Very rapid cloning, expression and identifying specificity of T-cell receptors for T-cell engineering

Neoantigens can be predicted and in some cases identified using the data obtained from the whole exome sequencing and transcriptome sequencing of tumor cells. These sequencing data can be coupled with single-cell RNA sequencing for the direct interrogation of the transcriptome, surfaceome, and pairing of αβ T-cell receptors (TCRαβ) from hundreds of single T cells. Using these 2 large datasets, we established a platform for identifying antigens recognized by TCRαβs obtained from single T cells. Our approach is based on the rapid expression of cloned TCRαβ genes as Sleeping Beauty transposons and the determination of the introduced TCRαβs’ antigen specificity and avidity using a reporter cell line. The platform enables the very rapid identification of tumor-reactive TCRs for the bioengineering of T cells with redirected specificity.

The pharmacological properties of 3-arm or 4-arm DOTA constructs for conjugation to α-melanocyte-stimulating hormone analogues for melanoma imaging

Background

Although a 3-arm DOTA construct, which has three carboxylic acids, h has been applied for conjugation to many peptides, we investigated if a 4-arm DOTA construct conjugated to peptides improves chemical properties for melanoma imaging of the melanocortin 1 receptor compared to 3-arm DOTA-conjugated peptides.

Methods

Specific activities, radiolabeling efficiencies, and partition coefficients were evaluated using ¹¹¹In-labeled 3-arm and 4-arm DOTA-α-melanocyte-stimulating hormone (MSH). For assessment of MC1-R affinity and accumulation in tumor cells in vitro, B16-F1 melanoma and/or 4T1 breast cancer cells were incubated with ¹¹¹In-labeled 3-arm and 4-arm DOTA-α-MSH with and without α-MSH as a substrate. The stability was evaluated using mouse liver homogenates and plasma. Biological distribution and whole-body single photon emission computed tomography imaging of ¹¹¹In-labeled 3-arm and 4-arm DOTA-α-MSH were obtained using B16-F1 melanoma-bearing mice.

Results

Specific activities and radiolabeling efficiencies of both radiotracers were about 1.2 MBq/nM and 90–95%, respectively. The partition coefficients were −0.28 ± 0.03 for ¹¹¹In-labeled 3-arm DOTA-α-MSH and −0.13 ± 0.04 for ¹¹¹In-labeled 4-arm DOTA-α-MSH. Although accumulation was significantly inhibited by α-MSH in B16-F1 cells, the inhibition rate of ¹¹¹In-labeled 4-arm DOTA-α-MSH was lower than that of ¹¹¹In-labeled 3-arm DOTA-α-MSH. ¹¹¹In-labeled 4-arm DOTA-α-MSH was taken up early into B16-F1 cells and showed higher accumulation than ¹¹¹In-labeled 3-arm DOTA-α-MSH after 10 min of incubation. Although these stabilities were relatively high, the stability of ¹¹¹In-labeled 4-arm DOTA-α-MSH was higher than that of ¹¹¹In-labeled 3-arm DOTA-α-MSH. Regarding biological distribution, ¹¹¹In-labeled 4-arm DOTA-α-MSH showed significantly lower average renal accumulation (1.38-fold) and significantly higher average melanoma accumulation (1.32-fold) than ¹¹¹In-labeled 3-arm DOTA-α-MSH at all acquisition times. ¹¹¹In-labeled 4-arm DOTA-α-MSH showed significantly higher melanoma-to-kidney, melanoma-to-blood, and melanoma-to-muscle ratios than ¹¹¹In-labeled 3-arm DOTA-α-MSH.

Conclusions

The 4-arm DOTA construct has better chemical properties for peptide radiotracers than the 3-arm DOTA construct.

Development of radioiodine labeled acetaminophen for specific, high-contrast imaging of malignant melanoma

INTRODUCTION

Due to its poor prognosis, specific imaging for early detection of malignant melanoma is strongly desired. Although radioiodine labeled 4-hydroxyphenylcysteamine, which we previously developed, has good affinity for tyrosinase, an enzyme in the melanin metabolic pathway, image contrast of the melanoma:organ ratios is not sufficiently high for detection of primary melanoma and metastases at early injection times. In this study, we developed radioiodine labeled acetaminophen (I-AP) for specific, high-contrast imaging of malignant melanoma.

METHODS

Radioiodine-125-labeled AP (¹²⁵I-AP) was prepared using the chloramine-T method under no carrier-added conditions. Accumulation of radioactivity and the mechanism were evaluated in vitro using B16 melanoma cells incubated with ¹²⁵I-AP or ¹⁴C(U)-labeled AP (¹⁴C-AP) with and without l-tyrosine as a substrate of tyrosinase, phenylthiourea as an inhibitor of tyrosinase, and thymidine as an inhibitor of DNA polymerase. The biological distribution of radioactivity in B16 melanoma-bearing mice was evaluated to determine the accumulation of ¹²⁵I-AP. The stability of ¹²⁵I-AP over time was evaluated in mice.

RESULTS

The labeling efficiency and radiochemical purity of ¹²⁵I-AP were >80% and 95%, respectively. Accumulation of ¹²⁵I-AP was higher than that of ¹⁴C-AP at 60 min of incubation in vitro. The affinity of ¹⁴C-AP for tyrosinase and DNA polymerase was higher than that of ¹²⁵I-AP, whereas the V_max of ¹²⁵I-AP was higher than that of ¹⁴C-AP. ¹²⁵I-AP showed the highest accumulation in the gall bladder, and clearance from the blood and kidney was rapid. Melanoma:muscle and melanoma:normal skin ratios of ¹²⁵I-AP for imaging contrast were the highest at 15 min after injection, whereas the melanoma:blood and melanoma:bone ratios gradually increased over time. ¹²⁵I-AP remained stable for 60 min after injection in mice.

CONCLUSIONS

¹²⁵I-AP has affinity for tyrosinase and high image contrast at early time points after injection. Therefore, ¹²³I-AP imaging has great potential for specific, high-contrast detection of malignant melanoma. ADVANCES IN KNOWLEDGE: ¹²³I-AP will provide specific, high-contrast imaging for malignant melanoma at early injection times. IMPLICATIONS FOR PATIENT CARE: ¹²³I-AP has good potential for the diagnosis of malignant melanoma compared with ¹²³I-labeled 4-hydroxyphenylcysteamine, which we previously developed.

Abstract 5260: Prevention of oxaliplatin-induced neuropathy by using minocycline as a chemoprotectant: demonstration by imaging and behavioral assessment

Purpose: To utilize neurography, a novel imaging method based on retrograde transport of a molecular nerve imaging tracer, to assess the protective effect of minocycline on the development of Oxaliplatin-induced neuropathy.

Materials and Methods: Female BALB/c mice received one of four treatments vehicle/vehicle, vehicle/minocycline, Oxaliplatin/vehicle, or Oxaliplatin/minocycline (n = 8/group). A 30 mg/kg cumulative dose of Oxaliplatin or dextrose vehicle was given in 10 divided intra-peritoneal doses across 3 weeks using two 5 days cycles. Animals were treated daily with 50 mg/kg minocycline or 0.9% saline vehicle by oral gavage beginning 48 h prior to the first Oxaliplatin treatment. Both imaging and behavioral data were collected at baseline and weekly for 3 weeks. For each imaging session, animals received fluorescently labeled TTc-Alexa790 (15 ug/20 uL) via intramuscular injection into the calf muscles. Fluorescent imaging (Xenogen IVIS 200) was used to image the distribution of TTc over 60 minutes, with ROI measurements taken over the lumbo-thoracic junction of the spine to quantitate fluorescent uptake. Neurobehavioral assessment for mechanical sensitivity was assessed through the use of von Frey nylon filaments to exert calibrated force on the footpads. The 50% hind paw withdrawal threshold was calculated.

