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Tian Z, Liang S, Zhou X, Luo H, Tian M, Zhang X, Guo C, Zhang J. Near-infrared-dye labeled tumor vascular-targeted dimer GEBP11 peptide for image-guided surgery in gastric cancer. Front Oncol 2022; 12:885036. [PMID: 36505820 PMCID: PMC9730820 DOI: 10.3389/fonc.2022.885036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Positive resection margins occur in about 2.8%-8.2% gastric cancer surgeries and is associated with poor prognosis. Intraoperative guidance using Nearinfrared (NIR) fluorescence imaging is a promising technique for tumor detection and margin assessment. The goal of this study was to develop a tumor-specific probe for real-time intraoperative NIR fluorescence imaging guidance. Methods The tumor vascular homing peptide specific for gastric cancer, GEBP11, was conjugated with a near-infrared fluorophore, Cy5.5. The binding specificity of the GEBP11 probes to tumor vascular endothelial cells were confirmed by immunofluorescent staining. The ability of the probe to detect tumor lesions was evaluated in two xenograft models. An orthotopic gastric cancer xenograft model was used to evaluate the efficacy of the GEBP11 NIR probes in real-time surgical guidance. Results In vitro assay suggested that both mono and dimeric GEBP11 NIR probes could bind specifically to tumor vascular epithelial cells, with dimeric peptides showed better affinity. In tumor xenograft mice, live imaging suggested that comparing with free Cy5.5 probe, significantly stronger NIR signals could be detected at the tumor site at 24-48h after injection of mono or dimeric GEBP11 probes. Dimeric GEBP11 probe showed prolonged and stronger NIR signals than mono GEBP11 probe. Biodistribution assay suggested that GEBP11 NIR probes were enriched in gastric cancer xenografts. Using dimeric GEBP11 NIR probes in real-time surgery, the tumor margins and peritoneal metastases could be clearly visualized. Histological examination confirmed the complete resection of the tumor. Conclusion (GEBP11)2-ACP-Cy5.5 could be a potential useful probe for intraoperative florescence guidance in gastric cancer surgery.
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Affiliation(s)
- Zuhong Tian
- State Key Laboratory of Cancer Biology & XiJing Hospital of Digestive Diseases, Air Force Medical University, Xi’an, China
| | - Shuhui Liang
- State Key Laboratory of Cancer Biology & XiJing Hospital of Digestive Diseases, Air Force Medical University, Xi’an, China
| | - Xinmin Zhou
- State Key Laboratory of Cancer Biology & XiJing Hospital of Digestive Diseases, Air Force Medical University, Xi’an, China
| | | | - Miaomiao Tian
- State Key Laboratory of Cancer Biology & XiJing Hospital of Digestive Diseases, Air Force Medical University, Xi’an, China
| | - Xianghan Zhang
- Engineering Research Center of Molecular-imaging and Neuroimaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, China
| | - Changcun Guo
- State Key Laboratory of Cancer Biology & XiJing Hospital of Digestive Diseases, Air Force Medical University, Xi’an, China,*Correspondence: Changcun Guo, ; Jing Zhang,
| | - Jing Zhang
- State Key Laboratory of Cancer Biology & XiJing Hospital of Digestive Diseases, Air Force Medical University, Xi’an, China,*Correspondence: Changcun Guo, ; Jing Zhang,
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2
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Nishino H, Turner MA, Amirfakhri S, Hollandsworth HM, Lwin TM, Hosseini M, Framery B, Cailler F, Pèlegrin A, Hoffman RM, Bouvet M. Proof of concept of improved fluorescence-guided surgery of colon cancer liver metastasis using color-coded imaging of a tumor-labeling fluorescent antibody and indocyanine green restricted to the adjacent liver segment. Surgery 2022; 172:1156-1163. [PMID: 35927078 DOI: 10.1016/j.surg.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Indocyanine green has been used for fluorescence-guided surgery of liver metastasis and labeling of liver segments. However, indocyanine green is nonspecific, and indocyanine green labeling does not always clearly outline tumor margins. In addition, it is difficult to distinguish between a tumor and its adjacent liver segment colored with indocyanine green alone. In the present study, we performed fluorescence-guided surgery in an orthotopic colon-cancer liver metastasis mouse model by labeling the metastatic liver tumor with an anti-carcinoembryonic antigen fluorescent antibody and with indocyanine green restricted to the adjacent liver segment. METHODS A liver metastasis model was established with human LS174T colon cancer tumor fragments. To label the tumor, mice received SGM-101, an anti-carcinoembryonic antigen antibody conjugated to a near-infrared fluorophore (700 nm), currently in clinical trials, 3 days before surgery. Indocyanine green (800 nm) was injected after ligation of the tumor-bearing Glissonean pedicle with fluorescence labeling restricted to the liver segment adjacent to the tumor. Bright-light surgery and fluorescence-guided surgery were performed to resect the liver metastasis. To assess recurrence, mice underwent necropsy 3 weeks after surgery and the tumor was weighed. RESULTS Fluorescence-guided anatomic left lateral lobectomy and fluorescence-guided partial liver resection were both performed with color-coded double labeled imaging. Tumor weight 3 weeks after surgery was significantly lower with fluorescence-guided surgery compared to bright-light surgery (38 ± 57 mg vs 836 ± 668 mg, P = .011) for partial liver resection. CONCLUSION The present study provides a proof-of-concept that color-coded and double labeling of the tumor and adjacent liver segment has the potential to improve liver metastasectomy.
