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Oblak ML, Lu HY, Ram AS, McKenna C. Comparative aspects of targeted sentinel lymph node mapping in veterinary and human medicine: opportunities for future research. Front Med (Lausanne) 2024; 11:1342456. [PMID: 38633313 PMCID: PMC11021648 DOI: 10.3389/fmed.2024.1342456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/29/2024] [Indexed: 04/19/2024] Open
Abstract
There is a significant overlap in the genetic, metabolic and epigenetic alterations between human and companion animal cancers, including those of the oral cavity, breast, bladder, skin, lungs and pancreas. In many cancer types, the identification and removal of affected lymph nodes are essential for accurate cancer management, including treatment and prognosis. Historically, lymphadenectomy and subsequent radical resection based on regional anatomy, palpation and lymph node aspirates were considered sufficient; however, modern approaches with sentinel lymph node mapping (SLN) mapping have increased the accuracy of surgical decision-making. Preoperative and intraoperative SLN mapping techniques in veterinary patients parallel those used in human medicine. While many of these techniques are highly successful, the main challenges with current methodologies are their sensitivity and specificity for the presence of cancer, which can be overcome via precision medicine and targeted SLN mapping agents. Given the large population of dogs and cats with cancer, the crossover of knowledge between species can help to deepen our understanding of many of these cancers and can be useful in evaluating new drugs and/or therapies. In this review, we discuss SLN mapping techniques in veterinary medicine and the concept of precision medicine as it relates to targeted SLN mapping imaging agents. The large number of companion animals affected by cancer is an underutilized resource to bridge the translational gap and we aim to provide a reference for the use of dogs and cats as a comparative model for human SLN mapping.
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Affiliation(s)
- Michelle L. Oblak
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Hui Yu Lu
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Ann S. Ram
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Charly McKenna
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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de Vries LH, Lodewijk L, Ververs T, Poot AJ, van Rooij R, Brosens LAA, de Krijger RR, Rinkes IHMB, Vriens MR, de Keizer B. Sentinel lymph node detection in thyroid carcinoma using [ 68Ga]Ga-tilmanocept PET/CT: a proof-of-concept study. Eur J Nucl Med Mol Imaging 2024; 51:512-520. [PMID: 37773437 PMCID: PMC10774182 DOI: 10.1007/s00259-023-06449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Sentinel lymph node (SLN) biopsy is rarely used for thyroid carcinoma staging. This is due to challenges associated with conventional Tc-99m-labeled tracers, often producing a large hotspot at the injection site, potentially hiding nearby SLNs (shine-through effect). The aim of this study was to demonstrate the feasibility and effectiveness of SLN visualization using the new PET tracer [68Ga]Ga-tilmanocept. METHODS Patients with thyroid carcinoma underwent ultrasound-guided peritumoral injection of [68Ga]Ga-tilmanocept and ICG-[99mTc]Tc-nanocolloid. [68Ga]Ga-tilmanocept PET/CT scans were conducted at 15 min and 60 min post-injection to visualize the SLNs. SLN biopsy was performed using ICG-[99mTc]TC-nanocolloid for intraoperative identification. The corresponding lymph node level was resected for reference. RESULTS Seven differentiated thyroid carcinoma (DTC) and 3 medullary thyroid carcinoma (MTC) patients were included, of which 6 were clinically node-negative. The median number of SLNs detected on [68Ga]Ga-tilmanocept PET/CT and resected was 3 (range 1-4) and 3 (range 1-5), respectively. Eight SLNs were found on PET/CT in the central compartment and 19 in the lateral compartment. The SLN procedure detected (micro)metastases in all patients except one. Seventeen of 27 pathologically assessed SLNs were positive, 8 negative, and 2 did not contain lymph node tissue, which led to upstaging in 5 out of 6 clinically node-negative patients. CONCLUSIONS [68Ga]Ga-tilmanocept PET/CT identified SLNs in all patients, mainly in the lateral neck. The SLNs were successfully surgically detected and resected using ICG-[99mTc]Tc-nanocolloid. This technique has the potential to improve neck staging, enabling more personalized treatment of thyroid cancer according to the lymph node status. TRIAL REGISTRATION 2021-002470-42 (EudraCT).
