Near-infrared fluorescence imaging of vital nerves and white matter tracts for fluorescence-guided neurosurgery

An estimated 700,000 people in the U.S currently live with a primary brain tumor. While survival correlates with extent of tumor resection, minimizing neurological morbidity means balancing resection against preserving critical white matter tracts (WMTs). But, without clear boundaries or a way to visualize WMTs directly during surgery, finding that balance remains a challenge. With fluorescence-guided surgery and imaging systems fully integrated into the clinic but no FDA-approved contrast agent to selectively imaging healthy tissue, a WMT-selective fluorophore that enabled direct, real-time visualization could revolutionize surgical practice. Developed by combining structural elements of BBB-permeable and WMT-targeting agents with strategies for improving properties of drug-like molecules, these novel fluorophores have enabled direct visualization of WMTs with improved specificity and uptake in peripheral nerves leading to a brighter signal that allows for equal contrast at lower doses. Enhancing safety and functionality, this work sets a new benchmark for intraoperatively imaging WMT, underscoring the transformative potential of chemistry-driven solutions in precision medicine.