Simultaneous In Vivo Imaging of Neutrophil Elastase and Oxidative Stress in Atherosclerotic Plaques Using a Unimolecular Photoacoustic Probe

Abstract Atherosclerosis, a major global health concern with high morbidity and mortality rates, involves complex interactions of chronic inflammation, oxidative stress, and proteolytic enzymes. Conventional imaging methods struggle to capture the dynamic biochemical processes in atherosclerotic plaques. Here, we introduce a novel unimolecular photoacoustic probe (UMAPP) designed with specific binding sites for neutrophil elastase (NE) and the redox pair O 2 ⋅ − /GSH, enabling real‐time monitoring of oxidative stress and activated neutrophils in plaques. UMAPP, comprising a boron‐dipyrromethene (BODIPY) core linked to a hydrophilic NE‐cleavable tetrapeptide and dual oxidative stress‐responsive catechol moieties, facilitates NE‐mediated modulation of photoinduced electron transfer impacting photoacoustic intensity at 685 nm (PA 685 ). Furthermore, oxidation and reduction of catechol groups by O 2 ⋅ − and GSH induce reversible, ratiometric changes in the photoacoustic spectrum (PA 745 /PA 685 ratio). Initial UMAPP applications successfully distinguished atherosclerotic and healthy mice, evaluated pneumonia‘s effect on plaque composition and verified the probe‘s effectiveness in drug‐treatment studies by detecting molecular alterations before visible histopathological changes. The integrated molecular imaging capabilities of UMAPP offer promising advancements in atherosclerosis diagnosis and management, enabling early and accurate identification of vulnerable plaques.