Workshop on the production, application and clinical translation of ''non-standard'' PET nuclides: a meeting report

A one-day satellite workshop was organized to coincide with the 17(th) International Symposium on Radiopharmaceutical Sciences held in Aachen, Germany, April 30-May 4, 2007. The workshop, ''Production and application of non-standard' PET nuclides'', was held on Sunday April 29, 2007 at the Eurogress Aachen and was organized by J. Lewis, PhD, L. Tang, and M. Welch, PhD. The workshop was designed for the radiopharmaceutical community discussing the production, use and dissemination of the ''non-standard'' PET nuclides. The definition of ''non-standard'' positron emission tomography (PET) nuclides included (45)Ti, (60)Cu, (61)Cu, (64)Cu, (66)Ga, (72)As, (74)As, (76)Br, (86)Y, (89)Zr, (94)mTc and (124)I. The workshop was supported by the grant Research Resource for Cancer Applications (R24 CA86307) funded by the National Cancer Institute at the National Institutes of Health. The workshop was attended by over 110 scientists and engineers from over 20 countries from all over the world and was designed with an open forum style to allow for discussions and interactions by all participants. All of the invited speakers were asked to make a contribution to this edition of the Quarterly Journal of Nuclear Medicine. The individual articles following this introduction are reviews of their area of expertise and the current state-of-the-art. This introduction briefly describes the role of the workshop, the aims and the general outcome. Also, the translation of these nuclides to the clinic, perhaps the most important goal of this work is discussed in this introductory article.

Radionuclide production and yields at Washington University School of Medicine

Washington University School of Medicine has carried out the production of ''non-standard'' nuclides for the positron emission tomography (PET) community since 1999 under the Radionuclide Resource for Cancer Applications grant R24 CA 86307 funded by the National Cancer Institute. With the support from the grant, we have successfully developed procedures for the high yield production of a wide range of radionuclides and made them available to the research community. The following non-standard PET nuclides, (60)Cu, (61)Cu, (64)Cu, (76)Br, (77)Br, (124)I, (94m)Tc, and (86)Y are routinely produced on Washington University on-site Cyclotron Corporation CS-15 or Japan Steel Works 16/8 cyclotrons. Additionally, a technique to produce (45)Ti has been developed and lately, (89)Zr is being investigated. This paper describes the production techniques and presents the performance results in terms of yields and radionuclidic purity. Sufficient yields for distribution are achieved and high radionuclide purity is also achieved yielding high quality product for medical research.

Measurement of nuclear transparency for the A(e,e'pi+) reaction

We have measured the nuclear transparency of the A(e,e'pi+) process in 2H, 12C, 27Al, 63Cu, and 197Au targets. These measurements were performed at the Jefferson Laboratory over a four momentum transfer squared range Q2=1.1 to 4.7 (GeV/c)2. The nuclear transparency was extracted as the super-ratio of (sigmaA/sigmaH) from data to a model of pion-electroproduction from nuclei without pi-N final-state interactions. The Q2 and atomic number dependence of the nuclear transparency both show deviations from traditional nuclear physics expectations and are consistent with calculations that include the quantum chromodynamical phenomenon of color transparency.

Increasing risk for negative ozone impacts on vegetation in northern Sweden

Trends were found for increasing surface ozone concentrations during April-September in northern Sweden over the period 1990-2006 as well as for an earlier onset of vegetation growing season. The highest ozone concentrations in northern Sweden occurred in April and the ozone concentrations in April showed a strong increasing trend. A model simulation of ozone flux for Norway spruce indicated that the provisional ozone flux based critical level for forests in Europe is exceeded in northern Sweden. Future climate change would have counteracting effects on the stomatal conductance and needle ozone uptake, mediated on the one hand by direct effect of increasing air temperatures and on the other through increasing water vapour pressure difference between the needles and air. Thus, there is a substantial and increasing risk for negative impacts of ozone on vegetation in northern Sweden, related mainly to increasing ozone concentrations and an earlier onset of the growing season.