Results: Oxaliplatin/vehicle treated animals showed a significant decrease in transport of TTc during the second week of treatment (F (1,12) = 39.604, p<0.001), while the TTc transport of the vehicle/vehicle and oxaliplatin/minocycline remained stable across the experiment. The vehicle/minocycline group saw an increase in transport of TTc during the second week of treatments (F (1,12) = 42.533, p<0.001). Behavioral data indicated that Oxaliplatin treatment resulted in increased mechanical sensitivity, while minocycline treatment abrogated this effect, such that animals in the Oxaliplatin/vehicle group showed increased sensitivity compared to all other groups. This effect emerged within the first week of treatment and remained throughout the study. A linear correlation between paw withdrawal threshold and TTc transport at week 3 was found, with r = 0.7939, p<0.01, such that subjects with reduced TTc transport also displayed reduced mechanical thresholds.

Conclusion: Oxaliplatin causes a decrease in retrograde axonal transport, and this reduction in transport correlates with neurobehavioral impairment due to neuropathy. We show that this effect can be attenuated by a chemo-protectant, minocycline, and that the protectant effect was apparent with both behavioral and imaging readouts. This suggests that minocycline can prevent the neuropathy induced by Oxaliplatin and that the mechanism of both the pathological effect and its prevention are related to retrograde axonal transport.

Citation Format: Dawid Schellingerhout, Elizabeth Vichaya, Leo G. Flores, Daniela Ramos, Lucia Le Roux. Prevention of oxaliplatin-induced neuropathy by using minocycline as a chemoprotectant: demonstration by imaging and behavioral assessment. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 5260.

Development of radioiodine-labeled 4-hydroxyphenylcysteamine for specific diagnosis of malignant melanoma

INTRODUCTION

A specific diagnosis for melanoma is strongly desired because malignant melanoma has poor prognosis. In a previous study, although radioiodine-125-labeled 4-hydroxyphenyl-L-cysteine ((125)I-L-PC) was found to have good substrate affinity for tyrosinase enzyme in the melanin metabolic pathway, (123/131)I-L-PC had insufficient substrate affinity for tyrosinase to diagnose melanoma. In this study, we synthesized 4-hydroxyphenylcysteamine (4-PCA) and developed a novel radioiodine-125-labeled 4-hydroxyphenylcysteamine ((125)I-PCA) to increase affinity for the melanin biosynthesis pathway.

METHODS

4-PCA was separated with 2-hydroxyphenylcysteamine (2-PCA), which is an isomer of 4-PCA, and was examined using melting point, proton nuclear magnetic resonance, mass spectrometry and elemental analysis. (125)I-PCA was prepared using the chloramine-T method under no-carrier added conditions. We performed biodistribution experiments using B16 melanoma-bearing mice using (125)I-PCA, (125)I-L-PC, (125)I-α-methyl-L-tyrosine, (123)I-m-iodobenzylguanidine and (67)Ga-citrate. In vitro assay was performed with B16 melanoma cells, and affinity for tyrosinase, DNA polymerase and amino acid transport was evaluated using phenylthiourea, thymidine, ouabine and L-tyrosine inhibitor. In addition, partition coefficients of (125)I-PCA were evaluated.

RESULTS

In the synthesis of 4-PCA, analysis values did not differ between calculated and reported values, and 4-PCA was separated from 2-PCA at high purity. In biodistribution experiments, (125)I-PCA was accumulated and retained in B16 melanoma cells when compared with (125)I-L-PC. (125)I-PCA showed the highest values at 60 min after radiotracer injection in melanoma-to-muscle ratios, melanoma-to-blood ratios and melanoma-to-skin ratios. Accumulation of (125)I-PCA was significantly inhibited by phenylthiourea and thymidine. Partition coefficients of (125)I-PCA were lower than those of N-isopropyl-p-[(123)I]iodoamphetamine and were not significantly different from (125)I-L-PC.

CONCLUSIONS

(125)I-PCA is a better substrate for tyrosinase and DNA polymerase and has higher uptake and longer retention in B16 melanoma cells when compared with (125)I-L-PC. Therefore, (123/131)I-PCA has good potential for diagnosis for malignant melanoma.

ADVANCE IN KNOWLEDGE

(125)I-PCA will be a specific diagnosis tool for malignant melanoma.

IMPLICATIONS FOR PATIENT CARE

(123/131)I-PCA has good potential for the diagnosis of malignant melanoma when compared with other SPECT tracers, as well as anti-melanoma chemotherapeutic drugs.

Monitoring therapy with MEK inhibitor U0126 in a novel Wilms tumor model in Wt1 knockout Igf2 transgenic mice using 18F-FDG PET with dual-contrast enhanced CT and MRI: early metabolic response without inhibition of tumor growth

PURPOSE

The understanding of the role of genetic alterations in Wilms tumor development could be greatly advanced using a genetically engineered mouse models that can replicate the development and progression of this disease in human patients and can be monitored using non-invasive structural and molecular imaging optimized for renal tumors.

PROCEDURES

Repetitive dual-contrast computed tomography (CT; intravenous and intraperitoneal contrast), T2-weighted magnetic resonance imaging (MRI), and delayed 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) positron emission tomography (PET) were utilized for characterization of Igf2 biallelic expression/Wt1 knockout mouse model of Wilms tumor. For CT imaging, Ioversol 678 mg/ml in 200 μl was administered i.p. followed by 100 μl injected intravenously at 20 and 15 min prior to imaging, respectively. Static PET imaging studies were acquired at 1, 2, and 3 h after i.v. administration of (18)F-FDG (400 μCi). Coronal and sagittal T1-weighted images (TE/TR 8.5/620 ms) were acquired before and immediately after i.v. injection of 0.4 ml/kg gadopentetate dimeglumine followed by T2-weighted images (TE/TR 60/300 ms). Tumor tissue samples were characterized by histopathology and immunohistochemistry for Glut1, FASN, Ki67, and CD34. In addition, six Wt1-Igf2 mice were treated with a mitogen-activated protein kinase (MEK) inhibitor U0126 (50 μmol/kg i.p.) every 4 days for 6 weeks. (18)F-FDG PET/CT imaging was repeated at different days after initiation of therapy with U0126. The percent change of initial tumor volume and SUV was compared to non-treated historic control animals.

RESULTS

Overall, the best tumor-to-adjacent kidney contrast as well as soft tissue contrast for other abdominal organs was achieved using T2-weighted MRI. Delayed (18)F-FDG PET (3-h post (18)F-FDG administration) and dual-contrast CT (intravenous and intraperitoneal contrast) provided a more accurate anatomic and metabolic characterization of Wilms tumors in Wt1-Igf2 mice during early development and progression of renal tumors. Over the 8-month period, 46 Wt1-Igf2 mice and 8 littermate control mice were studied. Renal tumors were identified in 54.3 % of Wt1-Igf2 mice between post-natal 50-100 days. In 35.6 % of Wt1-Igf2 mice, tumors were localized in the right kidney; in 24 %, in the left kidney, while 40.4 % of Wt1-Igf2 mice had bilateral kidney tumors. Metastatic lesions were identified in 15.4 % of Wt1-Igf2 mice. Increased levels of Glut1 and IGF1R expression, high Ki67 labeling index, and a dense network of CD34+ microvessels in renal tumors was consistent with increased (18)F-FDG accumulation. Treatment with a MEK 1/2 inhibitor U0126 did not cause the inhibition of tumor growth as compared to untreated animals. However, after the first three to four doses (~2 weeks of treatment), a decrease in (18)F-FDG SUV was observed, as compared to pre-treatment levels (p < 0.05, paired Student t test), which constitutes a metabolic response. Six weeks later, despite continuing therapy, the (18)F-FDG SUV increased again to previous levels.