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Affiliation(s)
- Hiroto Nishino
- Department of Surgery, University of California San Diego, CA; Department of Surgery, VA San Diego Healthcare System, San Diego, CA; Department of Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Michael A Turner
- Department of Surgery, University of California San Diego, CA; Department of Surgery, VA San Diego Healthcare System, San Diego, CA
| | - Siamak Amirfakhri
- Department of Surgery, University of California San Diego, CA; Department of Surgery, VA San Diego Healthcare System, San Diego, CA
| | - Hannah M Hollandsworth
- Department of Surgery, University of California San Diego, CA; Department of Surgery, VA San Diego Healthcare System, San Diego, CA
| | - Thinzar M Lwin
- Department of Surgery, University of California San Diego, CA; Department of Surgery, VA San Diego Healthcare System, San Diego, CA
| | - Mojgan Hosseini
- Department of Pathology, University of California San Diego, CA
| | | | | | - André Pèlegrin
- Surgimab, Montpellier, France; IRCM, Univ Montpellier, Inserm, ICM, Montpellier, France
| | - Robert M Hoffman
- Department of Surgery, University of California San Diego, CA; Department of Surgery, VA San Diego Healthcare System, San Diego, CA; AntiCancer, Inc., San Diego, CA
| | - Michael Bouvet
- Department of Surgery, University of California San Diego, CA; Department of Surgery, VA San Diego Healthcare System, San Diego, CA.
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Abstract
The translation of laboratory science into effective clinical cancer therapy is gaining momentum more rapidly than any other time in history. Understanding cancer cell-surface receptors, cancer cell growth, and cancer metabolic pathways has led to many promising molecular-targeted therapies and cancer gene therapies. These same targets may also be exploited for optical imaging of cancer. Theoretically, any antibody or small molecule targeting cancer can be labeled with bioluminescent or fluorescent agents. In the laboratory setting, fluorescence imaging (FI) and bioluminescence imaging (BLI) have long been used in preclinical research for quantification of tumor bulk, assessment of targeting of tumors by experimental agents, and discrimination between primary and secondary effects of cancer treatments. Many of these laboratory techniques are now moving to clinical trials. Imageable engineered fluorescent probes that are highly specific for cancer are being advanced. This will allow for the identification of tumors for staging, tracking novel therapeutic agents, assisting in adequate surgical resection, and allowing image-guided biopsies. The critical components of FI include (1) a fluorescent protein that is biologically safe, stable, and distinctly visible with a high target to background ratio and (2) highly sensitive optical detectors. This review will summarize the most promising optical imaging agents and detection devices for cancer clinical research and clinical care.