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Affiliation(s)
- Lisa H de Vries
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Lutske Lodewijk
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Tessa Ververs
- Department of Pharmacy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department of Nuclear Medicine and Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Alex J Poot
- Department of Nuclear Medicine and Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rob van Rooij
- Department of Nuclear Medicine and Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Lodewijk A A Brosens
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ronald R de Krijger
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department of Pathology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Nuclear Medicine and Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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de Vries LH, Lodewijk L, de Keizer B, Borel Rinkes IH, Vriens MR. Sentinel lymph node detection in thyroid carcinoma using 68Ga-tilmanocept PET/CT: a proof-of-concept study protocol. Future Oncol 2022; 18:3493-3499. [PMID: 36069284 DOI: 10.2217/fon-2022-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a diagnostic staging procedure. The procedure aims to identify the first draining lymph node(s), which are most likely to contain metastases. SLNB is applied in various cancers, but not currently in thyroid carcinoma. However, treatment strategies are changing, making SLNB clinically relevant. SLNB may lead to more accurate staging, prevent unnecessary treatment and help achieve earlier curation. 68Ga-tilmanocept PET/computed tomography (CT) can better localize sentinel lymph nodes (SLNs) near the primary tumor than planar scintigraphy and single-photon emission computed tomography (SPECT)/CT. This paper describes the rationale and design of a study investigating SLNB using 68Ga-tilmanocept PET/CT and indocyanine-green-99mTc-nanocolloid in ten differentiated and medullary thyroid carcinoma patients. Localization and number of SLNs, pathology result, optimal scan protocol, surgical time and surgeon's experience are examined. Clinical Trial Registration: 2021-002470-42 (EudraCT).
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Affiliation(s)
- Lisa H de Vries
- Department of Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Lutske Lodewijk
- Department of Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Bart de Keizer
- Department of Radiology & Nuclear Medicine, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Inne Hm Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Menno R Vriens
- Department of Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
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Recent Advances in the Development of Tetrazine Ligation Tools for Pretargeted Nuclear Imaging. Pharmaceuticals (Basel) 2022; 15:ph15060685. [PMID: 35745604 PMCID: PMC9227058 DOI: 10.3390/ph15060685] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 01/25/2023] Open
Abstract
Tetrazine ligation has gained interest as a bio-orthogonal chemistry tool within the last decade. In nuclear medicine, tetrazine ligation is currently being explored for pretargeted approaches, which have the potential to revolutionize state-of-the-art theranostic strategies. Pretargeting has been shown to increase target-to-background ratios for radiopharmaceuticals based on nanomedicines, especially within early timeframes. This allows the use of radionuclides with short half-lives which are more suited for clinical applications. Pretargeting bears the potential to increase the therapeutic dose delivered to the target as well as reduce the respective dose to healthy tissue. Combined with the possibility to be applied for diagnostic imaging, pretargeting could be optimal for theranostic approaches. In this review, we highlight efforts that have been made to radiolabel tetrazines with an emphasis on imaging.
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Within-patient comparison between [ 68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy and [ 99mTc]Tc-tilmanocept lymphoscintigraphy for sentinel lymph node detection in oral cancer: a pilot study. Eur J Nucl Med Mol Imaging 2021; 49:2023-2036. [PMID: 34962582 DOI: 10.1007/s00259-021-05645-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare sentinel lymph node (SLN) identification using [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy to [99mTc]Tc-tilmanocept lymphoscintigraphy (including SPECT/CT) in early-stage oral cancer. Furthermore, to assess whether reliable intraoperative SLN localization can be performed with a conventional portable gamma-probe using [99mTc]Tc-tilmanocept without the interference of [68Ga]Ga-tilmanocept in these patients. METHODS This prospective within-patient comparison pilot study evaluated SLN identification by [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy compared to conventional lymphoscintigraphy using [99mTc]Tc-tilmanocept (~ 74 MBq) in 10 early-stage oral cancer patients scheduled for SLN biopsy. After conventional [99mTc]Tc-tilmanocept lymphoscintigraphy, patients underwent peritumoral administration of [68Ga]Ga-tilmanocept (~ 10 MBq) followed by PET/CT acquisition initiated 15 min after injection. Intraoperative SLN localization was performed under conventional portable gamma-probe guidance the next day; the location of harvested SLNs was correlated to both lymphoscintigraphic images in each patient. RESULTS A total of 24 SLNs were identified by [99mTc]Tc-tilmanocept lymphoscintigraphy, all except one were also identified by [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy. [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy identified 4 additional SLNs near the injection site, of which two harbored metastases. Lymphatic vessels transporting [68Ga]Ga-tilmanocept were identified by PET/CT lymphoscintigraphy in 80% of patients, while draining lymphatic vessels were visualized by [99mTc]Tc-tilmanocept lymphoscintigraphy in 20% of patients. Of the 33 SLNs identified by [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy, 30 (91%) were intraoperatively localized under conventional gamma-probe guidance. CONCLUSION [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy provided more accurate identification of SLNs and improved visualization of lymphatic vessels compared to [99mTc]Tc-tilmanocept lymphoscintigraphy. When combined with peritumoral administration of [99mTc]Tc-tilmanocept, SLNs detected by [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy can be reliably localized during surgery under conventional gamma-probe guidance.
