Non-invasive sensing of free metal ions using ion chemical exchange saturation transfer
10753892 ยท 2020-08-25
Assignee
Inventors
- Amnon Bar-Shir (Baltimore, MD, US)
- Jeff W. M. Bulte (Fulton, MD, US)
- Michael T. McMahon (Columbia, MD, US)
Cpc classification
G01R33/5605
PHYSICS
G01R33/4608
PHYSICS
A61B5/055
HUMAN NECESSITIES
C07C229/40
CHEMISTRY; METALLURGY
G01R33/485
PHYSICS
International classification
G01R33/485
PHYSICS
G01R33/56
PHYSICS
C07C229/40
CHEMISTRY; METALLURGY
Abstract
The invention features a novel non-invasive approach for imaging, detecting and/or sensing metal ions with improved sensitivity and specificity in a biological sample or tissue. In certain embodiments, the invention provides a MR contrast-based approach for imaging, detecting and/or sensing metal ions in the biological sample/tissue containing various background ions by using .sup.19F-based chemical exchange saturation transfer (CEST) technique.
Claims
1. A method of obtaining a magnetic resonance (MR) image of a metal ion in a biological sample or tissue, comprising a) introducing a .sup.19F-based responsive magnetic resonance imaging (MRI) contrast agent to said biological sample or tissue; and b) imaging said biological sample or tissue using a chemical exchange saturation transfer (CEST)-based MRI technique, wherein said .sup.19F-based responsive MRI contrast agent is a compound of Formula (I), or a salt or ester thereof: ##STR00019## wherein R.sup.1, each independently, is C.sub.1-3 alkyl, and X is COOH or ##STR00020## and R.sup.2, each independently, is C.sub.1-3 alkyl.
2. The method of claim 1, wherein said metal ion is a divalent metal ion.
3. The method of claim 1, wherein said metal ion is selected from the group of Ca.sup.2+, Zn.sup.2+, Mg.sup.2+, Fe.sup.3+, Fe.sup.2+, Mn.sup.3+, K.sup.+, Na.sup.+, Cu.sup.2+, Gd.sup.3+, and Eu.sup.3+, or a combination thereof.
4. The method of claim 3, wherein said metal ion is Ca.sup.2+.
5. The method of claim 3, wherein said metal ion is Zn.sup.2+.
6. The method of claim 3, wherein said metal ion is Mg.sup.2+.
7. The method of claim 3, wherein said metal ion is Fe.sup.2+.
8. The method of claim 1, wherein each of R.sup.1 is CH.sub.2, and X is ##STR00021##
9. The method of claim 1, wherein said .sup.19F-based responsive MRI contrast agent is selected from the group consisting of ##STR00022## or a salt or ester thereof and ##STR00023## or a salt or ester thereof.
10. The method of claim 9, wherein said .sup.19F-based responsive MRI contrast agent is 2,2,2,2-(2,2-(ethane-1,2-diylbis(oxy))bis(4-fluoro-2,1-phenylene))bis(azanetriyl)tetraacetic acid (5F-BAPTA) or a salt thereof.
11. A method of detecting or sensing a metal ion in a biological sample or tissue comprising background ions, comprising a) introducing to said biological sample or tissue a .sup.19F-based responsive magnetic resonance imaging (MRI) contrast agent, wherein the .sup.19F-based responsive MRI contrast agent is bound to the metal ion to produce a chelation complex; b) radiofrequency (RF) labeling of .sup.19F frequency in said chelation complex; and c) detecting transfer of the RF labeling to .sup.19F frequency in a .sup.19F-based responsive MRI contrast agent free of metal ion chelation to image said biological sample or tissue by MRI, wherein the .sup.19F-based responsive MRI contrast agent is a compound of Formula (I), or a salt or ester thereof: ##STR00024## wherein R.sup.1, each independently, is C.sub.1-3 alkyl, and X is COOH or ##STR00025## and R.sup.2, each independently, is C.sub.1-3 alkyl.
12. The method of claim 11, comprising detecting a chemical shift change of .sup.19F through a .sup.19F NMR.
13. The method of claim 11, wherein said .sup.19F-based responsive MRI contrast agent is 5F-BAPTA.
14. The method of claim 11, wherein the metal ion is selected from the group consisting of K.sup.+, Na.sup.+, Ca.sup.2+, Mg.sup.2+, Cu.sup.2+, Fe.sup.2+ and Zn.sup.2+.
15. A method of detecting or sensing a metal ion in a biological sample or tissue, comprising a) introducing to said biological sample or tissue a .sup.19F-based responsive magnetic resonance imaging (MRI) contrast agent, wherein the .sup.19F-based responsive MRI contrast agent is bound to the metal ion to produce a chelation complex; b) radiofrequency (RF) labeling of .sup.19F frequency in said chelation complex; and c) detecting transfer of the RF labeling to .sup.19F frequency in a .sup.19F-based responsive MRI contrast agent free of metal ion chelation to image said biological sample or tissue by MRI, wherein the .sup.19F-based responsive MRI contrast agent is a compound of Formula (XV), or a salt or ester thereof: ##STR00026## wherein X is selected from F, Cl, Br, and I, with proviso that at least one X is F, and n is 2-4.
16. The method of claim 15, wherein X is F and n is 2.
17. The method of claim 15, wherein the .sup.19F-based responsive magnetic resonance imaging (MRI) contrast agent is 5,5,6,6-tetrafluoro-1,2,-bis(o-aminophenoxy)ethane-N,N,N,N-tetraacetate.
Description
BRIEF DESCRIPTION OF THE DRAWING
(1) For a fuller understanding of the nature and desired objects of the present invention, reference is made to the following detailed description taken in conjunction with the accompanying drawing figures wherein like reference character denote corresponding parts throughout the several views and wherein:
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DETAILED DESCRIPTION OF THE INVENTION
(23) Fluorescent metal ion sensors have been developed for the purpose, for example, studying intracellular calcium (R. Y Tsien, Biochemistry 19(1980); 2396), which enables a better understanding of calcium signals (Cell Calcium 40 (2006) 561). Many metal ion sensors derive from the foundational calcium sensor molecules, which were designed by tagging a fluorophore onto the backbone of a metal chelator to elicit a metal-dependent fluorescence response (L. M. Hyman et al., Coordination Chemistry Reviews, 256 (2012), 2333-2356).