CONCLUSIONS

The optimized dual contrast PET/CT imaging with early post i.v. and i.p. contrast CT and 3 h delayed PET imaging after (18)F-FDG administration provides a sensitive and reliable method for detecting early tumor lesions in this endogenous mouse model of Wilms tumor and for monitoring their growth in response to targeted therapies. Therapy with MEK inhibitor U0126 produces only a transient inhibition of tumor glycolytic activity but does not inhibit tumor growth, which is due to continuing IGF2-induced signaling from IGF1R through the PI3K-AKT-mTOR pathway.

Imaging epigenetic regulation by histone deacetylases in the brain using PET/MRI with ¹⁸F-FAHA

Epigenetic modifications mediated by histone deacetylases (HDACs) play important roles in the mechanisms of different neurologic diseases and HDAC inhibitors (HDACIs) have shown promise in therapy. However, pharmacodynamic profiles of many HDACIs in the brain remain largely unknown due to the lack of validated methods for noninvasive imaging of HDAC expression-activity. In this study, dynamic PET/CT imaging was performed in 4 rhesus macaques using [(18)F]FAHA, a novel HDAC substrate, and [(18)F]fluoroacetate, the major radio-metabolite of [(18)F]FAHA, and fused with corresponding MR images of the brain. Quantification of [(18)F]FAHA accumulation in the brain was performed using a customized dual-tracer pharmacokinetic model. Immunohistochemical analyses of brain tissue revealed the heterogeneity of expression of individual HDACs in different brain structures and cell types and confirmed that PET/CT/MRI with [(18)F]FAHA reflects the level of expression-activity of HDAC class IIa enzymes. Furthermore, PET/CT/MRI with [(18)F]FAHA enabled non-invasive, quantitative assessment of pharmacodynamics of HDAC inhibitor SAHA in the brain.

The Skp2-SCF E3 ligase regulates Akt ubiquitination, glycolysis, herceptin sensitivity, and tumorigenesis

Akt kinase plays a central role in cell growth, metabolism, and tumorigenesis. The TRAF6 E3 ligase orchestrates IGF-1-mediated Akt ubiquitination and activation. Here, we show that Akt ubiquitination is also induced by activation of ErbB receptors; unexpectedly, and in contrast to IGF-1 induced activation, the Skp2 SCF complex, not TRAF6, is a critical E3 ligase for ErbB-receptor-mediated Akt ubiquitination and membrane recruitment in response to EGF. Skp2 deficiency impairs Akt activation, Glut1 expression, glucose uptake and glycolysis, and breast cancer progression in various tumor models. Moreover, Skp2 overexpression correlates with Akt activation and breast cancer metastasis and serves as a marker for poor prognosis in Her2-positive patients. Finally, Skp2 silencing sensitizes Her2-overexpressing tumors to Herceptin treatment. Our study suggests that distinct E3 ligases are utilized by diverse growth factors for Akt activation and that targeting glycolysis sensitizes Her2-positive tumors to Herceptin treatment.

Effects of photoacoustic imaging and photothermal ablation therapy mediated by targeted hollow gold nanospheres in an orthotopic mouse xenograft model of glioma

Advancements in nanotechnology have made it possible to create multifunctional nanostructures that can be used simultaneously to image and treat cancers. For example, hollow gold nanospheres (HAuNS) have been shown to generate intense photoacoustic signals and induce efficient photothermal ablation (PTA) therapy. In this study, we used photoacoustic tomography, a hybrid imaging modality, to assess the intravenous delivery of HAuNS targeted to integrins that are overexpressed in both glioma and angiogenic blood vessels in a mouse model of glioma. Mice were then treated with near-infrared laser, which elevated tumor temperature by 20.7°C. We found that PTA treatment significantly prolonged the survival of tumor-bearing mice. Taken together, these results show the feasibility of using a single nanostructure for image-guided local tumor PTA therapy with photoacoustic molecular imaging.

Small-animal PET of tumor damage induced by photothermal ablation with 64Cu-bis-DOTA-hypericin

The purpose of this study was to investigate the potential application of small-molecular-weight (64)Cu-labeled bis-DOTA-hypericin in the noninvasive assessment of response to photothermal ablation therapy.

METHODS

Bis-DOTA-hypericin was labeled with (64)Cu with high efficiency (>95% without purification). Nine mice bearing subcutaneous human mammary BT474 tumors were used. Five mice were injected intratumorally with semiconductor CuS nanoparticles, followed by near-infrared laser irradiation 24 h later (12 W/cm(2) for 3 min), and 4 mice were not treated (control group). All mice were intravenously injected with (64)Cu-bis-DOTA-hypericin (24 h after laser treatment in treated mice). Small-animal PET images were acquired at 2, 6, and 24 h after radiotracer injection. All mice were killed immediately after the imaging session for biodistribution and histology study. In vitro cell uptake and surface plasmon resonance studies were performed to validate the small-animal PET results.

RESULTS

(64)Cu-bis-DOTA-hypericin uptake was significantly higher in the treatment group than in the control group. The percentage injected dose per gram of tissue in the treated and control groups was 1.72 ± 0.43 and 0.76 ± 0.19, respectively (P = 0.017), at 24 h after injection. Autoradiography and histology results were consistent with selective uptake of the radiotracer in the necrotic zone of the tumor induced by photothermal ablation therapy. In vitro results showed that treated BT474 cells had a higher uptake of (64)Cu-bis-DOTA-hypericin than nontreated cells. Surface plasmon resonance study showed that bis-DOTA-hypericin had higher binding affinity to phosphatidylserine and phosphatidylethanolamine than to phosphatidylcholine.

CONCLUSION

(64)Cu-bis-DOTA-hypericin has a potential to image thermal therapy-induced tumor cell damage. The affinity of (64)Cu-bis-DOTA-hypericin for injured tissues may be attributed to the breakdown of the cell membrane and exposure of phosphatidylserine or phosphatidylethanolamine to the radiotracer, which binds selectively to these phospholipids.

Systemic combinatorial peptide selection yields a non-canonical iron-mimicry mechanism for targeting tumors in a mouse model of human glioblastoma

The management of CNS tumors is limited by the blood-brain barrier (BBB), a vascular interface that restricts the passage of most molecules from the blood into the brain. Here we show that phage particles targeted with certain ligand motifs selected in vivo from a combinatorial peptide library can cross the BBB under normal and pathological conditions. Specifically, we demonstrated that phage clones displaying an iron-mimic peptide were able to target a protein complex of transferrin and transferrin receptor (TfR) through a non-canonical allosteric binding mechanism and that this functional protein complex mediated transport of the corresponding viral particles into the normal mouse brain. We also showed that, in an orthotopic mouse model of human glioblastoma, a combination of TfR overexpression plus extended vascular permeability and ligand retention resulted in remarkable brain tumor targeting of chimeric adeno-associated virus/phage particles displaying the iron-mimic peptide and carrying a gene of interest. As a proof of concept, we delivered the HSV thymidine kinase gene for molecular-genetic imaging and targeted therapy of intracranial xenografted tumors. Finally, we established that these experimental findings might be clinically relevant by determining through human tissue microarrays that many primary astrocytic tumors strongly express TfR. Together, our combinatorial selection system and results may provide a translational avenue for the targeted detection and treatment of brain tumors.

Abstract 582: Targeting the blood-brain barrier with a non-canonical iron-mimicry mechanism: A translational approach for the detection and treatment of human brain tumors

Treatment of central nervous system (CNS) diseases is limited by the blood-brain barrier (BBB), a selective vascular interface restricting passage of most molecules from blood into brain. Here we used the in vivo phage display technology to isolate peptide-targeted phage particles that can cross the BBB under normal and pathological conditions. We show that a non-canonical association of (i) transferrin, (ii) an iron-mimic ligand motif, and (iii) transferrin receptor mediates binding and transport of phage particles into the normal mouse brain through an allosteric mechanism. We also show that, in an orthotopic human glioma model, a combination of transferrin receptor overexpression plus extended vascular permeability and ligand retention results in remarkable brain tumor targeting. Such unique attributes enable molecular imaging and targeted therapy of intracranial tumors in a clinic-ready setting. Finally, we expand our data by analyzing a large panel of primary CNS tumors through comprehensive tissue microarrays. Together, our approach and results provide a translational avenue for the detection and treatment of brain tumors.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 582.