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Toribio RE, Young N, Schlesinger LS, Cope FO, Ralph DA, Jarjour W, Rosol TJ. Cy3-tilmanocept labeling of macrophages in joints of mice with antibody-induced arthritis and synovium of human patients with rheumatoid arthritis. J Orthop Res 2021; 39:821-830. [PMID: 33107629 DOI: 10.1002/jor.24900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/10/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
γ-Tilmanocept (99m Tc-tilmanocept) is a receptor-directed, radiolabeled tracer that is FDA-approved for guiding sentinel lymph node biopsy. Tilmanocept binds the C-type lectin mannose receptor (MR, CD206) on macrophages. In this study, nonradioactive, fluorescently-labeled Cy3-tilmanocept was used to detect CD206+ mononuclear cells in the cartilage of mice with antibody-induced arthritis and in the synovial fluid and tissue of human subjects with rheumatoid arthritis (RA) for comparison with osteoarthritis (OA), and healthy volunteer (HV) controls. Murine arthritis was induced by injection of monoclonal anti-cartilage antibody followed by injection of Escherichia coli lipopolysaccharide. Post-arthritis development (7-11 days), the mice were injected intravenously with Cy3-tilmanocept followed by in vivo and ex vivo epifluorescence imaging. Two-photon imaging, immunofluorescence, and immunohistochemistry were used to identify articular and synovial macrophages (CD206, F4/80, and Cy3-tilmanocept binding) in murine tissues. Cy3-tilmanocept epifluorescence was present in arthritic knees and elbows of murine tissues; no radiographic changes were noted in the skeletons. However, inflammatory arthritic changes were apparent by histopathology and immunohistochemistry (F4/80), immunofluorescence (CD206) and Cy3-tilmanocept binding. In human RA synovial fluid, Cy3-tilmanocept staining correlated with CD206+ /CD16+ cells; negligible labeling was observed in OA samples. Cy3-tilmanocept colocalized with CD206 and staining was significantly higher in RA synovial tissue compared to OA or HV. Our results demonstrate that imaging with Cy3-tilmanocept can detect in vivo inflammatory, CD206+ macrophages in an early arthritis animal model and in human RA patients. These data establish a novel tool for preclinical research of early arthritis and have implications for early RA detection and monitoring of therapeutic efficacy in humans.