(24) Among those calcium sensors, many share a chelating backbone of 1,2-bis(o-aminophenoxy)ethane-N,N,N,N-tetraacetic acid (BAPTA), with the following structure:
(25) ##STR00001##
(Biochemistry 19(1980); 2396). Currently, imaging dynamic changes in Ca.sup.2+ levels is restricted to fluorescence based methodologies which are limited by low tissue penetration and as a result do not allow in vivo Ca.sup.2+ imaging in deep tissues (Mank, M. et al., Chem Rev 2008, 108, 1550; and Tsien, R. Y. Annu Rev Neurosci 1989, 12, 227). As of today, a non-invasive means of detecting free Ca.sup.2+ in a deep tissue remains a formidable challenge.
(26) The present inventors discovered a novel approach for sensing the presence of biologically relevant metal ions (specifically, Ca.sup.2+), by using a strategy, in which the amplification effects of chemical exchange saturation transfer (CEST) is combined with the broad range in chemical shifts found in .sup.19F NMR to obtain MR images of the metal ions. The inventors exploited the chemical shift change () of .sup.19F upon binding of Ca.sup.2+ to a difluoro derivative of [1,2,-bis(oaminophenoxy)ethane-N,N,N,N, tetra-acetic acid], e.g., 5F-BAPTA with the following structure:
(27) ##STR00002##
(28) 2,2,2,2-(2,2-(Ethane-1,2-diylbis(oxy))bis(4-fluoro-2,1-phenylene))bis(azanetriyl)tetraacetic acid (alias, 1,2-bis-[2-bis(carboxymethyl)amino-5-fluorophenoxy]ethane; 5F-BAPTA).
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(30) Specifically, the inventors applied a CEST MRI contrast mechanism to .sup.19F-modified M+-chelates. In a typical CEST MRI contrast mechanism, a dynamic exchange process between radiofrequency labeled protons and bulk water is exploited for contrast enhancement. In particular, the inventors employed a saturation transfer approach that couples .sup.19F- and CEST-MRI for specifically sensing the presence of M.sup.2+ ions through their substrate binding kinetics, an approach called ion CEST (iCEST). Using radiofrequency (RF) labeling at the bound ion-.sup.19F frequency, (co[M.sup.2+-chelate]), and detection of label transfer to the free chelate .sup.19F frequency, (-chelate) (0 ppm), the adopted approach is able to amplify the signal of bound the metal ions by a factor of hundreds, depend on T1 and the exchange rate.
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(32) The .sup.19F-MRI approach offers advantages due to the high gyromagnetic ratio of .sup.19F (94% of that of .sup.1H), 100% natural isotopic abundance of .sup.19F, and the negligible amount of naturally occurring fluorine in soft biological tissues, which results in hot spot images without background signal. In addition, the large range of .sup.19F chemical shifts (about 20 times than that of .sup.1H) and the sensitivity of .sup.19F chemical shifts to the details of the local environment is another benefit for iCEST-based applications.
(33) Moreover, by using the iCEST approach, the contrast from low concentration solutes [M+-chelate] is amplified through back-and-forward chemical exchange and observed on the signal of the high concentration free chelate. Compared to the .sup.1H CEST imaging, which is based on water, the .sup.19F based approach enables detection of metal ions at lower concentrations through simply reducing the free chelate concentrations, as the contrast is dependent on the ratio of ion to agent.
(34) Additionally, the present disclosure also provides compositions and methods that allow simultaneously detection of more than one metal ion (e.g., K.sup.+, Na, Ca.sup.2+, Mg.sup.2+, Cu.sup.2+, Fe.sup.2+ and Zn.sup.2+). For example, by adding .sup.19F atoms to the 6 position of 5F-BAPTA to obtain TF-BAPTA (see, e.g.,
(35) Definitions
(36) Before further description of the invention, and in order that the invention may be more readily understood, certain terms are first defined and collected here for convenience.
(37) As used in the specification and claims, the singular form a, an and the include plural references unless the context clearly dictates otherwise. For example, the term a cell includes a plurality of cells, including mixtures thereof. The term a nucleic acid molecule includes a plurality of nucleic acid molecules.
(38) In this disclosure, comprises, comprising, containing and having and the like can have the meaning ascribed to them in U.S. Patent law and can mean includes, including, and the like; consisting essentially of or consists essentially likewise has the meaning ascribed in U.S. Patent law and the term is open-ended, allowing for the presence of more than that which is recited so long as basic or novel characteristics of that which is recited is not changed by the presence of more than that which is recited, but excludes prior art embodiments.
(39) The term administration or administering includes routes of introducing the compound of the invention to a subject to perform their intended function. Examples of routes of administration that may be used include injection (subcutaneous, intravenous, parenterally, intraperitoneally, intrathecal), oral, inhalation, rectal and transdermal. The pharmaceutical preparations may be given by forms suitable for each administration route. For example, these preparations are administered in tablets or capsule form, by injection, inhalation, eye lotion, ointment, suppository, etc. administration by injection, infusion or inhalation; topical by lotion or ointment; and rectal by suppositories. Oral administration is preferred. The injection can be bolus or can be continuous infusion. Depending on the route of administration, the compound of the invention can be coated with or disposed in a selected material to protect it from natural conditions which may detrimentally affect its ability to perform its intended function. The compound of the invention can be administered alone, or in conjunction with either another agent as described above or with a pharmaceutically-acceptable carrier, or both. The compound of the invention can be administered prior to the administration of the other agent, simultaneously with the agent, or after the administration of the agent. Furthermore, the compound of the invention can also be administered in a pro-drug form which is converted into its active metabolite, or more active metabolite in vivo.
(40) The phrase in combination with is intended to refer to all forms of administration that provide an a compound of the invention (e.g. a compound selected from any of the formulae described herein) together with a second agent, such as a second compound selected from any of the formulae described herein, or an existing therapeutic agent used for a particular disease or disorder, where the two are administered concurrently or sequentially in any order.
(41) The term alkyl refers to the radical of saturated aliphatic groups, including straight-chain alkyl groups, branched-chain alkyl groups, cycloalkyl (alicyclic) groups, alkyl substituted cycloalkyl groups, and cycloalkyl substituted alkyl groups. Preferred alkyl groups have from 1 to 8 carbon atoms in the alkyl backbone (e.g., C.sub.1-C.sub.8 alkyl). As will be clear from context, the term alkyl as used herein further includes divalent alkylene groups (e.g., (CH.sub.2).sub.n, wherein n is a positive integer, e.g., 1 to 8), and can further include oxygen, nitrogen, sulfur or phosphorous atoms replacing one or more carbons of the hydrocarbon backbone, e.g., oxygen, nitrogen, sulfur or phosphorous atoms. Thus, for example, in a compound of the formula:
(42) ##STR00003##
if each R.sup.1 is independently C.sub.1-3 alkyl, then each R.sup.1 is independently C.sub.1-3 alkylene. For convenience, C.sub.0alkyl used herein refers to a bond or a H atom.
