Radiation precautions for inpatient and outpatient 177Lu-DOTATATE peptide receptor radionuclide therapy of neuroendocrine tumours

Background

¹⁷⁷Lu-DOTATATE peptide receptor radionuclide therapy is administered to patients on an inpatient and outpatient basis for the treatment of well-differentiated, metastatic neuroendocrine tumours. Following administration, these patients present an external radiation hazard due to the gamma emissions of lutetium-177. The purpose of this study was to determine precautions to be observed by ¹⁷⁷Lu-DOTATATE patients to restrict the dose received by patients’ family members to less than 5 mSv in 5 years and members of the public to less than 1 mSv per year in line with the current UK legislation. Retrospective data from therapeutic administrations of ¹⁷⁷Lu-DOTATATE (Mallinckrodt Pharmaceuticals) and Lutathera® (Advanced Accelerator Applications) were analysed to measure activity retention at discharge. Patient dose rate measurements were assumed to follow the same activity decay curve as that derived from a least squares fit of geometric mean counts in planar whole-body scans performed at four time points post-administration. Combining this with social contact times, the cumulative dose received through contact with the patient was estimated and an iterative process used to determine the length of contact restrictions to ensure the relevant dose constraints are not exceeded.

Results

On average, 36% of the administered activity was retained at the time of discharge for inpatients receiving ¹⁷⁷Lu-DOTATATE (Mallinckrodt). Retentions of 24% and 38% were measured for Lutathera® inpatients and outpatients respectively. Inpatients should restrict day contact and sleep separately from their partner for 15 days and remain off work for 5 days post-therapy. Contact with children for whom the patient is the main carer should be restricted for 16, 13 and 9 days for children below 2, 2–5 and 5–11 years respectively. One additional day is added to outpatient restriction periods, except for children aged 2–5 years which remains 13 days. No private transport restrictions are required. Patients should limit travel by public transport to 1 h on the day of discharge.

Conclusion

Restrictions are necessary to limit radiation dose to members of patients’ household and the public. Proposed precautions for inpatient and outpatient ¹⁷⁷Lu-DOTATATE therapy protocols restrict the dose received to less than the limit imposed by the UK legislation.

Genetic divergence among native trout Salmo trutta populations from southern Balkans based on mitochondrial DNA and microsatellite variation

The genetic structure and the phylogenetic relationships among five Balkan populations of trout Salmo trutta that have been classified earlier into five different taxa were studied, using microsatellite and mitochondrial DNA (mtDNA) analyses. The pattern of population differentiation observed at microsatellites differed to that depicted by mtDNA variation, yet both methods indicated a very strong partitioning of the genetic variation among sampling locations. Results thus suggest that conservation strategies should be directed towards preserving the genetic integrity and uniqueness of each population.

Cellular responses in the skin of the gilthead sea bream Sparus aurata L. and the sea bass Dicentrarchus labrax (L.) exposed to high ammonia

Adult gilthead sea bream Sparus aurata and sea bass Dicentrarchus labrax were exposed for 24 and 48 h, respectively, to two concentrations of ammonia each (mean values of 3·34 and 13·10 mg l(-1) TA-N in S. aurata; 2·99 and 11·90 mg l(-1) TA-N in D. labrax). Light microscopy and computerized morphometry were used to evaluate ammonia-induced alterations in skin structure during exposure and following recovery in normal water. In S. aurata, ammonia exposure induced a concentration-dependent increase in the number (hyperplasia) of neutral mucous cells (mc), with peak values at 24 h recovery after exposure. An increase in the dispersion of melanosomes in skin melanocytes was also observed in the dermis and occasionally in the epidermis of S. aurata, with peak values at 24 h of ammonia exposure. Exposure of D. labrax to ammonia had, likewise, concentration-dependent effects on mucous secretion. Of the two types of mc in this species, there was an increase in the number of the neutral mc and a reduction in the much more numerous acid mc, with peak values at 24 and 48 h, respectively, of ammonia exposure. The more intense mucous secretion in D. labrax compared to S. aurata could be related to the lower tolerance to ammonia in D. labrax, as reported elsewhere. Finally, the increase in melanosome dispersion was less evident in D. labrax, due to highly variable control values. These morphological alterations to the skin could be useful indicators of non-specific stress in cultured fishes.