Biomass production and carbon sequestration potential in poplar plantations with different management patterns

Biomass production and carbon storage in short-rotation poplar plantations over 10 years were evaluated at the Hanyuan Forestry Farm, Baoying County, China. Experimental treatments applied in a split-plot design included four planting densities (1111, 833, 625 and 500 stems ha(-1)) and three poplar clones (NL-80351, I-69 and I-72). Based on the model of total biomass production developed, total plantation biomass production was significantly different in the plantations. The ranking of the plantation biomass production by planting density was 1111>833 more more than 625>500 stems ha(-1), and by components was stem>root>or=branch>leaf for all plantations. At 10 years, the highest total biomass in the plantation of 1111 stems ha(-1) reached about 146 t ha(-1), which was 5.3%, 11.6% and 24.2% higher than the plantations of 833, 625 and 500 stems ha(-1), respectively. The annual increment of biomass production over 10 years differed significantly among initial planting densities and stand ages (p<0.01), but no significant difference was observed from age 7 to 10. Mean carbon concentration among all biomass components ranged from 42-50%, with the highest carbon concentrations in stems and the lowest in leaves. Over the study period, the dynamic pattern of total plantation carbon storage by planting density was similar to that of total biomass production. At age 10, the highest total plantation carbon storage in the plantation of 1111 stems ha(-1) reached about 72.0 t ha(-1), which was 5.4%, 11.9% and 24.8% higher than in the plantations of 833, 625 and 500 stems ha(-1), respectively. The annual carbon storage increment over 10 years differed significantly among initial planting densities and stand ages (p<0.01), and it showed a pattern similar to the annual biomass production increment of the plantations. The results suggest that biomass production and carbon storage potential were highest for planting densities of 1111 and 833 stems ha(-1) grown over 5- and 6-year cutting cycles, respectively. If 3- or 4-year cutting cycles are used, the planting density should be higher than 1111 stems ha(-1) (e.g., 1667 or 2500 stems ha(-1)). Based on the mean annual carbon storage for the plantation of 625 stems ha(-1), as an estimation, the mean carbon storage in the biomass of poplar plantations (excluding leaves) amounts to 3.75x10(7) t ha(-1)yr(-1) in China.

NovaSil clay intervention in Ghanaians at high risk for aflatoxicosis. I. Study design and clinical outcomes

A 3-month double-blind and placebo-controlled, phase IIa clinical trial was conducted in Ghana to investigate the safety, tolerance and aflatoxin-sorption efficacy of dietary NovaSil (NS). Volunteers (507 subjects) were clinically screened to evaluate their general health, pregnancy status and blood AFB(1)-albumin adduct levels. Of these subjects, 177 were randomly assigned to three groups: high-dose (HD), low-dose (LD) and placebo-control (PL) groups receiving 3.0, 1.5 and 0 g NS day(-1) in capsules. Trained study-monitors supervised NS capsule administration to participants and recorded side-effects daily. Physical examinations were performed monthly. Blood and urine samples were collected for laboratory analysis. Approximately 92% of the participants (162 of 177) completed the study and compliance rate was over 97%. Overall, 99.5% of person x time reported no side-effects throughout the study. Mild to moderate health events ( approximately 0.5% of person x time) were recorded in some participants. Symptoms included nausea, diarrhea, heartburn and dizziness. These side-effects were statistically similar among all three groups. No significant differences were shown in hematology, liver and kidney function or electrolytes in the three groups. These findings demonstrate that NS clay is apparently safe and practical for the protection of humans against aflatoxins in populations at high risk for aflatoxicosis.

Selective hepatic vascular exclusion and Pringle maneuver: a comparative study in liver resection

OBJECTIVE

Most liver resections require champing of the hepatic pedicle (Pringle maneuver) to avoid excessive blood loss. But Pringle maneuver cannot control backflow bleeding of the hepatic vein. Resection of liver tumors involving hepatic veins may cause massive hemorrhage or air embolism from injuries of the hepatic vein. Although total hepatic vascular exclusion (THVE) can prevent bleeding of the hepatic vein effectively, it also may result in systemic hemodynamic disturbance because of the clamped inferior vena cava (IVC). SHVE, a new technique, can control the inflow and outflow of the liver without clamping the vena cava. We compared the effects of selective hepatic vascular exclusion (SHVE) and Pringle maneuver in resection of liver tumors involving the junction of the hepatic vein.