(43) Moreover, the term alkyl (or alkylene) as used throughout the specification and sentences is intended to include both unsubstituted alkyls and substituted alkyls, the latter of which refers to alkyl moieties having substituents replacing a hydrogen on one or more carbons of the hydrocarbon backbone. Such substituents can include, for example, halogen, hydroxyl, alkylcarbonyloxy, arylcarbonyloxy, alkoxycarbonyloxy, aryloxycarbonyloxy, carboxylate, alkylcarbonyl, alkoxycarbonyl, aminocarbonyl, alkylthiocarbonyl, alkoxyl, phosphate, phosphonato, phosphinato, cyano, amino (including alkyl amino, dialkylamino, arylamino, diarylamino, and alkylarylamino), acylamino (including alkylcarbonylamino, arylcarbonylamino, carbamoyl and ureido), amidino, imino, sulfhydryl, alkylthio, arylthio, thiocarboxylate, sulfates, sulfonato, sulfamoyl, sulfonamido, nitro, trifluoromethyl, cyano, azido, heterocyclyl, alkylaryl, or an aromatic or heteroaromatic moiety. It will be understood by those skilled in the art that the moieties substituted on the hydrocarbon chain can themselves be substituted, if appropriate. Cycloalkyls can be further substituted, e.g., with the substituents described above. An alkylaryl moiety is an alkyl substituted with an aryl (e.g., phenylmethyl (benzyl)). The term alkyl also includes unsaturated aliphatic groups analogous in length and possible substitution to the alkyls described above, but that contain at least one double or triple bond respectively.
(44) The term alkoxy refer to a O-alkyl group.
(45) The term aryl as used herein, refers to the radical of aryl groups, including S- and 6-membered single-ring aromatic groups that may include from zero to four heteroatoms, for example, benzene, pyrrole, furan, thiophene, imidazole, benzoxazole, benzothiazole, triazole, tetrazole, pyrazole, pyridine, pyrazine, pyridazine and pyrimidine, and the like. Aryl groups also include polycyclic fused aromatic groups such as naphthyl, quinolyl, indolyl, and the like. Those aryl groups having heteroatoms in the ring structure may also be referred to as aryl heterocycles, heteroaryls or heteroaromatics. The aromatic ring can be substituted at one or more ring positions with such substituents as described above, as for example, halogen, hydroxyl, alkoxy, alkylcarbonyloxy, arylcarbonyloxy, alkoxycarbonyloxy, aryloxycarbonyloxy, carboxylate, alkylcarbonyl, alkoxycarbonyl, aminocarbonyl, alkylthiocarbonyl, phosphate, phosphonato, phosphinato, cyano, amino (including alkyl amino, dialkylamino, arylamino, diarylamino, and alkylarylamino), acylamino (including alkylcarbonylamino, arylcarbonylamino, carbamoyl and ureido), amidino, imino, sulfhydryl, alkylthio, arylthio, thiocarboxylate, sulfates, sulfonato, sulfamoyl, sulfonamido, nitro, trifluoromethyl, cyano, azido, heterocyclyl, alkylaryl, or an aromatic or heteroaromatic moiety. Aryl groups can also be fused or bridged with alicyclic or heterocyclic rings which are not aromatic so as to form a polycycle (e.g., tetralin).
(46) The term heteroaryl refers to an aromatic 5-8 membered monocyclic, 8-12 membered bicyclic, or 11-14 membered tricyclic ring system having 1-4 ring heteroatoms if monocyclic, 1-6 heteroatoms if bicyclic, or 1-9 heteroatoms if tricyclic, with said heteroatoms selected from O, N, and S, and the remainder ring atoms being carbon. Heteroaryl groups may be optionally substituted with one or more substituents. Examples of heteroaryl groups include, but are not limited to, pyridyl, furanyl, benzodioxolyl, thienyl, pyrrolyl, oxazolyl, oxadiazolyl, imidazolyl thiazolyl, isoxazolyl, quinolinyl, pyrazolyl, isothiazolyl, pyridazinyl, pyrimidinyl, pyrazinyl, triazinyl, triazolyl, thiadiazolyl, isoquinolinyl, indazolyl, benzoxazolyl, benzofuryl, indolizinyl, imidazopyridyl, tetrazolyl, benzimidazolyl, benzothiazolyl, benzothiadiazolyl, benzoxadiazolyl, and indolyl. In one embodiment of the invention, heteroaryl refers to thienyl, furyl, pyridyl, or indolyl.
(47) The term associating with refers to a condition of proximity between a chemical entity or compound, or portions thereof, and a binding pocket or binding site on a protein. The association may be non-covalent (wherein the juxtaposition is energetically favored by hydrogen bonding or van der Waals or electrostatic interactions) or it may be covalent.
(48) The language biological activities of a compound of the invention includes all activities elicited by compound of the invention in a responsive cell. It includes genomic and non-genomic activities elicited by these compounds.
(49) Biological composition or biological sample refers to a composition containing or derived from cells or biopolymers. Cell-containing compositions include, for example, mammalian blood, red cell concentrates, platelet concentrates, leukocyte concentrates, blood cell proteins, blood plasma, platelet-rich plasma, a plasma concentrate, a precipitate from any fractionation of the plasma, a supernatant from any fractionation of the plasma, blood plasma protein fractions, purified or partially purified blood proteins or other components, serum, semen, mammalian colostrum, milk, saliva, placental extracts, a cryoprecipitate, a cryosupernatant, a cell lysate, mammalian cell culture or culture medium, products of fermentation, ascites fluid, proteins induced in blood cells, and products produced in cell culture by normal or transformed cells (e.g., via recombinant DNA or monoclonal antibody technology). Biological compositions can be cell-free. In a preferred embodiment, a suitable biological composition or biological sample is a red blood cell suspension. In some embodiments, the blood cell suspension includes mammalian blood cells. Preferably, the blood cells are obtained from a human, a non-human primate, a dog, a cat, a horse, a cow, a goat, a sheep or a pig. In preferred embodiments, the blood cell suspension includes red blood cells and/or platelets and/or leukocytes and/or bone marrow cells.