Morphology and physiology of abdominal projection interneurones in the locust with mechanosensory inputs from ovipositor hair receptors

The anatomy and physiological properties of eight non-giant projection interneurones which originate from the locust terminal abdominal ganglion and receive wind and tactile inputs from ovipositor hair receptors are described. Their cell bodies (diameter 25-40 mu m) are clustered in the anterolateral region of the eighth abdominal neuromere, and their axons ascend through either the contralateral or the ipsilateral connective to more anterior abdominal ganglia. In contrast to the giant interneurones, they have small-diameter axons and are not sensitive to cercal hair wind inputs. According to their arborisation pattern within the terminal abdominal ganglion, the non-giant projection interneurones can be divided into those with main central arborisations in the ventral neuropil (anterolateral interneurones 1-6, ALIN1-ALIN6) and those with arborisations in the dorsal neuropil (ALIN7 and ALIN8). Interneurones of the first type possess four to six secondary neurites, which form a dense dendritic field in the ventral neuropil, either contralaterally or ipsilaterally to their soma. Two interneurones have contralaterally ascending axons and main dendritic fields contralateral to their soma. Two interneurones have contralaterally ascending axons and ipsilateral main dendritic fields. One interneurone has an ipsilaterally ascending axon and an ipsilateral main dendritic field. The primary neurites of interneurones with contralateral axons transverse the ganglion through dorsal commissure I. Five interneurones have unilateral ventral dendritic fields. One interneurone possesses bilateral ventral branches. Some interneurones project only in the eighth abdominal neuromere, whereas others send branches posteriorly into the neuropil of the ninth abdominal neuromere. Interneurones of the second type send three to four secondary neurites to the dorsal neuropil of the eighth and ninth abdominal neuromeres. One interneurone has an ascending axon in the ipsilateral connective and the other in the contralateral connective. The axons of the projection interneurones pass through a lateral or dorsal tract to the seventh abdominal ganglion. Their axonal projections are sparse, remain ipsilateral to the axons, and are confined to the dorsomedial neuropil. ALIN1-ALIN7 are depolarised and spike in response to wind and direct mechanical deflection of trichoid sensilla on both left and right ovipositor valves. They respond with more spikes to stimulation of hairs on the ventral valve ipsilateral to their main dendritic field. ALIN8, in contrast, shows a delayed inhibitory/excitatory response.

Physiological properties of wind-sensitive and tactile trichoid sensilla on the ovipositor and their role during oviposition in the locust

The physiological properties of the ovipositor hair sensilla of the desert locust and their responses to wind and to direct mechanical displacement are described. The hairs on the external surfaces of the ventral and dorsal ovipositor valves respond to wind stimulation, whereas the hairs on the inner surfaces of the dorsal valves are not wind-sensitive. All ovipositor hairs, however, respond to tactile displacement. Imposed tactile stimulation reveals two physiologically distinct types of ovipositor tactile hairs: the hairs on the inner surface of the dorsal valves are high-threshold hairs (threshold angular deflection of 26­67 ° at 1 Hz) that respond phasically, whereas the hairs on the lateral and ventral areas of the ventral valves and the lateral areas of the dorsal valves are low-threshold hairs (threshold angular deflection of 6­20 ° at 1 Hz) that respond phasotonically. There is no apparent difference in the length of the two physiologically distinct types of hairs. Both high- and low-threshold hairs are directionally sensitive, with maximal responses to proximal deflection, towards the abdomen, and are also velocity-sensitive. High-threshold hairs have velocity thresholds of 40­50 ° s-1 for some hairs and 110­140 ° s-1 for others for a deflection angle of 35 °, whereas low-threshold hairs have lower velocity thresholds of less than 5 ° s-1 for the same deflection. High-threshold hairs adapt rapidly to repetitive stimulation after as few as four cycles of stimulation at 0.5 Hz. Low-threshold hairs continue to respond after 40 cycles of stimulation at 0.5 Hz and show little adaptation to repetitive stimulation at frequencies ranging from 0.1 to 5 Hz. Low-threshold hairs respond with bursts of spikes at frequencies that reflect both the velocity and the duration of the stimulus. Furthermore, low-threshold hairs show little adaptation after 30 min of stimulation that simulates oviposition digging. It is suggested (a) that low- and high-threshold ovipositor hairs detect phasic wind and/or tactile stimuli in non-ovipositing locusts and (b) that low-threshold hairs can also signal rhythmic tactile inputs during oviposition digging.