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4
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Lwin TM, Turner MA, Amirfakhri S, Nishino H, Debie P, Cosman BC, Hoffman RM, Hernot S, Bouvet M. Rapid tumor-labeling kinetics with a site-specific near-infrared anti-CEA nanobody in a patient-derived orthotopic xenograft mouse model of colon cancer. J Surg Oncol 2021; 124:1121-1127. [PMID: 34309885 PMCID: PMC8556245 DOI: 10.1002/jso.26623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND/OBJECTIVES Nanobodies are the smallest biologic antigen-binding fragments derived from camelid-derived antibodies. Nanobodies effect a peak tumor signal within minutes of injection and present a novel opportunity for fluorescence-guided surgery (FGS). The present study demonstrates the efficacy of an anti-CEA nanobody conjugated to near-infrared fluorophore LICOR-IRDye800CW for rapid intraoperative tumor labeling of colon cancer. METHODS LS174T human colon cancer cells or fragments of patient-derived colon cancer were implanted subcutaneously or orthotopically in nude mice. Anti-CEA nanobodies were conjugated with IRDye800CW and 1-3 nmol were injected intravenously. Mice were serially imaged over time. Peak fluorescence signal and tumor-to-background ratio (TBR) were recorded. RESULTS Colon cancer tumors were detectable using fluorescent anti-CEA nanobody within 5 min of injection at all three doses. Maximal fluorescence intensity was observed within 15 min-3 h for all three doses with TBR values ranging from 1.3 to 2.3. In the patient-derived model of colon cancer, fluorescence was detectable with a TBR of 4.6 at 3 h. CONCLUSIONS Fluorescent anti-CEA nanobodies rapidly and specifically labeled colon cancer in cell-line-based and patient-derived orthotopic xenograft (PDOX) models. The kinetics of nanobodies allow for same day administration and imaging. Anti-CEA-nb-800 is a promising and practical molecule for FGS of colon cancer.
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Affiliation(s)
- Thinzar M. Lwin
- Department of Surgery, University of California San Diego, San Diego, California, USA
- Department of Surgical Oncology, Dana Farber Cancer Center, Boston, Massachusetts, USA
| | - Michael A. Turner
- Department of Surgery, University of California San Diego, San Diego, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Siamak Amirfakhri
- Department of Surgery, University of California San Diego, San Diego, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Hiroto Nishino
- Department of Surgery, University of California San Diego, San Diego, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Pieterjan Debie
- Laboratory for In vivo Cellular and Molecular Imaging (ICMI-BEFY-MIMA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Bard C. Cosman
- Department of Surgery, University of California San Diego, San Diego, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Robert M. Hoffman
- Department of Surgery, University of California San Diego, San Diego, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
- AntiCancer, Inc., San Diego, California, USA
| | - Sophie Hernot
- Laboratory for In vivo Cellular and Molecular Imaging (ICMI-BEFY-MIMA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Michael Bouvet
- Department of Surgery, University of California San Diego, San Diego, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
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DE Vries HM, Schottelius M, Brouwer OR, Buckle T. The role of fluorescent and hybrid tracers in radioguided surgery in urogenital malignancies. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:261-270. [PMID: 34057342 DOI: 10.23736/s1824-4785.21.03355-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The increasing availability of new imaging technologies and tracers has enhanced the application of nuclear molecular imaging in urogenital interventions. In this context, preoperative nuclear imaging and radioactivity-based intraoperative surgical guidance have become important tools for the identification and anatomical allocation of tumor lesions and/or suspected lymph nodes. Fluorescence guidance can provide visual identification of the preoperatively defined lesions during surgery. However, the added value of fluorescence guidance is still mostly unknown. This review provides an overview of the role of fluorescence imaging in radioguided surgery in urogenital malignancies. The sentinel node (SN) biopsy procedure using hybrid tracers (radioactive and fluorescent component) serves as a prominent example for in-depth evaluation of the complementary value of radio- and fluorescence guidance. The first large patient cohort and long-term follow-up studies show: 1) improvement in the SN identification rate compared to blue dye; 2) improved detection of cancer-positive SNs; and 3) hints towards a positive effect on (biochemical) recurrence rates compared to extended lymph node dissection. The hybrid tracer approach also highlights the necessity of a preoperative roadmap in preventing incomplete resection. Recent developments focus on receptor-targeted approaches that allow intraoperative identification of tumor tissue. Here radioguidance is still leading, but fluorescent and hybrid tracers are also finding their way into the clinic. Emerging multiwavelength approaches that allow concomitant visualization of different anatomical features within the surgical field may provide the next step towards even more refined procedures.