Abstract 4322: Ligand-directed therapy and molecular imaging in a mouse model of androgen-independent osteogenic prostate cancer

In working towards a theranostic approach in human prostate cancer, we have used in vivo phage display in a unique animal model of androgen-independent human osteoblastic bone metastases (animal model described by Li et al. J. Clin. Invest. 2008 Aug;118(8):2697-710) to uncover accessible targets and peptide ligands for molecular imaging and treatment. This unbiased combinatorial screening identified a peptide targeting Glucose-regulated Protein 78kDa (GRP78), a protein previously implicated in human cancer, including prostate cancer.

By using a hybrid gene delivery vehicle consisting of phage capsid-proteins and AAV genomic elements (AAVP) we have successfully expressed thymidine kinase protein from Herpes Simplex Virus (HSVtk) for a gene-directed enzyme prodrug therapy (GDEPT) approach. In combination with 18FEAU as an imaging probe, the expression of this protein was monitored by Positron Emission Tomography (PET). After expression was confirmed, treatment with the prodrug gancyclovir was used to induce tumor-specific apoptosis. In a second approach, this ligand-receptor system was used to specifically and efficiently deliver small interfering RNA (siRNA) in vitro and in vivo. Both approaches clearly show that the newly identified peptide targeting GRP78 can be considered for targeted drug development against human metastatic androgen-independent osteogenic prostate cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4322.

Tumor site-specific silencing of NF-kappaB p65 by targeted hollow gold nanosphere-mediated photothermal transfection

NF-kappaB transcription factor is a critical regulator of the expression of genes involved in tumor formation and progression. Successful RNA interference (RNAi) therapeutics targeting NF-kappaB is challenged by small interfering RNA (siRNA) delivery systems, which can render targeted in vivo delivery, efficient endolysosomal escape, and dynamic control over activation of RNAi. Here, we report near-IR (NIR) light-inducible NF-kappaB downregulation through folate receptor-targeted hollow gold nanospheres carrying siRNA recognizing NF-kappaB p65 subunit. Using micro-positron emission tomography/computed tomography imaging, the targeted nanoconstructs exhibited significantly higher tumor uptake in nude mice bearing HeLa cervical cancer xenografts than nontargeted nanoparticles following i.v. administration. Mediated by hollow gold nanospheres, controllable cytoplasmic delivery of siRNA was obtained on NIR light irradiation through photothermal effect. Efficient downregulation of NF-kappaB p65 was achieved only in tumors irradiated with NIR light but not in nonirradiated tumors grown in the same mice. Liver, spleen, kidney, and lung were not affected by the treatments, in spite of significant uptake of the siRNA nanoparticles in these organs. We term this mode of action "photothermal transfection." Combined treatments with p65 siRNA photothermal transfection and irinotecan caused substantially enhanced tumor apoptosis and significant tumor growth delay compared with other treatment regimens. Therefore, photothermal transfection of NF-kappaB p65 siRNA could effectively sensitize the tumor to chemotherapeutic agents. Because NIR light can penetrate the skin and be delivered with high spatiotemporal control, therapeutic RNAi may benefit from this novel transfection strategy while avoiding unwanted side effect.

N(3)-Substituted thymidine analogues V: synthesis and preliminary PET imaging of N(3)-[(18)F]fluoroethyl thymidine and N(3)-[(18)F]fluoropropyl thymidine

INTRODUCTION

[(18)F]-Labeled analogues of thymidine have demonstrated efficacy for PET imaging of cellular proliferation. We have synthesized two [(18)F]-labeled N(3)-substituted thymidine analogues, N(3)-[(18)F]fluoroethyl thymidine (N(3)-[(18)F]-FET) and N(3)-[(18)F]fluoropropyl thymidine (N(3)-[(18)F]-FPrT), and performed preliminary PET imaging studies in tumor-bearing mice.

METHODS

Thymidine was converted to its 3',5'-O-bis-tetrahydropyranyl ether, which was then converted to the N(3)-ethyl and propyl-substituted mesylate precursors. Reactions of these mesylate precursors with n-Bu(4)N[(18)F] or K[(18)F]/kryptofix followed by acid hydrolysis and HPLC purification yielded N(3)-[(18)F]-FET and N(3)-[(18)F]-FPrT, respectively. Subcutaneous (sc) xenografts of H441 human non-small cell lung cancer were established in two groups of mice (each n=6). Micro-PET images of the tumor-bearing animals were acquired after intravenous injection of N(3)-[(18)F]-FET or N(3)-[(18)F]-FPrT (3700 KBq/animal).

RESULTS

The radiochemical yields were 2-12% (d.c.) for N(3)-[(18)F]-FET and 30-38% (d.c.) for N(3)-[(18)F]-FPrT. Radiochemical purity was >99% and calculated specific activity was >74 GBq/mumol at the end of synthesis. The accumulation of N(3)-[(18)F]-FET and N(3)-[(18)F]-FPrT in the tumor tissue at 2 h postinjection was 1.81+/-0.78 and 2.95+/-1.14 percent injected dose per gram (%ID/g), respectively; tumor/muscle ratios were 5.57+/-0.82 and 7.69+/-2.18, respectively; the unidirectional influx rates (K(i)) were 0.013 and 0.018 ml/g per minute, respectively.

CONCLUSION

Two novel [(18)F]- N(3)-substituted thymidine analogues have been synthesized in good yields, high purity and high specific activity. Preliminary in vivo studies demonstrated the efficacy of these [(18)F]- N(3)-substituted thymidine analogues for PET imaging of tumors.

Aromatic l-amino acid decarboxylase turnover in vivo in rhesus macaque striatum: A microPET study

The aromatic L-amino acid decarboxylase (AAAD) is involved in the de novo synthesis of dopamine, a neurotransmitter crucial in cognitive, neurobehavioral and motor functions. The goal of this study was to assess the in vivo turnover rate of AAAD enzyme protein in the rhesus macaque striatum by monitoring, using microPET imaging with the tracer [(18)F]fluoro-m-tyrosine (FMT), the recovery of enzyme activity after suicide inhibition. Results showed the AAAD turnover half-life to be about 86 h while total recovery was estimated to be 16 days after complete inhibition. Despite this relatively slow AAAD recovery, the animals displayed normal movement and behavior within 24 h. Based on the PET results, at 24 h, the animals have recovered about 20% of normal AAAD function. These findings show that normal movement and behavior do not depend on complete recovery of AAAD function but likely on pre-synaptic and post-synaptic compensatory mechanisms.

Aromatic L-amino acid decarboxylase (AAAD) inhibitors as carcinoid tumor-imaging agents: synthesis of 18F-labeled alpha-fluoromethyl-6-fluoro-m-tyrosine (FM-6-FmT)

The aromatic L-amino acid decarboxylase (AAAD) enzyme is significantly upregulated in neuroendocrine tumors and, thus, would be a good target for PET imaging agents. Alpha-fluoromethyl-DOPA (FMDOPA) is one of the most potent irreversible AAAD inhibitor and its non-catechol derivative, alpha-fluoromethyl-m-tyrosine (FMmT), is a promising AAAD imaging agent. We synthesized FMmT and its direct electrophilic fluorination provided a mixture of products identified by NMR analysis after HPLC purification as 6-fluoro-, 2-fluoro- and 2,6-difluoro-derivatives of FMmT. Using rat striatal homogenates, alpha-fluoromethyl-6-fluoro-m-tyrosine (FM-6-FmT) was found to have AAAD inhibitory activity comparable to that of FMDOPA. Electrophilic radiofluorination of FMmT using [18F]AcOF gave 18F labeled 6-fluoro-, 2-fluoro- and 2,6-difluoro-FMmT derivatives in 22.0%, 21.9% and 8.5% radiochemical yields, respectively. Based on its proposed mechanism of inhibition, FM-6-[18F]FmT is expected to irreversibly bind to AAAD and, hence, could be used as a PET agent to image tumors of endocrine origin containing high concentrations of AAAD. Since FM-6-FmT lacks the catechol moiety, it is expected to be better than FMDOPA since it is not a substrate for catechol-O-methyltransferase.