METHODS

From January 2000 to October 2005, 2100 patients with liver tumors had undergone liver resections in our department. Among them, tumors of 235 cases adhered to or were close to the junction of one or more hepatic veins. Both SHVE and Pringle maneuver were used to control blood loss during hepatectomy. These 235 cases were divided into two groups: Pringle maneuver group (110) from January 2000 to December 2002 and SHVE group (125) from January 2003 to October 2005. Data were analyzed regarding the intraoperative and postoperative courses of the patients. In the SHVE group, total SHVE (clamping the porta hepatis and all major hepatic veins) was used in 69 cases and partial SHVE (clamping the porta hepatic and one or two hepatic veins) in 56 cases. There were three methods in hepatic veins occlusion: ligating with suture, encircling and occluding with tourniquets and clamping with Satinsky clamps.

RESULTS

There was no difference between the two groups regarding the age, gender, tumor size, cirrhosis and HBsAg rate, ischemia time and operating time. Intraoperative blood loss and transfusion requirements were significantly decreased in the SHVE group. Hepatic veins rupture with massive blood loss occurred in 14 and air embolism in three during the tumor resection, but there was no massive blood loss and air embolism in the SHVE group due to hepatic vein occlusion. Postoperative bleeding, reoperation, liver failure and mortality rate were higher, and ICU stay and hospital stay were longer in the Pringle group than those in the SHVE group.

CONCLUSION

SHVE is much more effective than Pringle maneuver in controlling intraoperative bleeding. It can prevent massive blood loss and air embolism from hepatic veins rupture and can reduce the postoperative complication rate and mortality rate. Clamping the hepatic veins with Satinsky clamps is much safer and easier than ligating with suture and occluding with tourniquets.

Gene therapy with CX3CL1/Fractalkine induces antitumor immunity to regress effectively mouse hepatocellular carcinoma

CX3CL1/Fractalkine(FK), a chemokine existing in both secreted and membrane anchored form, was reported to induce suppressive activities in tumor models. Here, we demonstrate for the first time the antitumor effects of FK in murine hepatocellular carcinoma (HCC) by constructing a FK eukaryotic expression vector (pIRES-FK) and transferring it into such tumor cells. Tumor rejection experiments were performed by injecting FK gene-modified murine HCC cell line (MM45T.Li) into immunocompetent mice, which significantly inhibited tumorigenicity or growth of MM45T.Li-FK cells. Immunohistochemistry examination and fluorescence-activated cell sorting analyses revealed both CD4+ and CD8+ T cells infiltration within the tumor together with a marked increase of these cells in the peripheral blood. Splenic lymphocyte from mice treated with MM45T.Li-FK were effective in the induction of tumor-specific cytotoxic T cells. We also observed an increased production of IL-2 and IFN-gamma in MM45T.Li-FK tumor tissue. Our results suggest that transfer of the FK gene into tumor cells could elicit a specific antitumor immunity capable of inhibiting tumor growth which lead to increased survival of tumor-bearing hosts. FK should be considered as a chemokine suitable for cancer immunoprevention or gene therapy.

Minimal residual local disease predicts improved survival after chemoradiotherapy in patients with squamous cell carcinoma of the esophagus