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Affiliation(s)
- Ramiro E Toribio
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Nicholas Young
- Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Larry S Schlesinger
- Department of Microbial Infection & Immunity, The Ohio State University, Columbus, Ohio, USA.,Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Fred O Cope
- Navidea Biopharmaceuticals, Inc., Dublin, Ohio, USA.,Physis International LLC, Westerville, Ohio, USA
| | | | - Wael Jarjour
- Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas J Rosol
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
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Chen W, Barback CV, Wang S, Hoh CK, Chang EY, Hall DJ, Head BP, Vera DR. A receptor-binding radiopharmaceutical for imaging of traumatic brain injury in a rodent model: [ 99mTc]Tc-tilmanocept. Nucl Med Biol 2021; 92:107-114. [PMID: 32169304 DOI: 10.1016/j.nucmedbio.2020.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Blood-brain barrier (BBB) disruption and subsequent neuro-inflammation occur following traumatic brain injury (TBI), resulting in a spectrum of human nervous system disorders. [99mTc]Tc-tilmanocept is a receptor-binding radiopharmaceutical FDA-approved for sentinel lymph node mapping. We hypothesize that after an intravenous (i.v.) injection, [99mTc]Tc-tilmanocept, will traverse a disrupted BBB and bind to CD206-bearing microglial cells. METHODS Age-matched mice were divided into three groups: 5-days post TBI (n = 4), and 5-days post sham (n = 4), and naïve controls (n = 4). IRDye800CW-labeled [99mTc]Tc-tilmanocept (0.15 nmol per gram body weight) and FITC-labeled bovine serum albumin (FITC-BSA) were injected (i.v.) into each mouse. Mice were imaged with a high-resolution gamma camera for 45 min. Immediately after imaging, the brains were perfused with fixative, excised, imaged with a fluorescence scanner, assayed for radioactivity, and prepared for histology. RESULTS In vivo nuclear imaging, ex vivo fluorescence imaging, ex vivo gamma well counting, and histo-microscopy demonstrated enhanced tilmanocept uptake in the TBI region. The normalized [99mTc]Tc-tilmanocept uptake value from nuclear imaging and the maximum pixel intensity from fluorescence imaging of the TBI group (1.12 ± 0.12 and 2288 ± 278 a.u., respectively) were significantly (P < 0.04) higher than the sham group (0.64 ± 0.28 and 1708 ± 101 a.u., respectively) and the naive group (0.76 ± 0.24 and 1643 ± 391 a.u., respectively). The mean [99mTc]Tc-tilmanocept scaled uptake in the TBI brains (0.058 ± 0.013%/g) was significantly (P < 0.010) higher than the scaled brain uptake of the sham group (0.031 ± 0.011%/g) and higher (P = 0.04) than the uptake of the naïve group (0.020 ± 0.002%/g). Fluorescence microscopy demonstrated increased uptake of the IRDye800CW-tilmanocept and FITC-BSA in the TBI brain regions. CONCLUSION [99mTc]Tc-tilmanocept traverses disrupted blood-brain barrier and localizes within the injured region. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE: [99mTc]Tc-tilmanocept could serve as an imaging biomarker for TBI-associated neuroinflammation and any disease process that involves a disruption of the blood-brain barrier.
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Affiliation(s)
- Wen Chen
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | | | - Shanshan Wang
- Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA; Department of Anesthesiology, University of California, San Diego, La Jolla, USA
| | - Carl K Hoh
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - David J Hall
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Brian P Head
- Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA; Department of Anesthesiology, University of California, San Diego, La Jolla, USA
| | - David R Vera
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA.
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Mahieu R, de Maar JS, Nieuwenhuis ER, Deckers R, Moonen C, Alic L, ten Haken B, de Keizer B, de Bree R. New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12103055. [PMID: 33092093 PMCID: PMC7589685 DOI: 10.3390/cancers12103055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/03/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a diagnostic staging procedure that aims to identify the first draining lymph node(s) from the primary tumor, the sentinel lymph nodes (SLN), as their histopathological status reflects the histopathological status of the rest of the nodal basin. The routine SLNB procedure consists of peritumoral injections with a technetium-99m [99mTc]-labelled radiotracer followed by lymphoscintigraphy and SPECT-CT imaging. Based on these imaging results, the identified SLNs are marked for surgical extirpation and are subjected to histopathological assessment. The routine SLNB procedure has proven to reliably stage the clinically negative neck in early-stage oral squamous cell carcinoma (OSCC). However, an infamous limitation arises in situations where SLNs are located in close vicinity of the tracer injection site. In these cases, the hotspot of the injection site can hide adjacent SLNs and hamper the discrimination between tracer injection site and SLNs (shine-through phenomenon). Therefore, technical developments are needed to bring the diagnostic accuracy of SLNB for early-stage OSCC to a higher level. This review evaluates novel SLNB imaging techniques for early-stage OSCC: MR lymphography, CT lymphography, PET lymphoscintigraphy and contrast-enhanced lymphosonography. Furthermore, their reported diagnostic accuracy is described and their relative merits, disadvantages and potential applications are outlined.
