Image-guided surgery using near-infrared Turn-ON fluorescent nanoprobes for precise detection of tumor margins

Rachel Blau, Yana Epshtein, Evgeni Pisarevsky, Galia Tiram, Sahar Israeli Dangoor, Eilam Yeini, Adva Krivitsky, Anat Eldar-Boock, Dikla Ben-Shushan, Hadas Gibori, Anna Scomparin, Ori Green, Yael Ben-Nun, Emmanuelle Merquiol, Hila Doron, Galia Blum, Neta Erez, Rachel Grossman, Zvi Ram, Doron ShabatRonit Satchi-Fainaro*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

56 Scopus citations


Complete tumor removal during surgery has a great impact on patient survival. To that end, the surgeon should detect the tumor, remove it and validate that there are no residual cancer cells left behind. Residual cells at the incision margin of the tissue removed during surgery are associated with tumor recurrence and poor prognosis for the patient. In order to remove the tumor tissue completely with minimal collateral damage to healthy tissue, there is a need for diagnostic tools that will differentiate between the tumor and its normal surroundings. Methods: We designed, synthesized and characterized three novel polymeric Turn-ON probes that will be activated at the tumor site by cysteine cathepsins that are highly expressed in multiple tumor types. Utilizing orthotopic breast cancer and melanoma models, which spontaneously metastasize to the brain, we studied the kinetics of our polymeric Turn-ON nano-probes. Results: To date, numerous low molecular weight cathepsin-sensitive substrates have been reported, however, most of them suffer from rapid clearance and reduced signal shortly after administration. Here, we show an improved tumor-to-background ratio upon activation of our Turn-ON probes by cathepsins. The signal obtained from the tumor was stable and delineated the tumor boundaries during the whole surgical procedure, enabling accurate resection. Conclusions: Our findings show that the control groups of tumor-bearing mice, which underwent either standard surgery under white light only or under the fluorescence guidance of the commercially-available imaging agents ProSense® 680 or 5-aminolevulinic acid (5-ALA), survived for less time and suffered from tumor recurrence earlier than the group that underwent image-guided surgery (IGS) using our Turn-ON probes. Our "smart" polymeric probes can potentially assist surgeons' decision in real-time during surgery regarding the tumor margins needed to be removed, leading to improved patient outcome.

Original languageAmerican English
Pages (from-to)3437-3460
Number of pages24
Issue number13
StatePublished - 2018

Bibliographical note

Publisher Copyright:
© Ivyspring International Publisher.


  • HPMA copolymer
  • Image-guided surgery
  • Molecular imaging
  • NIR fluorescence
  • PGA
  • Polymers
  • Precision nanomedicine
  • Theranostics


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