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Background: Our recent analyses (JCO, in press) showed that residual nodal disease but not T-stage predicted survival after chemo-radiotherapy (CRT) and surgery for esophageal adenocarcinoma (AC). In this study, we investigated prognostic factors for esophageal squamous cell carcinoma (SCC) after CRT. Methods: Retrospective review of patients with esophageal SCC who had CRT and esophagectomy. Data collected: demographics, CRT details, pathologic findings, and survival. Statistical methods included recursive partitioning (RP) and Kaplan-Meier (KM) analyses. Results: Patients included in the study were treated between 1/1996 and 2/2006. Follow up was thru 5/06. 91 patients were appropriate for analysis. There were 56 men (61.5%) and 35 women (38.5%). 72 (79.1%) patients had clinical regional disease prior to treatment, while the rest had locally advanced disease. Median radiation dose was 5040 cGy, and 78 (85.7%) patients received cisplatin based chemotherapy. 49 (53.8%) patients had a complete local pathologic response (pCR), including 10/91 (10.9%) who had a pCR with residual nodal disease. 42 (46.2%) patients had residual local disease. RP analysis identified 3 prognostic groups: a) Group 1 (n=52), patients with minimal residual local disease (pCR & T1- regardless of nodal status), b) Group 2 (n=28), patients with residual T2 disease (N0 and N1) as well as patients with T3–4N0 disease, and c) Group 3 (n=11), patients with residual T3–4N1 disease. 3-year survival by KM analysis was 68.4% in group 1, 45.6% in group 2, and 0 % in group 3 (p<0.001). Conclusions: Unlike adenocarcinoma of the esophagus where residual nodal disease after CRT is the most significant predictor of survival, in SCC of the esophagus, the presence of minimal residual local disease after CRT, regardless of nodal status, predicts the best survival. The implications of these findings might include establishing different endpoints to assess response to treatment and prognostic criteria.

No significant financial relationships to disclose.

A phase II study of preoperative chemotherapy with irinotecan(CPT) and cisplatin(CIS) for gastric cancer(NCI 5917): FDG-PET/CT predicts patient outcome

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Introduction: Preoperative chemotherapy is a standard option for the treatment of locally advanced gastric cancer(GC). FDG-PET scans have been examined to identify early treatment response in esophagus and GEJ adenocarcinoma. We evaluated the utility of an early change in FDG-PET/CT at several time points in predicting response to preoperative chemotherapy in gastric cancer. Methods: 42 pts with locally advanced GC(preoperative stage T2N+M0 or T3–4NanyM0) were treated with CPT 65 mg/m2 and CIS 30mg/m2 on day(d)1 and d8, every 21 days for 4 cycles. FDG-PET/CT scans were performed at baseline, and in FDG avid patients, again on d15 and d35. The primary objective was to demonstrate that a decrease in FDG-SUV discriminates treatment response. Response was defined pathologically based on microscopic inspection for residual cancer cells and fibrosis(Mandard, Cancer 1994). Disease free survival(DFS) and overall survival(OS) were secondary endpoints. Results: Pt characteristics are as follows: median age 59(35–77), KPS 90%(70–100%), 27 male, gastric:GEJ 31:11. Median follow up is 23.3 months, with median DFS 23.8 months(95%CI 14-infinity) and median OS 39.1 months(95%CI 31–39months). Surgical resection occurred at a median of 101 days from study initiation. Pathologic response correlates significantly with DFS(p=0.005) and with OS(p=0.01). Amongst 31 FDG avid pts, a drop in SUV from baseline to d35 significantly predicts pathologic response(p=0.007) and DFS(p=0.01), whereas the change at d15 does not. 45% decrease in SUV at d35 best distinguishes good from poor pathologic response. With this cutoff, median DFS has not been reached(eg.>23.3 months) for patients with good PET response, and is 14.4 months(95%CI 8.3-infinity) for poor PET responders, p=0.03. Conclusions: Following preoperative chemotherapy, pathologic response at the time of resection significantly correlates with DFS and OS. We confirm that FDG-PET/CT response predicts both pathologic response and DFS following preoperative chemotherapy for locally advanced GC, although at d35. An early PET response assessment provides an opportunity to change therapy in non responding patients, and is currently under investigation(supported by ASCO CDA).

No significant financial relationships to disclose.

Three new triterpenoid saponins from the rhizomes of Impatiens pritzellii var. hupehensis

Three new triterpenoid saponins, impatiprins A-C (1-3), together with a known triterpenoid (4) and two known triterpenoid saponins (5, 6), were isolated from the rhizomes of Impatiens pritzellii Hook. f. var. hupehensis Hook. f. The structures of 1-3 were determined by 1D and 2D NMR, FAB-MS techniques and chemical methods. Compounds 1 and 2 showed weak cytotoxicities against S-180, HeLa and HepG2 cell lines.