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Affiliation(s)
- Hielke Martijn DE Vries
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Margret Schottelius
- Unit of Translational Radiopharmaceutical Sciences, Department of Nuclear Medicine and Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Oscar R Brouwer
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands - .,Department of Urology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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6
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van Keulen S, Rosenthal EL. Intraoperative Molecular Imaging Agents. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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van Beurden F, van Willigen DM, Vojnovic B, van Oosterom MN, Brouwer OR, der Poel HGV, Kobayashi H, van Leeuwen FWB, Buckle T. Multi-Wavelength Fluorescence in Image-Guided Surgery, Clinical Feasibility and Future Perspectives. Mol Imaging 2020; 19:1536012120962333. [PMID: 33125289 PMCID: PMC7607779 DOI: 10.1177/1536012120962333] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
With the rise of fluorescence-guided surgery, it has become evident that different types of fluorescence signals can provide value in the surgical setting. Hereby a different range of targets have been pursued in a great variety of surgical indications. One of the future challenges lies in combining complementary fluorescent readouts during one and the same surgical procedure, so-called multi-wavelength fluorescence guidance. In this review we summarize the current clinical state-of-the-art in multi-wavelength fluorescence guidance, basic technical concepts, possible future extensions of existing clinical indications and impact that the technology can bring to clinical care.
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Affiliation(s)
- Florian van Beurden
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Danny M van Willigen
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands
| | - Borivoj Vojnovic
- Department of Oncology, Cancer Research UK/MRC Oxford Institute for Radiation Oncology, 6396University of Oxford, Oxford, United Kingdom
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Oscar R Brouwer
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hisataka Kobayashi
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, 2511National Institutes of Health, Bethesda, MD, USA
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Orsi Academy, Melle, Belgium
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, 4501Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, 1228The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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8
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Li E, Lin N, Hao R, Fan X, Lin L, Hu G, Lin S, He J, Zhu Q, Jin H. 5-HMF induces anaphylactoid reactions in vivo and in vitro. Toxicol Rep 2020; 7:1402-1411. [PMID: 33102144 PMCID: PMC7578535 DOI: 10.1016/j.toxrep.2020.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 01/22/2023] Open
Abstract
AIM Excessive exposure to 5-hydroxymethylfurfural (5-HMF), which is a common impurity in various sugar-containing products, induces serious side effects. Our previous study revealed that 5-HMF exerted immune sensitizing potential when injected into rodents. In this study, we explored 5-HMF mediated anaphylactoid reactions and its underlying molecular mechanisms. METHODS We investigated anaphylactoid reactions in Brown Norway (BN) rats and Institute of Cancer Research (ICR) mice to identify 5-HMF mediated in vivo anaphylactoid reactions. RBL-2H3 and P815 cell degranulation models were also established, and degranulation, enzyme-linked immunosorbent, filamentous actin (F-actin) microfilament staining, and western blot assays were performed in these cells. RESULTS We showed that 5-HMF induced anaphylactoid reactions by increasing blood vessel permeability in mice, and significantly elevating histamine (His) and glutathione peroxidase-1 (Gpx-1) levels in rat serum. Moreover, after incubation with 5-HMF, β-hexosaminidase (β-Hex), His, IL-4 and IL-6 levels were all significantly increased, thereby inducing cellular degranulation in RBL-2H3 and P815 cells. Finally, 5-HMF also upregulated Lyn, Syk, p38 and JNK protein phosphorylation levels. CONCLUSIONS Our findings suggest that 5-HMF induces anaphylactoid reactions both in vivo and in vitro, therefore 5-HMF limits in sugar-containing products should receive more regulatory attention.