(50) The term chiral refers to molecules which have the property of non-superimposability of the mirror image partner, while the term achiral refers to molecules which are superimposable on their mirror image partner.
(51) The term diastereomers refers to stereoisomers with two or more centers of dissymmetry and whose molecules are not mirror images of one another.
(52) By agent is meant a polypeptide, polynucleotide, cell, or fragment, or analog thereof, small molecule, or other biologically active molecule.
(53) The term enantiomers refers to two stereoisomers of a compound which are non-superimposable mirror images of one another. An equimolar mixture of two enantiomers is called a racemic mixture or a racemate.
(54) The language improved properties refers to any activity associated with a responsive MRI contrast agent of the invention that reduces its toxicity and/or enhances its effectiveness in sensing or detecting biologically relevant metal ions in vitro or in vivo. In one embodiment, this term refers to any qualitative or quantitative improved property of a compound of the invention, such as reduced toxicity.
(55) The term optionally substituted is intended to encompass groups that are unsubstituted or are substituted by other than hydrogen at one or more available positions, typically 1, 2, 3, 4 or 5 positions, by one or more suitable groups (which may be the same or different). Such optional substituents include, for example, hydroxy, halogen, cyano, nitro, C.sub.1-C.sub.8alkyl, C.sub.2-C.sub.8 alkenyl, C.sub.2-C.sub.8alkynyl, C.sub.1-C.sub.8alkoxy, C.sub.2-C.sub.8alkyl ether, C.sub.3-C.sub.8alkanone, C.sub.1-C.sub.8alkylthio, amino, mono- or di-(C1-C.sub.8alkyl)amino, haloC.sub.1-C.sub.8alkyl, haloC.sub.1-C.sub.8alkoxy, C.sub.1-C.sub.8alkanoyl, C.sub.2-C.sub.8alkanoyloxy, C.sub.1-C.sub.8alkoxycarbonyl, COOH, CONH.sub.2, mono- or di-(C.sub.1-C.sub.8alkyl)aminocarbonyl, SO.sub.2NH.sub.2, and/or mono or di(C.sub.1-C.sub.8alkyl)sulfonamido, as well as carbocyclic and heterocyclic groups. Optional substitution is also indicated by the phrase substituted with from 0 to X substituents, where X is the maximum number of possible substituents. Certain optionally substituted groups are substituted with from 0 to 2, 3 or 4 independently selected substituents (i.e., are unsubstituted or substituted with up to the recited maximum number of substituents).
(56) The term isomers or stereoisomers refers to compounds which have identical chemical constitution, but differ with regard to the arrangement of the atoms or groups in space.
(57) The term obtaining as in obtaining a compound is intended to include purchasing, synthesizing or otherwise acquiring the compound.
(58) Responsive MRI Contrast Agents
(59) In certain embodiments, the invention features .sup.19F-based responsive MRI contrast agent(s) for detecting and/or sensing Ca.sup.2+ ions. The Ca.sup.2+ responsive MRI contrast agents include, for example, a compound of Formula (I), or a salt or ester thereof:
(60) ##STR00004##
Wherein
R.sup.1, each independently, is C.sub.1-3 alkyl,
X is COOH or
(61) ##STR00005##
and
R.sup.2, each independently, is C.sub.1-3 alkyl.
(62) In one embodiment, each of R's in Formula (I) is CH.sub.2. In another embodiment, X in Formula (I) is
(63) ##STR00006##
(64) Exemplified Ca.sup.2+ responsive MRI contrast agents include, such as,
(65) ##STR00007##
or a salt or ester thereof.
(66) As a specific example, the Ca.sup.2+ responsive MRI contrast agent used herein is 2,2,2,2-(2,2-(ethane-1,2-diylbis(oxy))bis(4-fluoro-2,1-phenylene))bis(azanetriyl)tetraacetic acid (alias, 1,2-bis-[2-bis(carboxymethyl)amino-5-fluorophenoxy]ethane; 5F-BAPTA), or a salt or ester thereof.
(67) Another example of the Ca.sup.2+ responsive MRI contrast agent is
(68) ##STR00008##
or a salt or ester thereof.
(69) Also featured herein are .sup.19F-based Zn.sup.2+ responsive MRI contrast agents. In certain embodiments, the Zn.sup.2+ responsive MRI contrast agent is a compound of Formula (II), or a salt or ester thereof:
(70) ##STR00009##
Wherein
(71) G is C or N;
(72) m is 1, 2, or 3;
(73) X and Y, each independently, are selected from the group of H, C.sub.1-3alkyl-COOH, C.sub.1-6alkyl, C.sub.0-3alkyl-aryl, and C.sub.0-3alkyl-heteroaryl, wherein said aryl moiety and said heteraryl moiety are substituted by F, and are further optionally substituted by one or more alkoxy and/or C.sub.1-3alkyl.
(74) One embodiment of Formula (II) provides that G is N.
(75) In a certain embodiment, at least one of X and Y in Formula (II) is a fluorine-substituted C.sub.0-3alkyl-heteroaryl. The heteroaryl can be, for example, pyridyl and thienyl.
(76) In still another embodiment, at least one of X and Y is C.sub.1-3 alkyl-COOH.
(77) In particular embodiments, the Zn.sup.2+ responsive MRI contrast agents include compounds of the following formulae, or a salt or ester thereof:
(78) ##STR00010## ##STR00011##
(79) Wherein
(80) m, n, and k, each independently, are 1, 2, or 3; and R is C.sub.1-3 alkyl.
(81) The invention also features other Zn.sup.2+ responsive MRI contrast agents, such as, a compound of Formula (X), or a salt or ester thereof:
(82) ##STR00012##
Wherein R.sub.1 and R.sub.2, independently, are alkoxy or C.sub.1-3alkyl.
(83) Also provided herein are .sup.19F-based responsive MRI contrast agent(s) for detecting and/or sensing Mg.sup.2+ ions. The Mg.sup.2+ responsive MRI contrast agents of the invention include, for example, a compound of Formula (XI), or a salt or ester thereof:
(84) ##STR00013##
Wherein R.sub.3 is H, C.sub.1-3 alkyl, or
(85) ##STR00014##
and R.sub.4 is H, or C.sub.1-3 alkyl.