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Affiliation(s)
- Rutger Mahieu
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Josanne S. de Maar
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Eliane R. Nieuwenhuis
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Roel Deckers
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Chrit Moonen
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Lejla Alic
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Bennie ten Haken
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands;
- Correspondence: ; Tel.: +31-88-7550819
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Lawal IO, Stoltz AC, Sathekge MM. Molecular imaging of cardiovascular inflammation and infection in people living with HIV infection. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00370-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Qin Z, Hoh CK, Olson ES, Jahromi AH, Hall DJ, Barback CV, You YH, Yanagita M, Sharma K, Vera DR. Molecular Imaging of the Glomerulus via Mesangial Cell Uptake of Radiolabeled Tilmanocept. J Nucl Med 2019; 60:1325-1332. [PMID: 30796169 PMCID: PMC6910642 DOI: 10.2967/jnumed.118.223727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/24/2019] [Indexed: 12/31/2022] Open
Abstract
An unmet need for the clinical management of chronic kidney disease is a predictive tool of kidney function during the first decade of the disease, when there is silent loss of glomerular function. The objective of this study was to demonstrate receptor-mediated binding of tilmanocept to CD206 within the kidney and provide evidence of kinetic sensitivity of this binding to renal function. Methods: Rats were positioned in a PET scanner with the liver and kidneys within the field of view. After an intravenous injection of 68Ga-IRDye800-tilmanocept, using 1 of 2 scaled molar doses (0.02 nmol/g, n = 5; or 0.10 nmol/g, n = 5), or coinjection (n = 3) of 68Ga-IRDye800-tilmanocept (0.10 nmol/g) and unlabeled tilmanocept (5.0 nmol/g), or a negative control, 68Ga-IRDye800-DTPA-galactosyl-dextran (0.02 nmol/g, n = 5), each animal was imaged for 20 min followed by a whole-body scan. Frozen kidney sections were stained for podocytes and CD206 using immunofluorescence. Molecular imaging of diabetic db/db mice (4.9 wk, n = 6; 7.3 wk, n = 4; 13.3 wk, n = 6) and nondiabetic db/m mice (n = 6) was performed with fluorescence-labeled 99mTc-tilmanocept (18.5 MBq, 2.6 nmol). Thirty minutes after injection, blood, liver, kidneys, and urine were assayed for radioactivity. Renal time-activity curves were generated. Results: Rat PET whole-body images and time-activity curves of 68Ga-IRDye800-tilmanocept demonstrated receptor-mediated renal accumulation with evidence of glomerular uptake. Activity within the renal cortex persisted during the 40-min study. Histologic examination demonstrated colocalization of CD206 and IRDye800-tilmanocept within the glomerulus. The glomerular accumulation of the coinjection and the negative control studies were significantly less than the CD206-targeted agent. The db/db mice displayed a multiphasic renal time-activity curve with high urinary bladder accumulation; the nondiabetic mice exhibited renal uptake curves dominated by a single phase with low bladder accumulation. Conclusion: This study demonstrated receptor-mediated binding to the glomerular mesangial cells and kinetic sensitivity of tilmanocept to chronic renal disease. Given the role of mesangial cells during the progression of diabetic nephropathy, PET or SPECT renal imaging with radiolabeled tilmanocept may provide a noninvasive quantitative assessment of glomerular function.
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Affiliation(s)
- Zhengtao Qin
- Department of Radiology, University of California, San Diego, La Jolla, California
- In Vivo Cancer and Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Carl K Hoh
- Department of Radiology, University of California, San Diego, La Jolla, California
- In Vivo Cancer and Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Emilia S Olson
- Department of Radiology, University of California, San Diego, La Jolla, California
- In Vivo Cancer and Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Amin Haghighat Jahromi
- Department of Radiology, University of California, San Diego, La Jolla, California
- In Vivo Cancer and Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - David J Hall
- Department of Radiology, University of California, San Diego, La Jolla, California
- In Vivo Cancer and Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Christopher V Barback
- Department of Radiology, University of California, San Diego, La Jolla, California
- In Vivo Cancer and Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Young-Hyun You
- Center for Renal Translational Medicine, University of California, San Diego, La Jolla, California
- Department of Medicine, Division of Nephrology, University of California, San Diego, La Jolla, California; and
| | | | - Kumar Sharma
- Center for Renal Translational Medicine, University of California, San Diego, La Jolla, California
- Department of Medicine, Division of Nephrology, University of California, San Diego, La Jolla, California; and
| | - David R Vera
- Department of Radiology, University of California, San Diego, La Jolla, California
- In Vivo Cancer and Molecular Imaging Program, University of California, San Diego, La Jolla, California
