Accumulation of radioiodinated 15-(p-iodophenyl)-6-tellurapentadecanoic acid in ischemic myocardium during acute coronary occlusion and reperfusion

BMIPP-design and development

In the early 1980s a major obstacle for myocardial SPECT using iodine-123-labeled fatty acids and imaging technology available at that time was the rapid metabolism and myocardial washout of activity. Development of the 15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) fatty acid analogue was based on the established effects of methyl-branching in delineating the enzymatic aberration in Refum's disease and our early studies with the tellurium (Te)-substituted fatty acid analogues. Extensive animal studies with the Te-fatty acids demonstrated that this major structural alteration did not affect initial myocardial extraction, but could successfully inhibit subsequent metabolism and significantly delay washout. Tracer kinetic evaluation and metabolic studies on experimental animals and Langendorff-perfused rat hearts clearly demonstrated that introduction of methyl-branching is an effective approach which alters tracer kinetics by delaying myocardial washout of radioiodinated fatty acids by increasing myocardial retention. Although irreversible retention of iodine-123 BMIPP is not observed, subsequent extensive human studies have clearly substantiated the delayed myocardial washout of BMIPP in comparison with the p-IPPA straight chain analogue. Although contemporary SPECT capabilities allow much more rapid acquisition periods, the delayed washout is still a practical benefit in relation to the use of BMIPP. Most important, the unexpected mis-match which has been widely observed between perfusion tracer distribution and the regional BMIPP distribution (i.e. BMIPP < flow tracer) has been linked to the identification of jeopardized, but viable myocardial regions. In this paper the development of BMIPP is discussed and the results of recent studies focusing on evaluating the effects of the absolute configuration of the branched methyl group using the 3(R)-BMIPP and 3(S)-BMIPP are described.

Gas-liquid chromatographic properties of positional isomers of methyl thia, selena, and tellura laurate analogs

Gas-liquid chromatographic analyses of three complete series of synthetic positional isomers of methyl thia, selena, and tellura laurate analogs were carried on a nonpolar (SE-30) and a polar (SP-2330) stationary phase. The average ECL (equivalent chain length) values of the thia, selena, and tellura laurate on SE-30 stationary phase were 13.8, 14.8, and 15.7, respectively, while on SP-2330 the average values for the same series were 17.1, 19.0, and 19.1, respectively. Positional isomers with the heteroatom at the 2-position exhibited the lowest ECL values, while those with the heteroatom at the omega-1 position gave the highest ECL values and were readily separated from the other positional isomers of the same series of analogs by this technique.

Iodine-123-labelled fatty acids for myocardial single-photon emission tomography: current status and future perspectives

Renewed interest in the clinical use of iodine-123-labelled fatty acids is currently primarily focused on the use of iodine-123-labelled 15-(p-iodophenyl)pentadecanoic acid (IPPA) and "modified" fatty acid analogues such as 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) which show delayed myocardial clearance, thus permitting single-photon emission tomographic imaging. Interest in the use of BMIPP and similar agents results from the differences which have often been observed in various types of heart disease between regional myocardial uptake patterns of [123I]BMIPP and flow tracer distribution. Although the physiological basis is not completely understood, differences between regional fatty acid and flow tracer distribution may reflect alterations in important parameters of metabolism which can be useful for patient management or therapy planning. These tracers may also represent unique metabolic probes for correlation of energy substrate metabolism with regional myocardial viability. The two agents currently most widely used clinically are 123I-labelled IPPA and BMIPP. While [123I]IPPA is commercially available as a radiopharmaceutical in Europe (Cygne) and Canada (Nordion), multicenter trials are in progress in the United States as a prelude to approval for broad use. [123I]BMIPP was recently introduced as Cardiodine for commercial distribution in Japan (Nihon Medi-Physics, Inc.). [123I]BMIPP is also being used in clinical studies on an institutional approval basis at several institutions in Europe and the United States. In this review, the development of a variety of radioiodinated fatty acids is discussed. The results of clinical trials with [123I]IPPA and [123I]BMIPP are discussed in detail, as are the future prospects for fatty acid imaging.