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Affiliation(s)
- Encan Li
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Ni Lin
- Beijing Institute for Drug Control, NMPA Key Laboratory for Quality Evaluation of Traditional Chinese Medicine (Traditional Chinese Patent Medicine), Beijing Key Laboratory of Analysis and Evaluation on Chinese Medicine, 25 Science Park Road, Changping District, Beijing, 102206, China
| | - Ruirui Hao
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Xiaoyu Fan
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Lin Lin
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Guang Hu
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Sheng Lin
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Jiuming He
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
| | - Qingfen Zhu
- Shandong Institute for Food and Drug Control, Jinan, 250101, China
| | - Hongtao Jin
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China
- Beijing Union-Genius Pharmaceutical Technology Development Co., Ltd., Beijing, 100050, China
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de Valk KS, Deken MM, Schaap DP, Meijer RP, Boogerd LS, Hoogstins CE, van der Valk MJ, Kamerling IM, Bhairosingh SS, Framery B, Hilling DE, Peeters KC, Holman FA, Kusters M, Rutten HJ, Cailler F, Burggraaf J, Vahrmeijer AL. Dose-Finding Study of a CEA-Targeting Agent, SGM-101, for Intraoperative Fluorescence Imaging of Colorectal Cancer. Ann Surg Oncol 2020; 28:1832-1844. [PMID: 33034788 PMCID: PMC7892528 DOI: 10.1245/s10434-020-09069-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/09/2020] [Indexed: 12/28/2022]
Abstract
Background Carcinoembryonic antigen is overexpressed in colorectal cancer (CRC), making it an optimal target for fluorescence imaging. A phase I/II study was designed to determine the optimal imaging dose of SGM-101 for intraoperative fluorescence imaging of primary and recurrent CRC. Methods Patients were included and received a single dose of SGM-101 at least 24 h before surgery. Patients who received routine anticancer therapy (i.e., radiotherapy or chemotherapy) also were eligible. A dedicated near-infrared imaging system was used for real-time fluorescence imaging during surgery. Safety assessments were performed and SGM-101 efficacy was evaluated per dose level to determine the most optimal imaging dose. Results Thirty-seven patients with CRC were included in the analysis. Fluorescence was visible in all primary and recurrent tumors. In seven patients, no fluorescence was seen; all were confirmed as pathological complete responses after neoadjuvant therapy. Two tumors showed false-positive fluorescence. In the 37 patients, a total of 97 lesions were excised. The highest mean intraoperative tumor-to-background ratio (TBR) of 1.9 (p = 0.019) was seen in the 10-mg dose. This dose showed a sensitivity of 96%, specificity of 63%, and negative predictive value of 94%. Nine patients (24%) had a surgical plan alteration based on fluorescence, with additional malignant lesions detected in six patients. Conclusions The optimal imaging dose was established at 10 mg 4 days before surgery. The results accentuate the potential of SGM-101 and designated a promising base for the multinational phase III study, which enrolled the first patients in June 2019. Electronic supplementary material The online version of this article (10.1245/s10434-020-09069-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim S de Valk
- Centre for Human Drug Research, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Marion M Deken
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Dennis P Schaap
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Ruben P Meijer
- Centre for Human Drug Research, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Leonora S Boogerd
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Charlotte E Hoogstins
- Centre for Human Drug Research, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | - Denise E Hilling
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen C Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Fabian A Holman
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Miranda Kusters
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Harm J Rutten
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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10
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Lwin TM, Hoffman RM, Bouvet M. Fluorescence-guided hepatobiliary surgery with long and short wavelength fluorophores. Hepatobiliary Surg Nutr 2020; 9:615-639. [PMID: 33163512 DOI: 10.21037/hbsn.2019.09.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Fluorescence-guided surgery (FGS) is a potentially powerful tool for hepatobiliary (HPB) surgery. The high sensitivity of fluorescence navigation is especially useful in settings where tactile feedback is limited. Objective The present narrative review evaluates literature on the use of FDA-approved fluorophores such as methylene blue (MB), 5-aminolevulinic acid (5-ALA), and indocyanine green (ICG) for clinical intra-operative image-guidance during HPB surgery. Evidence Review Approaches such as dosing, timing, imaging devices and comparative endpoints are summarized. The feasibility and safety of fluorophores in visualizing the biliary tree, identify biliary leaks, outline anatomic hepatic segments, identify tumors, and evaluate perfusion and graft function in liver transplants are discussed. Findings Tumor-specific probes are a promising advancement in FGS with a greater degree of specificity. The current status of tumor-specific probes being evaluated in clinical trials are summarized. Conclusions and Relevance for Reviews Relevant discussion of promising tumor-specific probes in pre-clinical development are discussed. Fluorescence-guidance in HPB surgery is relatively new, but current literature shows that the dyes are reliably able to outline desired structures with a variety of dosing, timing, and imaging devices to provide real-time intra-operative anatomic information to surgeons. Development of tumor-specific probes will further advance the field of HPB surgery especially during oncologic resections.