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Zhang M, Kobayashi N, Zettlitz KA, Kono EA, Yamashiro JM, Tsai WTK, Jiang ZK, Tran CP, Wang C, Guan J, Wu AM, Reiter RE. Near-Infrared Dye-Labeled Anti-Prostate Stem Cell Antigen Minibody Enables Real-Time Fluorescence Imaging and Targeted Surgery in Translational Mouse Models. Clin Cancer Res 2018; 25:188-200. [PMID: 30301826 DOI: 10.1158/1078-0432.ccr-18-1382] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/22/2018] [Accepted: 10/03/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The inability to intraoperatively distinguish primary tumor, as well as lymphatic spread, increases the probability of positive surgical margins, tumor recurrence, and surgical toxicity. The goal of this study was to develop a tumor-specific optical probe for real-time fluorescence-guided surgery. EXPERIMENTAL DESIGN A humanized antibody fragment against PSCA (A11 minibody, A11 Mb) was conjugated with a near-infrared fluorophore, IRDye800CW. The integrity and binding of the probe to PSCA were confirmed by gel electrophoresis, size-exclusion chromatography, and flow cytometry, respectively. The ability of the probe to detect tumor-infiltrated lymph nodes and metastatic lesions was evaluated in 2 xenograft models, as well as in transgenic mice expressing human PSCA (hPSCA). An invasive intramuscular model was utilized to evaluate the efficacy of the A11 Mb-IRDye800CW-guided surgery. RESULTS A11 Mb was successfully conjugated with IRDye800CW and retained specific binding to PSCA. In vivo imaging showed maximal signal-to-background ratios at 48 hours. The A11 Mb-IRDye800CW specifically detected PSCA-positive primary tumors, tumor-infiltrated lymph nodes, and distant metastases with high contrast. Fluorescence guidance facilitated more complete tumor resection, reduced tumor recurrence, and improved overall survival, compared with conventional white light surgery. The probe successfully identified primary orthotopic tumors and metastatic lesions in hPSCA transgenic mice. CONCLUSIONS Real-time fluorescence image-guided surgery with A11 Mb-IRDye800CW enabled detection of lymph node metastases and positive surgical margins, facilitated more complete tumor removal, and improved survival, compared with white light surgery. These results may be translatable into clinical practice to improve surgical and patient outcomes.
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Affiliation(s)
- Mo Zhang
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Urology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Naoko Kobayashi
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Kirstin A Zettlitz
- Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, California
| | - Evelyn A Kono
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Joyce M Yamashiro
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Wen-Ting K Tsai
- Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, California
| | - Ziyue K Jiang
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Chau P Tran
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Chung Wang
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Johnny Guan
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Anna M Wu
- Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, California
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
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12
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Anderson KM, Barback CV, Qin Z, Hall DJ, Hoh CK, Vera DR, McHale MT. Molecular Imaging of endometrial sentinel lymph nodes utilizing fluorescent-labeled Tilmanocept during robotic-assisted surgery in a porcine model. PLoS One 2018; 13:e0197842. [PMID: 29965996 PMCID: PMC6028102 DOI: 10.1371/journal.pone.0197842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/09/2018] [Indexed: 11/19/2022] Open
Abstract
Molecular imaging with a fluorescent version of Tilmanocept may permit an accurate and facile detection of sentinel nodes of endometrial cancer. Tilmanocept accumulates in sentinel lymph nodes (SLN) by binding to a cell surface receptor unique to macrophages and dendritic cells. Four female Yorkshire pigs underwent cervical stromal injection of IRDye800-Tilmanocept, a molecular imaging agent tagged with near-infrared fluorescent dye and radiolabeled with gallium-68 and technetium-99m. PET/CT scans 1.5 hours post-injection provided pre-operative SLN mapping. Robotic-assisted lymphadenectomy was performed two days after injection, using the FireFly imaging system to identify nodes demonstrating fluorescent signal. After removal of fluorescent nodes, pelvic and periaortic node dissections were performed. Nodes were assayed for technetium-99m activity, and SLNs were established using the “10%-rule”, requiring that the radioactivity of additional SLNs be greater than 10% of the “hottest” SLN. Thirty-four nodal samples were assayed ex vivo for radioactivity. All the SLNs satisfying the “10%-rule” were detected using the FireFly system. Five fluorescent nodes were detected, corresponding with preoperative PET/CT scan. Three pigs had one SLN and one pig had two SLNs, with 100% concordance between fluorescence and radioactivity. Fluorescent-labeled Tilmanocept permits real-time intraoperative detection of SLNs during robotic-assisted lymphadenectomy for endometrial cancer in a porcine model. When radiolabeled with gallium-68, Tilmanocept allows for preoperative localization of SLNs using PET/CT, and shows specificity to SLNs with persistent fluorescent signal, detectable using the FireFly system, for two days post-injection. In conclusion, these findings suggest that a phase I trial in human subjects is warranted, and that a long-term goal of an intra-operative administration of non-radioactive fluorescent-labeled Tilmanocept is possible.