Proton spin structure in the resonance region

We have examined the spin structure of the proton in the region of the nucleon resonances (1.085 GeV<W<1.910 GeV) at an average four momentum transfer of Q2=1.3 GeV2. Using the Jefferson Lab polarized electron beam, a spectrometer, and a polarized solid target, we measured the asymmetries A|| and A(perpendicular) to high precision, and extracted the asymmetries A1 and A2, and the spin structure functions g1 and g2. We found a notably nonzero A(perpendicular), significant contributions from higher-twist effects, and only weak support for polarized quark-hadron duality.

Molecular mobility of polymeric implants and acute inflammatory response: an experimental study in mice

An overlooked factor in biomaterial research is the surface molecular flexibility for polymer based implants. The mobility of the polymer chains provides a way for the surface to adapt itself to the environment. This is relevant when the implant comes in contact with a biological fluid and its constituents. By changing the length of the alkyl side chain of poly(alkyl methacrylates) (PAMAs) an interesting opportunity is provided where it is possible to study the surface molecular mobility without changing the surface hydrophobicity, nor does it introduce any additives or any changes in the degree of polymer cross-linking. Four variants of PAMAs were implanted in the peritoneum of Balb/c mice using a well described setup. End points were taken after 18 h and estimations of inflammatory cell recruitment and implant-associated cells were studied. Relationship between surface molecular mobility and inflammatory cell recruitment as well as surface-associated cells was noted.

Onset of quark-hadron duality in pion electroproduction

A large data set of charged-pion (pi+/-) electroproduction from both hydrogen and deuterium targets has been obtained spanning the low-energy residual-mass region. These data conclusively show the onset of the quark-hadron duality phenomenon, as predicted for high-energy hadron electroproduction. We construct several ratios from these data to exhibit the relation of this phenomenon to the high-energy factorization ansatz of electron-quark scattering and subsequent quark-->pion production mechanisms.

Effects of selective estrogen receptor modulators and genistein on the expression of ERalpha/beta and COX-1/2 in ovarectomized mouse uteri

This study was performed to examine the effects of selective estrogen receptor modulators [tamoxifen (TAM) and toremifene (TOR)] and pure anti-estrogen, ICI-182780 (ICI, Faslodex) and soybean isoflavone, genistein (GE) on the expression of estrogen-stimulated c-fos/jun, ERalpha/beta and COX-1/2 in the uteri of ovarectomized mice. TAM, TOR, ICI and GE treatment significantly decreased the levels of estradiol (E2)-induced c-fos. ICI and GE treatment significantly decreased the levels of E2-induced c-jun and ERalpha expressions. High doses of TOR treatment significantly increased the E2-induced ERbeta expression. In contrast, ICI and GE treatment significantly decreased the levels of E,-induced COX-2 expression, thus suggesting that TOR and GE might prevent E2-related endometrial carcinogenesis.

Surface morphology and adsorbed proteins affect phagocyte responses to nano-porous alumina

This study evaluates human neutrophil responses to aluminum oxide membranes with different pore sizes (20 nm and 200 nm in diameter) uncoated and pre-coated with serum, collagen I, or fibrinogen. The effect of released neutrophil granule components on the survival of osteoblastic cells (MG63) bound to the alumina membranes has also been evaluated. Without protein coatings the 20 nm pore-size membranes prompt higher reactive oxygen species (ROS) production as assessed by luminol-amplified chemiluminescence than the 200 nm pore-size membranes. Such pore-size depending responses were also found on membranes pre-coated with fibrinogen, but not with collagen or serum were in fact a much lower ROS production was observed. In addition, uncoated and fibrinogen-coated membranes prompt stronger release of the granule enzymes, myeloperoxidase and elastase, than collagen or serum-coated alumina. Equally important, we found that surface-mediated phagocyte activation and the subsequent release of granule components had a significant affect on the adhesion, viability and proliferation of osteoblasts. This stresses the importance of studying not only cell/surface interactions but also cell/cell interactions in wound healing and tissue regeneration processes.