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Affiliation(s)
- Thinzar M Lwin
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Robert M Hoffman
- Department of Surgery, University of California San Diego, San Diego, CA, USA.,AntiCancer, Inc., San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - Michael Bouvet
- Department of Surgery, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
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11
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de Gooyer JM, Elekonawo FMK, Bos DL, van der Post RS, Pèlegrin A, Framery B, Cailler F, Vahrmeijer AL, de Wilt JHW, Rijpkema M. Multimodal CEA-Targeted Image-Guided Colorectal Cancer Surgery using 111In-Labeled SGM-101. Clin Cancer Res 2020; 26:5934-5942. [PMID: 32900795 DOI: 10.1158/1078-0432.ccr-20-2255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/22/2020] [Accepted: 09/02/2020] [Indexed: 12/09/2022]
Abstract
PURPOSE Intraoperative image guidance may aid in clinical decision-making during surgical treatment of colorectal cancer. We developed the dual-labeled carcinoembryonic antigen-targeting tracer, [111In]In-DTPA-SGM-101, for pre- and intraoperative imaging of colorectal cancer. Subsequently, we investigated the tracer in preclinical biodistribution and multimodal image-guided surgery studies, and assessed the clinical feasibility on patient-derived colorectal cancer samples, paving the way for rapid clinical translation. EXPERIMENTAL DESIGN SGM-101 was conjugated with p-isothiocyanatobenzyl-diethylenetriaminepentaacetic acid (DTPA) and labeled with Indium-111 (111In). The biodistribution of 3, 10, 30, and 100 μg [111In]In-DTPA-SGM-101 was assessed in a dose escalation study in BALB/c nude mice with subcutaneous LS174T human colonic tumors, followed by a study to determine the optimal timepoint for imaging. Mice with intraperitoneal LS174T tumors underwent micro-SPECT/CT imaging and fluorescence image-guided resection. In a final translational experiment, we incubated freshly resected human tumor specimens with the tracer and assessed the tumor-to-adjacent tissue ratio of both signals. RESULTS The optimal protein dose of [111In]In-DTPA-SGM-101 was 30 μg (tumor-to-blood ratio, 5.8 ± 1.1) and the optimal timepoint for imaging was 72 hours after injection (tumor-to-blood ratio, 5.1 ± 1.0). In mice with intraperitoneal tumors, [111In]In-DTPA-SGM-101 enabled preoperative SPECT/CT imaging and fluorescence image-guided resection. After incubation of human tumor samples, overall fluorescence and radiosignal intensities were higher in tumor areas compared with adjacent nontumor tissue (P < 0.001). CONCLUSIONS [111In]In-DTPA-SGM-101 showed specific accumulation in colorectal tumors, and enabled micro-SPECT/CT imaging and fluorescence image-guided tumor resection. Thus, [111In]In-DTPA-SGM-101 could be a valuable tool for preoperative SPECT/CT imaging and intraoperative radio-guided localization and fluorescence image-guided resection of colorectal cancer.
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Affiliation(s)
- Jan Marie de Gooyer
- Department of Radiology, Nuclear Medicine & Anatomy, Radboud University Medical Center, Nijmegen, Gelderland, the Netherlands. .,Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, Gelderland, the Netherlands
| | - Fortuné M K Elekonawo
- Department of Radiology, Nuclear Medicine & Anatomy, Radboud University Medical Center, Nijmegen, Gelderland, the Netherlands.,Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, Gelderland, the Netherlands
| | - Desirée L Bos
- Department of Radiology, Nuclear Medicine & Anatomy, Radboud University Medical Center, Nijmegen, Gelderland, the Netherlands
| | - Rachel S van der Post
- Department of Pathology, Radboud University Medical Center, Nijmegen, Gelderland, the Netherlands
| | - André Pèlegrin
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut régional du Cancer de Montpellier, Montpellier, France
| | | | | | | | - Johannes H W de Wilt
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, Gelderland, the Netherlands
| | - Mark Rijpkema
- Department of Radiology, Nuclear Medicine & Anatomy, Radboud University Medical Center, Nijmegen, Gelderland, the Netherlands
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