(86) The invention also provides .sup.19F-based responsive MRI contrast agent(s) for detecting and/or sensing Fe.sup.2+ ions. The Fe.sup.2+ responsive MRI contrast agents of the invention include, for example, a compound of Formula (XII) to (XIV), or a salt or ester thereof:
(87) ##STR00015##
(88) In certain embodiments, the invention features the use of a salt or ester of a compound of the above formulae. Suitable salts that can be used include those well known in the art (see, e.g., Berge et al. (1977) Pharmaceutical Salts, J. Pharm. Sci. 66:1-19). Such a salt can be an inorganic salt (e.g., a sodium salt, a potassium salt, and a cesium salt, and etc.) and an organic salt. The esters used herein are pharmaceutically acceptable esters. In particular embodiments, the invention features acetoxymethyl (AM) esters acetate esters of the compounds of the above formulae.
(89) It is desired that the .sup.19F-based responsive MRI contrast agents are prepared and administered in good cell permeable forms.
(90) As an example, 5F-BAPTA can be used and/or administered in one of the following salt/ester forms:
(91) ##STR00016##
all of which are cell permeant.
(92) The invention also provides .sup.19F-based responsive MRI contrast agent(s) for detecting and/or sensing multiple metal ions simultaneously (e.g., K.sup.+, Na.sup.+, Ca.sup.2+, Mg.sup.2+, Cu.sup.2+, Fe.sup.2+ and Zn.sup.2+). The multiple metal ion responsive MRI contrast agents of the invention include, for example, a compound of Formula (XV), or a salt or ester thereof:
(93) ##STR00017##
(94) wherein X is selected from the group consisting of F and one or more of F, Cl, Br, and I, and n is 2-4. In another embodiment, X is F, and n is 1-4. In a preferred embodiment, X is F and n is 2.
(95) Also included herein are stereoisomers (including regio-isomers, diastereomers, and enantiomers), hydrates, and solvates of the compounds provided supra.
(96) Methods and Kits
(97) Metals are essential for sustaining all forms of life, but alterations in their cellular homeostasis are connected to severe human disorders, including cancer, diabetes and neurodegenerative diseases (Nat Chem Biol, 2008; 4: 168-175). For example, during transplanting human islet in a diabetes therapy, the vast majority of the islet are beta cells secreting insulin and the main ions that could be detected to determine their functionality are Calcium and zinc (
(98) a) Glucose is transported into the beta cell by type 2 glucose transporters (GLUT2). Once inside, the first step in glucose metabolism is the phosphorylation of glucose to produce glucose-6-phosphate. This step is catalyzed by glucokinaseit is the rate-limiting step in glycolysis, and it effectively traps glucose inside the cell;
(99) b) As glucose metabolism proceeds, ATP is produced in the mitochondria.
(100) c) The increase in the ATP:ADP ratio closes ATP-gated potassium channels in the beta cell membrane. Positively charged potassium ions (K.sup.+) are now prevented from leaving the beta cell.
(101) d) The rise in positive charge inside the beta cell causes depolarization.
(102) e) Voltage-gated calcium channels open, allowing calcium ions (Ca.sup.2+) to flood into the cell.
(103) f) The increase in intracellular calcium concentration triggers the secretion of insulin via exocytosis.
(104) Many metal ion indicators are well characterized as well as commercially available, especially for optical-imaging based approaches.
(105) The invention relates to .sup.19F-CEST-MRI methods for detecting and/sensing metal ions in a biological sample or tissue. Specifically, the invention provides a non-invasive means of detecting and/or sensing free metal ions in a deep tissue.
(106) The CEST contrast mechanism has also been applied to generate MRI-based contrast from reporter genes. The process in
(107) The inventors have discovered that chemical saturation transfer is applicable for .sup.19F-based MRI. For example, the inventors found that Ca.sup.2+ could be monitored with specificity and high sensitivity with iCEST MRI using 5F-BAPTA, e.g., Ca.sup.2+ could be detected in the presence of competitive metal ions. It is believed that the responsive agent (.sup.19F) is the contrast generator (.sup.19F).
(108) In a particular embodiment, the invention presents a novel approach for specifically sensing the presence of Ca.sup.2+ in which the amplification strategy of chemical exchange saturation transfer (CEST) is combined with the broad range in chemical shifts found in .sup.19F NMR to obtain MR images of Ca.sup.2+. The chemical shift change () of .sup.19F upon binding of Ca.sup.2+ to a difluoro derivative of [1,2,-bis(oaminophenoxy)ethane-N,N,N,N, tetra-acetic acid], also named as 5F-BAPTA, by RF labeling at the bound-19F frequency, .sub.[Ca-5F-BAPTA], and detecting the label transfer to the free-.sup.19F frequency, .sub.5F-BAFTA. Through the substrate binding kinetics, the signal of Ca.sup.2+ onto free 5F-BAPTA is amplified. Thus, the method of the invention enables an indirect detection of low Ca.sup.2+ concentrations with high sensitivity.
(109) In one aspect, provided herein is a method of obtaining a magnetic resonance (MR) image of a metal ion in a biological sample or tissue, said method comprising
(110) a) introducing a .sup.19F-based responsive magnetic resonance imaging (MRI) contrast agent to the biological sample or tissue containing the metal ion; and
(111) b) imaging the biological sample or tissue using a chemical exchange saturation transfer (CEST)-based MRI technique.
(112) Another aspect of the invention provides a method of detecting or sensing a metal ion in a biological sample or tissue comprising background ions. The method comprises
(113) a) introducing to the biological sample or tissue .sup.19F-based responsive magnetic resonance imaging (MRI) contrast agents, wherein at least one of the .sup.19F-based responsive MRI contrast agents is bound to the metal ion to produce a chelation complex;
(114) b) radiofrequency (RF) labeling of .sup.19F frequency in said chelation complex; and
(115) c) detecting label transfer to .sup.19F frequency in a .sup.19F-based responsive MRI contrast agent free of metal ion chelation.
(116) The methods of the invention can be applied to many metal ions. In particular embodiments, the metal ion is a divalent metal ion (e.g., Ca.sup.2+, Zn.sup.2+, Mg.sup.2+, Fe.sup.2+, Cu.sup.2+, Ba.sup.2+, Sr.sup.2+, Cd.sup.2+, Pb.sup.2+, Co.sup.2+ and Ni.sup.2+). One embodiment provides that the metal ion is Ca.sup.2+, Zn.sup.2+, Mg.sup.2+, or Fe.sup.2+, or a combination thereof.
