor Imaging
Published on: March 17, 2023
Advances in NIR-II Fluorescence Laparoscopy for Precision Diagnosis and Theranostics of Urological Oncology
Quanyong Liu1,2, Sha Li1, Mingquan Xu1
1First Clinical Medical College, Shanxi Medical University, Taiyuan, People's Republic of China.
Abstract:
Precision surgical intervention in urological oncology is inherently constrained by the limited penetration depth and lack of tactile feedback in traditional endoscopy. Near infrared II (NIR-II, 1000-1700 nm) fluorescence laparoscopy overcomes these limitations by drastically suppressing photon scattering and tissue auto-fluorescence, facilitating sub-millimeter deep-tissue navigation. However, navigating the urological system requires circumventing unique physiological barriers, notably dense adipose encapsulation and fluid-filled cavities. This review comprehensively evaluates the translational integration of high-performance InGaAs hardware architectures and advanced nanomedicines designed to conquer these specialized anatomical niches. We trace the evolution of NIR-II molecular probes from leveraging the tail fluorescence of ICG to biomarker-driven active targeting (eg, PSMA, CAIX, Nectin-4) and tumor micro-environment (TME)-responsive smart nanoplatforms. By meticulously modulating supramolecular physical chemistry, such as leveraging lipid critical packing parameter (CPP) phase transitions and mitigating aggregation-caused quenching (ACQ). These platforms achieve spatially synchronized diagnostic imaging and targeted phototheranostic ablation. Preclinically and in early human trials, this synergy enables precise primary lesion delineation, trans-adipose pelvic lymph node mapping, and neurovascular bundle (NVB) preservation across prostate, renal, and bladder malignancies. It also fosters systemic anti-tumor immunity through immunogenic cell death. Despite these breakthroughs, broad clinical translation remains impeded by formidable nanotoxicological hurdles, particularly reticuloendothelial system sequestration and the accelerated blood clearance (ABC) phenomenon, alongside robotic surgery integration challenges. To rewrite standard-of-care guidelines, future paradigms must prioritize "safe-by-design" architectures, logic-gated multi-receptor targeting to eliminate diagnostic ambiguity, and large-scale, multicenter randomized controlled trials evaluating long-term oncological outcomes.
Insights
Near-infrared II (NIR-II) fluorescence laparoscopy enhances urological cancer surgery by improving deep-tissue navigation and enabling precise tumor delineation. Advanced nanomedicines and InGaAs hardware overcome anatomical barriers, paving the way for improved patient outcomes.
Area of Science:
- Urological Oncology
- Surgical Innovation
- Nanomedicine
Background:
- Traditional endoscopy limits precision in urological oncology due to poor penetration and lack of tactile feedback.
- Navigating complex anatomy like dense fat and fluid-filled spaces presents significant surgical challenges.
- Near-infrared II (NIR-II) fluorescence laparoscopy offers superior deep-tissue visualization by minimizing light scattering and auto-fluorescence.
Purpose of the Study:
- To review the integration of InGaAs hardware and nanomedicines for advanced NIR-II fluorescence laparoscopy in urological oncology.
- To evaluate the evolution and application of NIR-II molecular probes for enhanced surgical guidance.
- To assess the potential of these technologies in overcoming specific anatomical barriers and improving surgical outcomes.
Main Methods:
- Comprehensive review of InGaAs hardware architectures and nanomedicine development for NIR-II imaging.
- Analysis of NIR-II molecular probe evolution: from ICG to active targeting and TME-responsive platforms.
- Evaluation of nanomedicine strategies, including lipid CPP phase transitions and ACQ mitigation.
Main Results:
- NIR-II technology facilitates sub-millimeter deep-tissue navigation, surpassing traditional endoscopic limitations.
- Advanced nanomedicines enable synchronized diagnostic imaging and targeted phototherapy for precise lesion delineation.
- Successful preclinical and early human trial applications include trans-adipose lymph node mapping and neurovascular bundle preservation in prostate, renal, and bladder cancers.
- Potential for fostering systemic anti-tumor immunity via immunogenic cell death.
Conclusions:
- The synergy of NIR-II laparoscopy, advanced hardware, and nanomedicines shows promise for revolutionizing urological cancer surgery.
- Significant challenges remain, including nanotoxicology (RES sequestration, ABC) and robotic integration.
- Future directions require "safe-by-design" principles, logic-gated targeting, and robust clinical trials to establish new standard-of-care guidelines.