[Evaluation of technetium-99m-MIBI scintigraphy in metastatic differentiated thyroid cancer--comparison study with 131I and 201Tl]

Detectability of metastasis in differentiated thyroid cancer using technetium-99m-methoxyisobutyl isonitrile (99mTc-MIBI) was compared with that of 131I and 201Tl. Forty patients after total thyroidectomy were evaluated. The scan results were compared with those of 131I and 201Tl whole body scintigraphy per patient. The positive rate was 68% in 99mTc-MIBI, 84% in 131I, 60% in 201Tl respectively. As to the lymph node metastasis, the positive rates were 56% in 99mTc-MIBI, 78% in 131I, 39% in 201Tl. In lung metastasis, the positive rate was 46% in 99mTc-MIBI, 82% in 131I and 55% in 201Tl. Serum thyroglobulin (Tg) was significantly higher in 201Tl and/or 99mTc-MIBI positive group compared to that of negative group independent of 131I scan results. Although the detectability of both 99mTc-MIBI and 201Tl were inferior to that of 131I, 9 to 22% of metastasis were detected only by these radiopharmaceuticals. Both 99mTc-MIBI and 201Tl, therefore, should be used in cases with high serum Tg even with negative 131I uptake. Basing on the fact there was no prominent difference between 99mTc-MIBI and 201Tl in the detectability of metastasis, 99mTc-MIBI might be more suitable tracer because of better quality image.

A new radiopharmaceutical for the cerebral dopaminergic presynaptic function: 6-radioiodinated L-meta-tyrosine

Geometric isomers of radioiodinated L-meta-tyrosine, 6-[I-125]iodo-and 4-[1-125]iodo-L-meta-tyrosine (6-I-L-mTyr, 4-I-L-mTyr) were separated by high-performance liquid chromatography . Both 6-I- and 4-I-L-mTyr had high energy-dependent brain accumulation. 6-I- and 4-I-L-mTyr were also metabolically stable and were rapidly excreted through the urine. 6-I-L-mTyr had a predilection for the cerebral aromatic L-amino acid decarboxylase (DOPA decarboxylase), the final enzyme of dopamine biosynthesis. 6-Radioiodinated L-mTyr is a new radiopharmaceutical that can be both useful in assessing cerebral amino acid transport mechanism and quantifying metabolically active DOPA decarboxylase.

rCBF in neurodegenerative diseases as estimated by the autoradiographic (ARG) method and delayed I-123-IMP studies

A total of 24 patients with a mean age of 45.8 +/- 20.8 were included in the study. The patients were grouped as Control (C), Degenerative Syndromes (DS), Degeneration Associated with External Factors (DEF), Degeneration Associated with Focal Neurologic Lesion (DFN) and Demyelinating Disease (DM). Imaging started 15 minutes for early and 4 hours for delayed scans after i.v. infusion of I-123 IMP. The rCBF was calculated by the IMP autoradiographic (ARG) method. The wash-out ratio (WR) was calculated as the ratio of the Delay/Early count. In the rCBF of the various areas of the brain, significant differences were noted between various disease groups. No correlation was noted between rCBF and WR (r = -0.50). The WR of patients grouped according to various disease processes did not show a significant difference between various areas of the brain. In conclusion, the rCBF was effective in separating both various areas of the brain and disease entities. WR from a delayed study is less useful in neurodegenerative diseases.

Retention of Tc-99m ECD in delayed SPECT of the brain

We determined the effect of retention on the changes in regional biodistribution of Tc-99m ECD in the brain. A total of 14 cases, 7 normal volunteers and 7 patients with various diagnoses but with very minimal radiologic findings or none were included in the study. SPECT images were taken at 30 min, 1, 2, 3, 4 and 6 hrs after an intravenous injection. Retention rates were calculated in various regions and were corrected according to the time decay of technetium. There was a tendency for the retention rate to increase up to three hours of imaging and then a decrease was noted in most regions of the brain. In the thalamus, increasing retention was noted. In conclusion, Tc-99m ECD retention in the different regions of the brain varies with time. These differences should always be considered when planning and interpreting SPECT quantitative studies.

Brain uptake of iodinated L-meta-tyrosine, a metabolically stable amino acid derivative

The possibility of using L-meta-tyrosine (L-mTyr) with high metabolic stability and amino acid transport affinity was evaluated. mTyr was first separated into D- and L-isomers with high-performance liquid chromatography and both were labelled with non-carrier-mediated 125I. Biodistribution and pharmacological studies of radioiodinated mTyr in mice and rats were then performed. 125I-L-mTyr showed greater accumulation in the brain and the pancreas. It accumulated in the brain stereospecifically in the in vivo studies and by the L-tyrosine competitive energy dependent transport system in the in vitro studies. It was resistant to deiodination, appeared to have no retention mechanism and was rapidly excreted. 123I-L-mTyr has the potential of an amino acid transport marker, especially in the brain and the pancreas.

123I-MIBG myocardial scintigraphy in diabetic patients: relationship with 201Tl uptake and cardiac autonomic function

PURPOSE

To investigate the influence of diabetic myocardial damage (suspected myocardial damage; SMD) diagnosed by 201Tl-SPECT and diabetic cardiac autonomic neuropathy (AN) on myocardial MIBG uptake in patients with non-insulin-dependent diabetes mellitus (NIDDM).

SUBJECTS AND METHODS

Eighty-seven diabetic patients divided into four subgroups: 23 with SMD (+) AN (+); 19 with SMD (+) AN (-); 27 with SMD (-) AN (+); 18 with SMD (-) AN (-), and 10 controls were studied. Both planar and SPECT images were taken at 30 minutes (early) and 3 hours (delayed) after 123I-MIBG injection. The heart to mediastinum uptake ratio (H/M) and washout ratio of 123I-MIBG (WR) were obtained from both planar images. On SPECT images, the total uptake score (TUS) was obtained by the 5 point score method by dividing the myocardium into 20 segments on visual analysis. Similarly, the difference between the 201Tl image and the 123I-MIBG image in TUS was taken as the difference in the total uptake score (delta TUS) representing cardiac sympathetic denervation without SMD.

RESULTS

On both early and delayed planar images, the mean H/M value in the subgroups of diabetic patients was significantly lower in the SMD (+) AN (+) group than in the control group, but among those subgroups, there was statistically significant difference between the SMD (+) AN (+) and SMD (-) AN (-) groups only on the delayed images. Regarding the WR value, there was no statistically significant difference among subjects. On SPECT image analysis, the diabetic subgroup with AN or SMD had statistically significant lower values for TUS than those of the control group. Among diabetics, there was a statistically significant differences between SMD [+] AN [+] and SMD [-] AN [-] on both early and delayed images. Similarly, the SMD [+] AN [-] group also had significantly lower values than those of SMD [-] AN [-] on early images. Regarding delta TUS, there was a statistically significant differences between AN [+] subgroups and controls. Similarly, the mean value for delta TUS was much higher in AN [+] subgroups than in AN [-] subgroups with or without SMD in diabetes mellitus.

CONCLUSION

123I-MIBG myocardial uptake is affected by both SMD and cardiac autonomic neuropathy. Based on the finding that delta TUS was much higher in AN [+] subgroups and there was no statistically significant difference between SMD [+] AN [+] and SMD [-] AN [+] subgroups, a decrease in myocardial 123I-MIBG uptake might progress independently of SMD.