(117) The methods of the invention can also be applied to other metal ions, such as, Fe.sup.3+, Mn.sup.3+, K.sup.+, Na, cu.sup.2+, Cu, Gd.sup.3+, and Eu.sup.3+, or a combination thereof.
(118) According to the invention, the useful .sup.19F-based responsive magnetic resonance imaging (MRI) contrast agents include those provided supra. Alternatively, other .sup.19F-based fluorescent metal ion sensors known in the art can also be used in the invention.
(119) As above discussed, the invention presents a novel method of detecting or sensing Ca.sup.2+ in a biological sample or tissue comprising background ions, said method comprising
(120) a) introducing to said biological sample or tissue a .sup.19F-derivative of 1,2,-bis(o-aminophenoxy)ethane-N,N,N,N, tetra-acetic acid (BAPTA), or a salt or ester thereof to obtain a chelation complex containing the metal ion and the .sup.19F-derivative; and
(121) b) detecting a chemical shift change of .sup.19F through a .sup.19F NMR.
(122) In one particular embodiment, the invention relates to the use of 5F-BAPTA as a .sup.19F-based responsive MRI contrast agent for detecting and/or sensing metal ions (especially, Ca.sup.2+).
(123) The invention thus offers a novel method for monitoring Ca.sup.2+ by using MRI, specifically, the method combines the conventional amplification strategy and exchange sensitivity of CEST with the specificity of the .sup.19F frequency in free and bound substrate to obtain MR images of calcium binding kinetics.
(124) It is discovered that BAPTA and its derivatives share high (>10.sup.5) selectivity for Ca.sup.2+ over Mg.sup.2+ of EGTA but are very much less affected by pH changes and are faster at taking up and releasing Ca.sup.2+ (Biochemistry 19(1980); 2396). .sup.19F-NMR magnetization transfer between 5F-BAPTA and its complexes was presented in literature (such as, NMR In Biomedicine, 7 (1994), 330-338).
(125) Compared to .sup.1H-based approach, the methods of the invention offer advantages, such as, large range of .sup.19F chemical shifts (about 20 times that of .sup.1H); and high sensitivity of .sup.19F chemical shifts to the details of the local environment (
(126) The invention also provides kits for imaging free metal ions in a biological sample or tissue. The kit of the invention includes one or more .sup.19F-based responsive MRI contrast agents (e.g., 5F-BAPTA) of the invention, and instructions for imaging free metal ions (e.g., Ca.sup.2+) in a biological sample or tissue.
(127) The invention also provides a method with improved specificity and sensitivity for imaging a metal ion in a biological sample or tissue containing background ions, comprising the steps of chelating said metal ion with a .sup.19F-based responsive magnetic resonance imaging (MRI) contrast agent to obtain a chelation metal complex, and imaging said chelation metal complex using a CEST-based MRI technique.
(128) The iCEST approach of the invention can be further extended to designing of novel responsive agents for molecular and cellular MRI applications. Any potential novel responsive agents are assessed by an optical assay (using multi-well plates) for their potentiality for the iCEST approach.
(129) The invention also includes a method of chemically modifying commercially available chelates for metal ion detection, comprising steps of designing and synthesizing novel chelates, and screening the novel metal ions for their usefulness in the iCEST approach.
(130) Certain design criteria for creating metal responsive MRI contrast agents can be found in Que et al. (Chem Soc. Rev. 2010, 39, 51-60) and Hyman et al. (Coordination Chemistry Reviews, 256 (2012), 2333-2356).
(131) Further, the .sup.19F-based iCEST MRI approach of the invention can also be widely applied in other types of applications, for example, as a method for imaging and/or analysis reactive oxygen species and other biologically relevant compounds, or as a diagnostic method for various diseases or conditions.
EXAMPLE
(132) General Methods:
(133) Material:
(134) 5F-BAPTA (5,5-difluoro BAPTA): The difluoro derivative of the tetra potassium salt of [1,2,-bis(o-aminophenoxy)ethane-N,N,N,N, tetra-acetic acid], 5F-BAPTA, was purchased from Biotium, Inc. (Hayward, Calif., USA).
(135) Sample Preparation:
(136) 5F-BAPTA was dissolved in Hepes buffer (40 mM) to a final concentration of 10 mM and the pH was adjusted to the following values: 5.6, 6.0, 6.4, 6.8, 7.0, 7.2, and 7.6. Stock 10 mM solutions of CaCl.sub.2, MgCl.sub.2, and ZnCl.sub.2 were prepared in 40 mM Hepes buffer. Five L of the stock solution was added to 1 mL of 10 mM 5F-BAPTA resulting in a 200:1 ratio (10 mM: 50 M) between the free 5F-BAPTA and the M.sup.2+ ion following by a pH adjustment. One mL of each sample (with adjusted pH) was transferred into a 8 mm NMR tube within a 25 mm NMR tube in order to center the sample in the coil for the MRI experiments.
(137) .sup.19F NMR Experiments:
(138) .sup.19F-NMR spectra were acquired with 11.7 T NMR scanner (Bruker) with a dedicated .sup.19F coil (470 MHz). Samples contained 5F-BAPTA (5.0 mM) M.sup.2+ (Ca2+, Mg2+ or Zn2+, 0.5 mM), 5-Fluoro-Cytosine (5-FC, 0.5 mM) and D2O (10%) that was used for signal lock. 5FC was assigned as an internal reference with a fixed frequency of 47.0 ppm. The data show that the frequency of free 5FBAPTA is affected by pH, while that of bound 5F-BAPTA is not.
(139) Mri Experiments:
(140) MRI experiments were performed on a vertical 16.4 T scanner (Bruker Avance system) at 37 C. A 25 mm birdcage radiofrequency coil was used to acquire both .sup.1H and .sup.19F MR images by sweeping the coil frequency from proton (700 MHz) to fluorine (658.8 MHz) frequency.
(141) .sup.1H-MRI:
(142) A RARE sequence was used to acquire the .sup.1H-MR images with the following parameters: TR/TE=5,000/7.7 ms, RARE factor=8, 1 mm slice thickness, FOV=44 cm, matrix size=128128, resolution=0.31250.3125 mm, and 1 average (NA=1).
(143) Magnetization Transfer Ratio (MTR) Images, iCEST Images:
(144) The saturation transfer effect on the free 5F-BAPTA, i.e., the MTR or iCEST, was calculated for each voxel in the image by using a Lorentzian line shape fitting as described in Jones et al. (Magn Reson Med 2012, 67, 1579), and Liu et al. (Molecular imaging 2012, 11, 47).