The motor innervation of the oviducts and central generation of the oviductal contractions in two orthopteran species (Calliptamus sp. and Decticus albifrons)

The oviducts of the female Decticus albifrons (Orthoptera: Tettigonidae) are innervated by six bilaterally paired neurones, while those of the female Calliptamus sp. (Orthoptera: Catantopidae) are innervated by three bilaterally paired neurones, located in the seventh abdominal ganglion. Using intracellular recording and staining, five of the six oviductal neurones of D. albifrons and the three oviductal neurones of Calliptamus sp. were physiologically and morphologically identified. All three oviductal neurones of Calliptamus sp. have a motor function. In D. albifrons, however, there is evidence for motor function in only three of the five identified oviductal neurones that appear to participate in the generation of the oviductal contractions. The remaining two identified neurones of D. albifrons have a branching pattern similar to that of motor neurones, but their physiological characteristics, large overshooting soma action potentials (30­40 mV) with a long afterhyperpolarising phase, are similar to those of the oviductal unpaired median neurones, which are known to modulate the oviductal contractions. The oviductal muscle exhibits two different modes of contractions: (a) fast and slow myogenic contractions, the fast contractions being produced by spontaneous potentials (30­40 mV) generated by some oviductal muscle fibres; and (b) neurogenic contractions caused by the rhythmic spiking of the oviductal motor neurones. This motor pattern is produced by the oviductal central pattern generator, a neural network residing in the last two abdominal ganglia (seventh and terminal abdominal ganglia) of the species examined here. When isolated both anteriorly and posteriorly, the seventh abdominal ganglion generates rhythmic oviductal contractions of lower frequency and amplitude than those recorded when the connectives between the genital ganglia are intact. The oviductal pattern generator is activated through release from descending inhibition, which originates, in Calliptamus sp., from the compound metathoracic ganglion (fused metathoracic and first three abdominal neuromeres) and in, D. albifrons, from the first free abdominal ganglion (fused second and third abdominal neuromeres).

CENTRALLY GENERATED RHYTHMIC ACTIVITY AND MODULATORY FUNCTION OF THE OVIDUCTAL DORSAL UNPAIRED MEDIAN (DUM) NEURONES IN TWO ORTHOPTERAN SPECIES (CALLIPTAMUS SP. AND DECTICUS ALBIFRONS)

The rhythmic firing pattern of the putatively octopaminergic dorsal unpaired median (DUM) neurones supplying the oviductal system of female orthopterans, Calliptamus sp. and Decticus albifrons, was examined. Our data provide evidence that the oviductal DUM neurones in the seventh abdominal ganglion modulate the oviductal motor pattern, both peripherally and centrally, during the inhibition of egg-laying behaviour. In a minimally dissected animal, rhythmic activation of the oviductal DUM and motor neurones can be readily elicited by isolation of the seventh abdominal ganglion from the anterior part of the nerve cord. The bursting activity of the DUM neurones is temporally correlated with the oviductal motor rhythm. Both populations of oviductal neurones retain their rhythmic firing pattern after total isolation of the genital ganglia, indicating the presence of an oviductal central pattern generator. The effects of stimulation of oviductal DUM neurones on the oviductal motor activity were monitored by recording intracellularly from oviductal muscle fibres and extracellularly from motor axons. These effects consist of a reduction in the amplitude and frequency of excitatory postsynaptic potentials (EPSPs) in the muscle fibre and in the firing rate in oviductal motor neurones. We suggest that the change in EPSP amplitude results from peripheral release of octopamine by DUM neurones. The decreased firing rate of motor neurones, however, appears to be a central effect, possibly caused by central release of octopamine by DUM neurones.

Mapping of insect muscle fibres innervated by the same motoneurone by intracellular injection with cobalt dye

A method which allows the intracellular staining of physiologically identified muscle fibres is described. The possible applications of this method have been discussed.