Gallium-67 scintigraphy in the treatment and prognosis of acute adult T-cell lymphoma

The case of a 77-year-old male patient who complained of left upper quadrant pain and progressive vomiting. Laboratory examination showed extremely high lactic acid dehydrogenase (LDH) and adult T-cell leukemia antibody (ATLA). The anatomical studies CT, MRI, US and upper GI series substantiated an omental lymphadenopathy which was causing a circumferential compression of portions of the duodenum and jejunum. Gallium-67 citrate (Ga-67) scintigraphy showed high uptake at LUQ. Ultrasound guided biopsy failed to confirm the diagnosis. Irradiation was performed. Ga-67 scintigraphy had a contributory role in clinical subtyping of the disease, planning of treatment, posttreatment assessment and prognostication of adult T-cell lymphoma.

Relationship between extraosseous accumulation in bone scintigraphy with 99Tcm-HMDP and histopathology

We assessed the relationship between 99Tcm-HMDP extraosseous accumulation (EOA), the histopathology of primary lesions and various laboratory findings. In 155 of 4824 patients, 163 EOA were noted. Of these, 33.7% were in the abdomen, 27.6% in the chest, 22.7% in the extremities, 9.8% in the pelvic area and 6.1% in the head and neck area. We found that 72.4% of EOA were due to malignant processes and 27.6% to benign processes. In the abdomen, 36.6% of the EOA were due to hepatocellular carcinoma and intestinal carcinoma. In the chest, 46.7% of EOA were a result of breast carcinoma. In the extremities, 28.7% of the EOA were due to sarcoma. The mean white blood cell count was elevated (8.0 +/- 6.3 x 10(3)) in patients with malignant processes. The mean serum haemoglobin and haematocrit in benign and malignant processes, for both males and females, were below normal values. All other laboratory findings were within normal limits. Significant differences in serum haemoglobin and haematocrit were noted between male and female patients with benign processes (P = 0.04 and P = 0.04, respectively). No other significant differences between benign and malignant processes were noted. Therefore, EOA is more frequently associated with malignant processes of primary lesions and is often accompanied by leukocytosis and anaemia.

[Evaluation of brain tumor by 99mTc-MIBI: comparison study with 201Tl and predictivity of therapeutic effect]

We compared the detectability of 99mTc-MIBI and 201Tl-chloride for brain tumor in relationship with histopathology. We also evaluated correlation between therapeutic effect using ACNU, Cisplatine and the degree of MIBI tumor uptake. The subjects were 31 brain tumor histologically confirmed by operation or biopsy. Dual-isotope SPECT technique was performed at both 20 min and 180 min after tracer injection. A tumor to normal lung ratio on both early (ER) and delayed image (DR) and retention index (RI) were calculated. The positive rates of 99mTc-MIBI (90.3% and 77.4%) were comparable to that of 201Tl (90.3% and 80.6%). In the relationship with histopathology, both MIBI and Tl accumulated in 100% of glioblastoma (GBM), metastasis (meta), anaplastic astrocytoma and 25% of low grade astrocytoma on both early and delayed images. On semiquantitative analysis, there were no statistical significance among GBM, meta and anaplastic astrocytoma of ER, DR, RI in the both radiopharmaceuticals. However, both ER and DR in GBM tended to be higher than those of anaplastic astrocytoma. In spite of intense MIBI uptake, GBM patients died within six months except one patient. We concluded that MIBI can be helpful in detecting brain tumor as Tl. MIBI also might be useful in estimating the degree of malignancy in glioma. However, intense MIBI uptake did not mean favorable therapeutic effect in patients with GBM treated with ACNU and Cisplatine.

[123I-MIBG lung uptake in patients with diabetes mellitus]

The purpose of this study is to clarify the relationship between 123I-MIBG lung uptake and silent myocardial ischemia (SMI), cardiac autonomic neuropathy (AN) or clinical characteristics. For the quantitative analysis, lung to upper mediastinum uptake ratio (L/M) and heart to upper mediastinum uptake ratio (H/M) were obtained from chest planar image. In addition, both lung washout ratio (%WR-L) and heart washout ratio (%WR-H) were calculated from early and delayed images. Each indices were compared in both diabetic and control groups. Mean values of H/M in diabetes with complication were significantly lower than those of control group. Particularly, AN(+)SMI(+) group showed lowest value. Similarly, mean values of %WR-H in diabetes with complication were significantly higher than those of control group and AN(+)SMI(+) group showed highest value. Although mean value of L/M in each diabetic group was significantly higher than that of control group, there was no statistical significance among each diabetes except AN(+)SMI(-) group on early image. Mean value of %WR-L in AN(+) or SMI(+) group was also significantly higher than that of control group, but there was no statistical significance among each diabetic group. The current study suggested that high pulmonary 123I-MIBG uptake in diabetes was independent of the complication of SMI or AN. Pulmonary endothelial dysfunction related with severity of diabetes mellitus was considered to be the most important factor.

[Evaluation of primary lung cancer and mediastinal lymph node metastasis using 99mTc-MIBI: comparison with 201T1 and relation to chemotherapeutic effect]

We compared the detectability of 99mTc-MIBI and 201T1-chloride for primary lung cancer and mediastinal lymph node metastasis. We also analyzed the relationship between 99mTc-MIBI uptake and effectiveness of chemotherapy in patients with small cell lung cancer. The subjects were fourty-six primary lesions and 8 mediastinal metastatic lymph nodes confirmed by operation, and dual-isotope SPECT technique was performed at both 20 min and 180 min after tracer injection. A tumor to normal lung ratio on both early (ER) and delayed image (DR) and retention index (RI) were calculated. The positive rates of 99mTc-MIBI (early; 82.6%, delayed; 54.3%) were comparable to 201T1 in most primary tumor (87.0% and 84.8%). Whereas tumor smaller than 3 cm diameter was poorly visualized on both 99mTc-MIBI (25% and 0%) and 201T1 (37.5% and 37.5%). Detectabilities of metastatic mediastinal lymph nodes of 99mTc-MIBI (62.5% and 25.0%) was comparable to those of 201T1 (62.5% and 50.0%). Regarding effectiveness of chemotherapy, NC group showed lower uptake of 99mTc-MIBI and significant lower value of RI compared to PR group. We concluded that early image of 99mTc-MIBI SPECT can be helpful in detecting primary lung cancer and metastatic mediastinal lymph node. Additionary, it might be useful for predicting the effects of chemotherapy in small cell lung cancer.

Gadolinium-enhanced MR imaging of thyroid and parathyroid masses

PURPOSE

To evaluate spin-echo and contrast material-enhanced dynamic magnetic resonance (MR) imaging in characterization of thyroid and parathyroid masses.

MATERIALS AND METHODS

Conventional T1- and T2-weighted, gadolinium-enhanced dynamic, and gadolinium-enhanced T1-weighted spin-echo imaging sequences were performed in 85 patients with thyroid and parathyroid tumors. Findings from spin-echo imaging and dynamic curve patterns from mean signal intensity ratios were evaluated for each histologic tumor type.

RESULTS

T1- and T2-weighted imaging did not enable differentiation of benign from malignant tumors. Primary thyroid lymphoma enhanced less than other solid thyroid tumors, and parathyroid adenoma also enhanced less than other tumors (P < .05 compared with papillary carcinoma.

CONCLUSION

Gadolinium-enhanced MR imaging cannot enable prediction of histologic type in thyroid and parathyroid tumors. However, in cases of multiple tumors, the technique may improve the contrast between the different histologic types and sometimes suggest the diagnosis of primary thyroid lymphoma or parathyroid adenoma.