(145) Relaxation Times:
(146) The same image geometry as in the .sup.19F-CEST experiments was used for the determination of T1 and T2 of the imaged samples. For T1 measurements, a saturation recovery experiment was performed with TR values of 61, 214, 395, 615, 899, 1296 1964, and 4961 ms. A spin-echo experiment (TR=5000 ms) with multiple echoes was performed with variable echo times (TE=5, 10 15, 20, 25, 30, 35, and 40 ms) to determine the T2 value of each sample.
(147) Bloch Equation Simulations:
(148) Numerical solutions to the six Bloch equations including direct saturation of free 5F-BAPTA were obtained as described previously (McMahon, M. T. et al., Magnetic Resonance in Medicine 2006, 55, 836). The relaxation parameters for .sup.19F used in the Bloch equations were R.sub.1=1/T.sub.1 with bound calcium (Rib)=0.71 s.sup.1, R.sub.2 bound calcium (R.sub.2b)=29 s.sup.1, whereas the R.sub.1 and R.sub.2 values of free 5F-BAPTA (R.sub.1f and R.sub.2f) were determined experimentally through inversion-recovery and saturation-recovery experiments as a function of pH on solutions containing 20 mM 5F-BAPTA as listed in Table 1 as follows:
(149) TABLE-US-00001 TABLE 1 pH (ppm) T.sub.2 (ms) T.sub.1 (ms) 5.6 2.1 .sup.6.sup.a 715 6.0 4.0 10 715 6.4 5.0 11 715 6.8 5.6 25 715 7.0 5.9 32 715 7.2 6.2 38 715 7.6 6.2 N.D 715 .sup.aEstimated from the Bloch equation fitting N.D. = Not Determined
(150) .sup.19F-iCEST Experiments:
(151) A modified RARE sequence (TR/TE=4,000/3.4 ms, RARE factor=4, 10 mm slice thickness, FOV=44 cm, matrix size=3232, resolution=1.251.25 mm, and NA=8) including a magnetization transfer (MT) module (B1=3.6 T) was used to acquire CEST-weighted images from 7.2 to +7.2 ppm around the resonance of the .sup.19F atoms at the free 5F-BAPTA, which was assigned as 0 ppm. Saturation time (tsat) was either 1500 ms to 2000 ms as indicated in the text.
(152) .sup.19F-iCEST of 500 nM of Ca.sup.2+:
(153) An aqueous solution containing 0.5 mM of 5F-BAPTA and 500 nM in Hepes buffer (40 mM, pH=7.2) was transferred into a 20 mm NMR tube, which was located within a 25 mm NMR tube in order to centralize the sample in the coil for the MRI experiment. The same parameters used for .sup.19F-iCEST experiments were used except the followings: TR=3000 ms, RARE=8, FOV=6.0 cm (resolution=1.8751.875 mm), and 168 averages.
(154) .sup.19F-CEST Experiments with 5F-BAPTA
(155) .sup.19F-CEST experiments were performed on solutions containing 1,2-Bis-[2-bis(carboxymethyl)amino-5-fluorophenoxy]ethane (5F-BAPTA), with and without divalent cations (M.sup.2+).
(156) Experiments were performed on an 11.7T NMR spectrometer (Bruker). 5F-BAPTA (AnaSpec, Inc.) was dissolved in 40 mM HEPES buffer (pH=7.0) to a concentration of 5 mM, and CaCl.sub.2 was dissolved to a final Ca.sup.2+ concentration of 50 m.
(157) .sup.19F-CEST spectra (z-spectra) were acquired with a saturation transfer sequence consisting of a saturation pulse (B1=4.7 T, 4 sec) with variable offset (from 7.5 to +7.5 ppm relative to the 5FBAPTA frequency set at 0 ppm). Experiments were performed without (room temperature, RT) and with sample heating (37 C.). The MTRasym=100(S.sub.S.sub.+)/S.sub.0 was computed at different offsets , where S.sub.0 is the 5F-BAPTA signal without saturation.
(158) MRI:
(159) Imaging experiments were performed on a 16.4T MRI scanner (Bruker). 5F-BAPTA was dissolved to 10 mM in 40 mM HEPES, pH=7.0, with or without 100 M of M.sup.2+ (Mg.sup.2+, Zn.sup.2+, or Ca.sup.2+).
(160) .sup.19F-CEST images were acquired using a continuous wave presaturation pulse (B.sub.1=3.6 T, 3 sec) followed by a multi-echo MRI pulse sequence (RARE, rare factor 4, TR/TE=6000/10 ms). FOV of 44 cm, matrix 3232 and slice thickness 10 mm. Mean .sup.19F-CEST spectra were derived after B.sub.0 correction for each voxel using MatLab. MTRasym plots and maps were calculated.
(161)
(162)
(163) Evaluation of the Sensitivity of iCEST Contrast Approach
(164) The iCEST contrast of 5FBAPTA solutions (pH=7.2) at different ratios of Ca.sup.2+ to 5F-BAPTA were examined Ca,
(165) This study shows for the first time that spatial information of Ca.sup.2+ and Me.sup.+2 levels can be obtained using amplification of the sensitivity by iCEST with 5F-BAPTA as the ion indicator. One advantage of using 5F-BAPTA as an MRI responsive agent for detecting metal ions over .sup.1H-MRI.sup.26 or .sup.129Xe-MRI.sup.27 based probes is that no attachment of a contrast enhancer is required. The .sup.19F atoms serve on the chelates as the responsive group as well as contrast generators.
(166) The study shows the potential of exploiting the iCEST imaging concept using .sup.19F-MRI, as 1:2000 concentration ratios are amplified to 1:20 changes in .sup.19F signal (
(167) Finally, the unique found for each [M.sup.2-5FBAPTA] and the diversity of the obtained kex may be exploited for multi-ion MR imaging approaches in which each ion generates iCEST contrast with an identifiable amplitude and .
(168) .sup.19F-CEST Properties of 5F-BAPTA in the Presence of Different Metal Ions
(169)
(170) the NMR time scale (<<k.sub.ex), no peak can be resolved. When the k.sub.ex is sufficiently slow at the field strength used, a well-defined peak is observed for the [M.sup.2+-5F-BAPTA] resonance as is shown for Zn.sup.2+>>kex) and Ca.sup.2+ (>kex).