Radioiodinated tracers for myocardial imaging

Recent advances in the efficient production of high purity radioiodine (123I) and new efficient radiolabeling techniques have allowed the development of new classes of cardiovascular radiopharmaceuticals. These include 123I-labeled fatty acids to assess myocardial metabolism, 123I-metaiodobenzylguanidine (MIBG) for myocardial neuronal activity, labeled monoclonal antibodies for myocardial necrosis, and labeled lipoproteins for receptor concentration. 123I-labeled fatty acids and MIBG are under clinical investigation with encouraging results. 123I- and 111In-labeled fragments of monoclonal antibodies to myosin have been used for imaging myocardial necrosis in humans. The development of radiotracers for imaging of cholinergic and adrenergic receptors is still in the experimental stage. Recent advances in imaging instrumentation and radiopharmaceuticals have resulted in cardiac imaging applications beyond blood pool ventriculography, perfusion, and infarct-avid imaging. Developments of radioiodine (123I)-labeled agents promise to play an important role in the assessment of myocardial metabolism, neuronal activity, and receptor concentration. The chemistry of iodine is well defined compared with that of 99mTc; therefore, iodine isotopes are well suited for labeling biologically important molecules. Among the iodine isotopes, 123I has nearly ideal nuclear properties for nuclear medical applications with a 13.3-hour half-life (T1/2) and 159 keV gamma emission (83%). Despite the nearly ideal chemical and nuclear properties of 123I, the widespread application of 123I-based radiopharmaceuticals in clinical practice has been limited by high production costs (123I is produced in a cyclotron), relatively limited availability, and the presence of undesirable radionuclidic impurities (124I, T1/2 = 4.2 days; 125I, T1/2 = 60 days; 126I, T1/2 = 13.1 days). The relatively long T1/2 and beta particle emission can substantially increase the higher radiation burden to the patient. High energy gamma rays (greater than 600 KeV) from these impurities can degrade images obtained using low energy collimators. Recent developments in production techniques have greatly reduced the levels of the undesirable radionuclides in 123I. Ready availability of pure 123I at modest cost, in concentrations suitable for the radio-labeling of a variety of useful biomolecules, should enhance the clinical applications of 123I-labeled compounds. Molecules labeled with 123I that are useful in cardiac imaging studies are fatty acid analogs, monoclonal antibodies, receptor binding agents, and norepinephrine analogs. This article will discuss developments in radioiodine (123I)-labeled radiotracers for myocardial imaging.

Augmented uptake of 2-C-14-D-deoxyglucose in reversibly-injured myocardium

We studied the cardiac uptake of 2-14C-D-deoxyglucose (14C-DG) in 6 dogs subjected to a 15 min left anterior descending coronary artery (LAD) occlusion followed by 30 min reflow. Coronary arterial flows during occlusion were determined with 46Sc microspheres. After 30 min reflow, 50 microCi 14C-DG were given intravenously to determine cardiac uptake. The animal was killed 45 min later and 46Sc counts/min were determined in gamma and beta counters. Quenching was determined with non radioactive blood for both isotopes in the beta counter. Contribution of 46Sc counts/min to the 14C channel was subtracted. 14C uptake was in DPM/g and was higher in the cardiac ischemic regions of four of the six dogs. In three of the six animals there was an inverse curvilinear relation between 14C-DG cardiac uptake and occlusion flow. This observation was further confirmed by high resolution autoradiography, indicating that enhanced cardiac uptake of radiolabeled DG may be a useful positron emission tomographic marker for reversible myocardial ischemia.

Current status and prospects of new radionuclides and radiopharmaceuticals for cardiovascular nuclear medicine