[Usefulness of rCBF SPECT in patients with encephalitis: comparison study with MRI]

Twenty-nine rCBF SPECT study was done in 17 patients with encephalitis. Five of 6 patients (83.3%) showed regional high uptake in acute phase within a week after onset and 16 of 23 studies (69.6%) showed regional low uptake in subacute and chronic phase. Six of 19 lesions (31.6%) with regional high uptake changed to low uptake and 11 lesions (57.9%) improved to normal uptake on follow up studies. Seventeen of 51 lesions with low uptake (33.3%) improved to normal uptake. On the comparative study with MRI, 8 of 18 (44.4%) high uptake area showed cortical thickness or high intensity on T2 weighted images. Thirty-six of 74 low uptake area (48.6%) showed cortical thickness, brain atrophy or high intensity on T2 weighted images. Forty-eight of 212 regions (22.6%) with normal MRI findings showed abnormal accumulation of cerebral tracer on rCBF SPECT studies. rCBF SPECT was useful tool for diagnosis and follow up management in patients with encephalitis.

[A case of transient tic disorder with abnormal findings on 99mTc-HMPAO SPECT]

We report a case of transient tic disorder with abnormal findings on 99mTc-HMPAO SPECT. The patient was 5-year-old girl with vocal and motor tic. There was no evidence of structural abnormality on magnetic resonance imaging (MRI). Electroencephalogram (EEG) showed spikes and sharp waves on both frontal lobes and parietal lobes (left-side dominant). 99mTc-HMPAO SPECT demonstrated focal regions of hyperperfusion in the both frontal lobes, both parietal lobes and right temporal lobe corresponding to the abnormal findings detected by EEG. It also demonstrated an area of hyperperfusion in the right basal ganglia. It is suggested that 99mTc-HMPAO SPECT is useful for the diagnosis and the understanding of the clinical state of tic disorder.

The use of 201Tl SPET to predict the response to radiotherapy in patients with head and neck cancer

Thallium-201 (201Tl) is widely used in the diagnosis of malignant tumours. However, its use in predicting the response to radiation therapy for head and neck cancer has not been established. Nineteen patients with histologically proven head and neck cancer were studied. 201Tl single photon emission tomographic (SPET) images were obtained 15 min (early) and 4 h (delayed) post-injection of the radionuclide. For a semi-quantitative assessment, regions of interest were drawn over the lesions and normal soft tissue. Lesion-to-normal tissue uptake ratios of 201Tl activity were measured from mean counts-per-voxel obtained on both the early and delayed scans, representing the early index (EI) and delayed index (DI) respectively. Subsequently, a retention index (RI) was calculated using the formula: RI = (DI - EI) x 100/(EI). The patients were classified into two groups according to the effect of radiotherapy: a partial response or complete response group (PR-CR group) and a no change group (NC group). In the analysis of primary lesions, both the delayed and retention indexes of the PR-CR group were significantly higher than those of the NC group. However, the early index was not significantly different between the two groups. In the metastatic lymph nodes, only the retention index was significantly different between the two groups. Our results demonstrate that 201Tl SPET and a 201Tl index can be used to predict the response to radiotherapy for primary head and neck cancer and lymph node metastases. The retention index is a useful parameter for estimating the effects of radiotherapy.

Increased bone marrow uptake of Ga-67 in patients with fever of unknown origin

The relationships of clinical diagnosis, the effect of blood chemistry, and the clinical implication of increased Ga-67 citrate uptake in the bone marrow of patients with signs and symptoms of fever of unknown origin were studied. Based on intensity of Ga-67 citrate uptake in bone marrow, patients were classified as follows: type 1 when there was no evidence or very faint bone marrow uptake in the vertebrae, type 2 when mild to moderate, type 3 when uptake was severe. The relationships of WBC count, hemoglobin, hematocrit, serum iron, and unsaturated iron-binding capacity with the occurrence of increased bone marrow uptake in the different groups were noted. Analysis of variance with Fisher's protected least significant difference was used. A P value of less than 0.05 was considered significant. The results showed significant differences between types 1 and 2 and between types 1 and 3 for WBC counts, hemoglobin, and hematocrit levels. Serum iron concentration and unsaturated iron-binding capacity, however, did not show any significant differences. Significant changes in WBC count, hemoglobin and hematocrit in patients with fever of unknown origin were accompanied by a varying intensity of Ga-67 citrate uptake in the bone marrow.

Nasal mucosal thickening simulating a tumor: potential for misdiagnosis in brain perfusion imaging

A 33-year-old, female presenting with dementia was admitted to our institution. Except for slight muscle atrophy noted on both lower extremities there were no other significant physical signs or laboratory findings. Since initial Tc-99m HMPAO SPECT showed hypoperfusion on both temporal, parietal and occipital lobes, follow up study with the same radiotracer was done. Increase in uptake was noted in the left side of the face. There was no abnormality noted on ENT examination. CT scan and MRI showed slight nasal mucosal wall thickening. T1-201 SPECT showed increased uptake in the nasal area. The increase in uptake could be due to nasal mucosal thickening. This could simulate nasal tumor and interfere in determining ROI for brain perfusion studies.

123I-MIBG myocardial scintigraphy in diabetic patients: relationship to autonomic neuropathy

The aim of this study was to investigate the relationship between autonomic nerve dysfunction and myocardial uptake of 123I-meta-iodobenzyl guanidine (MIBG) in patients with diabetes mellitus. Twenty-two non-insulin-dependent diabetic patients, 9 with autonomic neuropathy [ANP(+)] and 13 without autonomic neuropathy [ANP(-)], and 8 controls were included in the study. Both planar and single photon emission tomographic (SPET) images were obtained 30 min (early) and 3 h (delayed) after the 123I-MIBG injection. The heart-to-mediastinal uptake ratio (H/M) and the washout ratio of 123I-MIBG (%WR) were calculated from planar images. The uptake ratio of the inferior wall to the anterior wall (I/ A) and the %WR of both the inferior and anterior walls were calculated from the SPET images. On the early plantar images, the mean H/M ratio in the ANP(+) group was significantly lower than that of the control group. The mean %WR on the planar images in the ANP(-) group was significantly higher than that of the controls. The SPET images demonstrated a reduction in MIBG uptake and significantly increased clearance in the inferior wall of the ANP(-) patients. These findings extended to other areas of the heart in the ANP(+) patients. In the quantitative analysis of the SPET images, the ANP(+) group had significantly lower I/A values and significantly higher %WR values in the anterior wall. The ANP(+) group showed significantly increased clearance of 123I-MIBG in the inferior wall. We conclude that 123I-MIBG myocardial scintigraphy is a useful diagnostic tool both in the early detection and evaluation of the progression of myocardial sympathetic nerve dysfunction in patients with diabetes mellitus. Both the I/A and %WR calculated from SPET images are useful parameters.

The diagnostic role of 201T1 SPET imaging in patients with lung tumours: comparison with computed tomography

The aim of the study was to evaluate the use of 201Tl single photon emission tomography (SPET) in differentiating histological types and lymph node sized of lung tumours based on the early uptake ratio (EUR), delayed uptake ratio (DUR) and retention index (RI). We also wished to compare the effectiveness of 201Tl SPET and computed tomography (CT) in detecting lymphadenopathy. We examined 41 subjects using both 201Tl SPET and CT. Fifty-seven lymph nodes were detected and were grouped according to size. The EUR, DUR and RI were determined and analysed using Student's t-test and a P-value < 0.05 was considered significant. Lymphadenopathy detected by both 201Tl SPET and CT correlated with the operative findings. There were no statistically differences in the EUR, DUR and RI between the various histological types. Statistically significant differences in EUR were noted between lymph nodes > 5 cm in size and those 3-5 cm in size, as well as between those < 3 cm and > 5 cm in size No significant differences were seen for the RI. The specificity, sensitivity and accuracy of 201Tl SPET were 81.3, 90.2 and 87.7% respectively, whereas for CT they were 81.3, 100 and 94.74% respectively. In conclusion, quantitative analysis with 201Tl SPET was unable to differentiate with accuracy between histological types but it could differentiate between nodes of varying sizes. However, CT had a better specificity and accuracy.

Technetium-99m-sestamibi scintigraphy compared with thallium-201 in evaluation of thyroid tumors

Technetium-99m methoxyisobutylisonitrile (MIBI) is a myocardial perfusion imaging agent that has been reported to effectively localize in various tumors (e.g., lung and thyroid carcinomas and osteogenic sarcoma). To determine its usefulness in thyroid tumors, we compared 99mTc-MIBI with 201TI imaging.