(171) The observed 's are typical and unique for each ion that is complexed by 5F-BAPTA and ranges from a few ppm in the cases of Ca.sup.2+, Zn.sup.2+, Ba.sup.2+, Cd.sup.2+, Pb.sup.2+ and others to tens of ppm upon binding of Fe.sup.2+, Co.sup.2+ and Ni.sup.2+ (Smith et al., Proc Natl Acad Sci USA 1983, 80, 7178; Kirschenlohr, H. L. et al., Biochem J 2000, 346 Pt 2, 385). The dissociation constant (K.sub.d) of [M.sup.2+-5F-BAPTA] is different for each M.sup.2+, and as a result so is the k.sub.ex for the process in
(172) The .sup.19F-CEST properties of 5F-BAPTA in the presence of Ca.sup.2+ (slow-to-intermediate k.sub.ex), Zn.sup.2+ (very slow k.sub.ex) and Mg.sup.2+ (fast kex) were determined on a 16.4 T. MRI scanner and are summarized in
(173) Importantly, a broad asymmetry is observed at very high fractional Mg.sup.2+ concentrations (
(174) Interestingly, the between [Ca-5F-BAPTA] and free 5F-BAPTA was found to be dependent on pH (
(175) (19010 s.sup.1,
(176) .sup.19F-NMR spectra collected with an internal reference revealed that upon pH change, the frequency of the free 5F-BAPTA shifts but not the frequency of bound M.sup.2+-5F-BAPTA (
(177) As expected no difference in MR contrast was observed between the samples when using conventional .sup.1H-MRI or .sup.19F-MRI. However, contrary to the Mg.sup.2+- or Zn.sup.2+-containing samples, which did not generate iCEST contrast at this concentration, a large iCEST contrast was detected for the Ca.sup.2+ containing sample when a saturation pulse (B.sub.1=3.6 T/2000 ms) was applied at the appropriate frequency offset of the [Ca.sup.2+-5F-BAPTA] complex, i.e., =6.2 ppm (pH=7.2) and =5.0 ppm (pH=6.4).
(178) In addition, iCEST images were acquired for solutions containing mixtures of Ca.sup.2+ and Mg.sup.2+ (50 M Ca.sup.2+, 200 M Mg.sup.2+) and Ca.sup.2+ and Zn.sup.2+ (50 M Ca.sup.2+, 50 M Zn.sup.2+) with 10 mM BAPTA at pH 7.2. The iCEST contrast produced by the Ca.sup.2+ was still significant (22%) at =6 ppm for all mixtures (
(179) Ca.sup.2+ Specificity of 5F-BAPTA
(180) The iCest approach regarding Ca.sup.2+ specificity was studied by using 5F-BAPTA as a metal ion indicator. The results were presented in
(181) The .sup.19F-CEST MR images shown in
(182) The variance in the of [M.sup.2+-5F-BAPTA] complex for each examined M.sup.2+ makes .sup.19F-CEST MRI more specific than relaxation based .sup.1H MRI methodologies. The specificity is comparable to that of PARACEST agents used for Ca.sup.+2 and Zn.sup.+2 binding (G. Angelovski et al., Bioorg Med Chem 19, 1097 (2011); R. Trokowski et al., Angew Chem Int Ed Engl 44, 6920 (2005)), but no paramagnetic agent is needed. The higher saturation transfer effect for 5F-BAPTA obtained at 37 C. as compared to RT (
(183) It is contemplated that the specificity of the .sup.19F-CEST method proposed here is not just due to the different values of the examined ions (
(184) Simultaneous Detection of Multiple Metal Ions Using a Single 19F-iCEST Probe
(185) In another embodiment of the invention, the .sup.19F iCEST MRI approach may be extended by chemical modification of a BAPTA derivative, 5,5, 6,6-tetrafluoro-BAPTA (TF-BAPTA, AG Scientific, Inc.), that alters the binding kinetics of metal ions and their chelates, enabling specific and simultaneous detection of Zn.sup.2+ and Fe.sup.2+. TF-BAPTA has the following structure:
(186) ##STR00018##
Without being bound by theory, it is believed that the above-shown acetate form allows the TF-BAPTA compound to enter into desired target cells, where the acetate may be hydrolyzed and the free acid form is released. The free acid form may allow binding of the ions to be detected. Accordingly, one of skill in the art will appreciate that the acetate form may typically be used to facilitate the transport of TF-BAPTA into the cell for in vivo imaging application, whereas ex vivo imaging applications will typically involve an appropriate free acid form of the molecule.
Methods
(187) Experiments were performed on solutions containing TF-BAPTA and multiple biologically relevant metal ions (K.sup.+, Na.sup.+, Ca.sup.2+, Mg.sup.2+, Cu.sup.2+, Fe.sup.2+ and Zn.sup.2+) at 37 C. and pH=7.4. MR Spectroscopy as follows: TF-BAPTA was dissolved to a final concentration of 5 mM, and ions were add at 500 M. Using 5-Fluorocytosine (5-FC) as an internal .sup.19F reference, .sup.19F-NMR spectra were acquired (11.7 T NMR spectrometer, Bruker). MRI: Experiments were performed on a 17.6 T MRI scanner (Bruker). TF-BAPTA was dissolved to 10 mM with 200 AM of ion. A RARE (factor 8) sequence was used to acquire 1H MRI (TR/TE=5,000/7.7 ms, 1 mm slice, FOV=22 cm, matrix size=128128). For .sup.19F MRI, the center frequency (O1) was set at the frequency of the 19F atom at the 6 position (0.0 ppm) of TF-BAPTA (
(188)
(189) The high sensitivity of the .sup.19F NMR spectrum Au) values for changes in chemical environment together with the specificity of these s for certain metal ions allows the development of novel responsive contrast agents for .sup.19F-iCEST. By adding .sup.19F atoms to the 6 position of 5F-BAPTA, which previously allowed only detection of Ca.sup.2+ using iCEST (Bar-Shir et al., 2013, J Am Chem Soc 135:12164; Gilboa et al., 1994, NMR Biomed 7:330), to obtain TF-BAPTA (
(190) Although a preferred embodiment of the invention has been described using specific terms, such description is for illustrative purposes only, and it is to be understood that changes and variations may be made without departing from the spirit or scope of the following claims.
INCORPORATION BY REFERENCE
(191) All patents, published patent applications and other references disclosed herein are hereby expressly incorporated by reference in their entireties by reference.
EQUIVALENTS
(192) Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents of the specific embodiments of the invention described herein. Such equivalents are intended to be encompassed by the following claims.