The rapid emergence of new imaging modalities like positron emission tomography (PET) and single photon emission computerized tomography (SPECT) and their advance into the clinical arena offered new opportunities for, but also stimulated research and development of new radiopharmaceuticals suitable for cardiac imaging. While tracers of myocardial blood flow remained in the center of interest, other trends heralded possibilities of studying more comprehensively cardiac physiology and pathophysiology as, for example, metabolism, the severity of tissue injury, neural activity and membrane function. N-13 ammonia and rubidium-82 became the primary tracers for evaluating and possibly quantifying regional myocardial blood flow with PET, while cationic Tc-99m isonitrile complexes have now reached a stage where high contrast images of the human heart are obtained on planar scintigraphy and SPECT. These radiopharmaceuticals hold considerable promise for routine clinical use. Tracers of metabolism, especially those labeled with positron emitting isotopes as for example, C-11 palmitate, F-18 2-deoxyglucose, are approaching the phase of clinical use and provide information on regional myocardial substrate metabolism and oxidative processes. Less successful and more limited were developments of single photon emitting tracers of metabolism which remained largely confined to radioiodinated fatty acid analogs. Exploration and characterization of the metabolic fate of the radiolabel in tissue and its relation to the externally observed signal have been truly impressive. Tested in humans primarily in western European countries, these tracers promise to yield metabolic information on a more limited scope. Most widely applied are iodohepta- and hexadecanoic acid and, more recently, the aromatic fatty acid analog, paraiodophenylpentadecanoic acid. Labeled monoclonal antibodies rapidly advanced to the point of clinical use. Accurate identification and sizing of acute myocardial infarction is now possible with Tc-99m or indium-111 labeled specific antimyosin antibody fragments. This success stimulated new research activities for use of labeled antibody techniques in other areas as for example, scintigraphic evaluation of formation and presence of vascular thrombi. While promising, these efforts have however remained in an early stage of development. The same holds true for single photon and positron emitting tracers that are suitable for assessing sympathetic neuron densities in myocardium as well as imaging of both cholinergic and adrenergic receptors.(ABSTRACT TRUNCATED AT 400 WORDS)

Iodine 123-phenylpentadecanoic acid myocardial scintigraphy: usefulness in the identification of myocardial ischemia

In this study, we tested the hypothesis that myocardial ischemia induced by exercise in patients is associated with diminished metabolism and/or delayed clearance of an intravenously injected fatty acid, iodine 123-labeled phenylpentadecanoic acid (IPPA). Fifteen normal volunteers and 18 patients with significant coronary heart disease (CHD) received IPPA during exercise. In the patients with CHD, radionuclide ventriculograms were also obtained during exercise. The normal volunteers had relatively uniform initial left ventricular segmental IPPA activity after exercise and uniform IPPA clearance in the interval from 4 to 20 min immediately after exercise. In contrast, the patients with CHD had increased initial left ventricular segmental IPPA activity (63%, p less than .001) and delayed IPPA clearance (44%, p less than .01) in segments supplied by significantly narrowed coronary arteries. Based on analysis with the mean values +/- 1 SD for initial IPPA activity, clearance, or both in normal volunteers, the sensitivity and specificity of exercise IPPA scintigraphy for detecting CHD were 89% and 67%, respectively; when +/- 2 SD differences from the mean values in the normal volunteers were considered, the sensitivity and specificity were 72% and 100%, respectively. Among the total of 27 noninfarcted left ventricular segments supplied by significantly narrowed coronary arteries in the study patients, 26 (96%) had an abnormality (mean +/- 1 SD) of either initial IPPA activity or clearance compared with corresponding segments in the normal volunteers and/or with other left ventricular segments in the same image that were not supplied by significantly narrowed coronary arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of glucose and insulin infusion on the myocardial extraction of a radioiodinated methyl-substituted fatty acid

We investigated the one-way, AV extraction of 14-iodophenyl-tetradecanoic acid (BMTDA) in the canine heart under fasting conditions and during infusion of glucose plus insulin in eight anesthetized greyhound dogs. Myocardial extraction measurements were made with dual tracer approach, using Tc-99m albumin as reference tracer. Prior to, and during, infusion of 10% glucose and 25 units of regular insulin, heart rate, blood pressure, plasma glucose, insulin and free fatty acid levels were measured. Myocardial blood flow was determined using Sn-113 and Ru-103 radioactive microspheres. The mean extraction fraction of BMTDA was 0.38 +/- SEM 0.06 at baseline and increased to 0.44 +/- 0.06 during hyperglycemia plus insulin (P less than 0.025). Plasma glucose and insulin were higher during the infusion (P less than 0.01) while plasma free fatty acids significantly declined (P less than 0.01). There were no changes in hemodynamics or myocardial blood flow during the infusion. We conclude that glucose and insulin infusion result in increased first-pass extraction fraction of radioiodinated BMTDA unaccompanied by changes in coronary flow or hemodynamics, implying an insulin-mediated augmented transport of BMTDA.