METHOD

We evaluated 25 patients with thyroid tumors (papillary carcinoma in 11, follicular carcinoma in 2, follicular adenoma in 7, adenomatous goiter in 5). Fifteen metastatic lesions from differentiated thyroid carcinomas were also evaluated. Early (10 min after injection) and delayed images (120 min after injection) were obtained for both 99mTc-MIBI and 201TI scintigraphy.

RESULTS

The early images showed very similar findings for both 99mTc-MIBI and 201TI. However, the delayed images showed that malignant tumors tended to retain more tracer agent than benign nodules. Marked retention was in 61.5% (8 of 13) of 201TI images and 53.8% (7 of 13) of 99mTc-MIBI images. For metastatic lesions from thyroid carcinomas, the findings for 99mTc-MIBI imaging were nearly identical to those for 201TI imaging. A slight difference in clarity was seen that may have been due to the effect of the 99mTc.

CONCLUSION

Although 99mTc-MIBI scintigraphy does not have particularly good results in differentiating malignant from benign thyroid tumors, it may be useful in evaluating metastases or predicting recurrence because of its better imaging characteristics.

Tl-201 SPECT in Kimura's disease involving the parotid glands and cervical nodes

Kimura's disease is a chronic inflammatory condition producing subcutaneous tumor-like nodules, mainly in the head and neck region. Most patients have involvement of regional lymph nodes and major salivary glands. The authors present two cases of Kimura's disease with parotid gland and postauricular lymph node involvement. With Tl-201 SPECT, elevated uptake was noted on early and delayed images. Kimura's disease should be included in the differential diagnosis when increased Tl-201 uptake in head and neck mass lesions is noted.

201TL SPECT for evaluating head and neck cancer

BACKGROUND

Thallium-201 (201Tl) has come to be widely used in diagnosis of several kinds of malignant tumor, but its usefulness in diagnosing head and neck cancer has not been established.

PURPOSE

This study investigated the usefulness of 201Tl SPECT imaging in patients with head and neck cancer histologically confirmed.

METHODS

Eighteen patients with histologically proven head and neck cancer were studied. 201Tl SPECT images were obtained both 15 min and 4 hours after intravenous injection of 148 MBq of 201Tl-chloride. 201Tl-indices were calculated semiquantitatively to assess the tracer uptake in relation to tumor size and histological type.

RESULTS

High 201Tl uptake was noted in all primary tumors and metastatic lymph nodes on the both early and delayed images, but 201Tl-indices did not show any correlation with tumor size or histological type.

CONCLUSION

Primary had and neck cancer and lymph node metastasis can be effectively visualized with 201Tl SPECT. It may provide information in addition to morphological changes and may be supplemental method to use in the evaluation of head and neck cancer.

Scintigraphic evaluation of testicular torsion and acute epididymitis

PURPOSE OF THE STUDY

To evaluate the effectiveness of testicular scintigraphy in differentiating testicular torsion from acute epididymitis.

METHOD

14 out of 17 patients previously screened by urologist were referred for testicular scintigraphy. Preoperative diagnosis was made based on dynamic and static image findings. Close follow-up was done and final diagnosis was confirmed on the basis of operative findings or relief of symptoms after conservative management.

RESULTS

Eight of the nine patients with a photopenic area in the hemiscrotum were confirmed surgically as having testicular torsion. One patient was diagnosed as having an inflammatory process. Relief from symptoms after conservative management was noted in three patients with increased activity on the affected side and in two others whose uptake patterns were not different from the unaffected side.

CONCLUSION

Testicular scintigraphy is effective in differentiating testicular torsion from acute inflammation when all other scrotal anomalies have been eliminated.

Cerebral perfusion imaging evaluates pharmacologic treatment of unilateral moyamoya disease

Unilateral Moyamoya disease presents as unilateral stenosis or obstruction of the supraclinoid internal carotid artery, which causes cerebral hypoperfusion resulting in seizures or TIA-like attacks. In severe cases, surgical treatment is performed with superficial temporal artery-middle cerebral artery anastomosis. In mild cases, conservative management is the treatment of choice. Flunarizine is a calcium ion anti-blocking agent, whose primary effect is that the cerebral vessels have been used for the treatment of postcerebrovascular disorders. Recently, it has been suggested that flunarizine could be used to treat Moyamoya disease. This report documents the efficacy of flunarizine to improve regional cerebral perfusion in Moyamoya disease.

High-resolution SPECT to assess hippocampal perfusion in neuropsychiatric diseases

The purpose of this study is to clarify the changes of hippocampal perfusion in neuropsychiatric diseases, including dementia, compared with control subjects, and to correlate hippocampal perfusion with the dementia rating scale and the severity of memory disturbance in patients with these diseases.

METHODS

A total of 45 right-handed patients were investigated (13 with dementia of Alzheimer type, 6 with multi-infarct dementia, 4 with progressive dementia with motor neuron disease (MND), 3 with transient global amnesia, 5 with other diseases and 14 control subjects). Regional cerebral blood flow (rCBF) in the parietal cortex and hippocampus was evaluated by high-resolution SPECT technique with HMPAO in all subjects.

RESULTS

The rCBF measurements in the bilateral parietal cortices and hippocampus were lower in dementia of Alzheimer type and multi-infarct dementia patients than in controls. Hypoperfusion in the hippocampus was a more sensitive marker than hypoperfusion in the parietal cortex in diagnosing dementia of Alzheimer type. Hippocampal hypoperfusion was observed in demented patients regardless of etiology and in patients having memory disturbance without dementia, such as transient global amnesia. Finally, hippocampal hypoperfusion reflected the severity of dementia and memory disturbance regardless of etiology.

CONCLUSION

The rCBF image with high-resolution SPECT system may be useful in assessing the extent of dementia and memory disturbance in patients with neuropsychiatric diseases.

Crossed cerebellar diaschisis: analysis of iodine-123-IMP SPECT imaging

The aim of this study was to review the etiology of CCD and study factors that affect the development and manifestation of CCD.

METHODS

Three hundred and eleven patients with supratentorial lesions were evaluated for the presence of CCD with SPECT and 123I-IMP. In representative cases, continuous arterial blood sampling was done and rCBF was calculated using Kuhl's method.

RESULTS

IMP-SPECT detected an abnormality in 206 patients, of whom 30 had CCD. Of CCD patients, 27 had more than single lobe involvement, 17 had motor impairment, 8 of 11 had rCBF of less than 29.1 +/- 10.9 ml/100 g/min. There was also a significant difference in rCBF between non-CCD and CCD cases.

CONCLUSION

Although CCD can also occur with dementia (mixed or vascular type), it is more common with multilobar lesions. It is also associated with the presence of motor impairment but not related to its severity. It is more likely to develop, however, if rCBF is less than 29.1 +/- 10.9 ml/100 g/min regardless of etiology.

Thallium-201 uptake in eosinophilic granuloma of the frontal bone: comparison with technetium-99m-MDP imaging

An 11-yr-old female presented with a 6-wk history of left upper lid tenderness and left eye lacrimation. Left lateral supraorbital mass and left preauricular lymph node were the only significant physical examination findings. On skull x-ray, a left frontal bone defect was noted. CT and MRI showed a soft-tissue mass in the area of the bone defect. Bone scintigraphy exhibited peripheral uptake within the central photon deficient area. With 201TI SPECT, high uptake was noted on early and delayed images. Diagnosis of eosinophilic granuloma was performed by biopsy. Since thallium uptake was seen in the area where photon deficiency was exhibited by 99mTc-MDP scintigraphy, we speculate that thallium SPECT could detect eosinophilic granuloma when radiographic skeletal survey or radionuclide bone scan are equivocal. It could also rule out multiple bone involvement and recurrence or regrowth after therapy.