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Affiliation(s)
- Kristen M. Anderson
- Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, United States of America
- * E-mail:
| | - Christopher V. Barback
- Department of Radiology, University of California, San Diego, United States of America
- UCSD Molecular Imaging Program, University of California, San Diego, United States of America
| | - Zhengtao Qin
- Department of Radiology, University of California, San Diego, United States of America
- UCSD Molecular Imaging Program, University of California, San Diego, United States of America
| | - David J. Hall
- Department of Radiology, University of California, San Diego, United States of America
- UCSD Molecular Imaging Program, University of California, San Diego, United States of America
| | - Carl K. Hoh
- Department of Radiology, University of California, San Diego, United States of America
- UCSD Molecular Imaging Program, University of California, San Diego, United States of America
| | - David R. Vera
- Department of Radiology, University of California, San Diego, United States of America
- UCSD Molecular Imaging Program, University of California, San Diego, United States of America
| | - Michael T. McHale
- Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, United States of America
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13
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Doughton JA, Hofman MS, Eu P, Hicks RJ, Williams S. A First-in-Human Study of 68Ga-Nanocolloid PET/CT Sentinel Lymph Node Imaging in Prostate Cancer Demonstrates Aberrant Lymphatic Drainage Pathways. J Nucl Med 2018; 59:1837-1842. [DOI: 10.2967/jnumed.118.209171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/30/2018] [Indexed: 11/16/2022] Open
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14
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Beer P, Pozzi A, Rohrer Bley C, Bacon N, Pfammatter NS, Venzin C. The role of sentinel lymph node mapping in small animal veterinary medicine: A comparison with current approaches in human medicine. Vet Comp Oncol 2017; 16:178-187. [DOI: 10.1111/vco.12372] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/17/2017] [Indexed: 12/20/2022]
Affiliation(s)
- P. Beer
- Clinic for Small Animal Surgery, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - A. Pozzi
- Clinic for Small Animal Surgery, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - C. Rohrer Bley
- Division of Radiation Oncology, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - N. Bacon
- Fitzpatrick Referrals Oncology and Soft Tissue; Guildford Hospital; Guildford UK
| | - N. S. Pfammatter
- Clinic for Diagnostic Imaging, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - C. Venzin
- Clinic for Small Animal Surgery, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
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15
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Varasteh Z, Hyafil F, Anizan N, Diallo D, Aid-Launais R, Mohanta S, Li Y, Braeuer M, Steiger K, Vigne J, Qin Z, Nekolla SG, Fabre JE, Döring Y, Le Guludec D, Habenicht A, Vera DR, Schwaiger M. Targeting mannose receptor expression on macrophages in atherosclerotic plaques of apolipoprotein E-knockout mice using 111In-tilmanocept. EJNMMI Res 2017; 7:40. [PMID: 28470406 PMCID: PMC5415447 DOI: 10.1186/s13550-017-0287-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/18/2017] [Indexed: 12/26/2022] Open
Abstract
Background Atherosclerotic plaque phenotypes are classified based on the extent of macrophage infiltration into the lesions, and the presence of certain macrophage subsets might be a sign for plaque vulnerability. The mannose receptor (MR) is over-expressed in activated macrophages. Tilmanocept is a tracer that targets MR and is approved in Europe and the USA for the detection of sentinel lymph nodes. In this study, our aim was to evaluate the potential of 111In-labelled tilmanocept for the detection of MR-positive macrophages in atherosclerotic plaques of apolipoprotein E-knockout (ApoE-KO) mouse model. Methods Tilmanocept was labelled with 111In. The labelling stability and biodistribution of the tracer was first evaluated in control mice (n = 10) 1 h post injection (p.i.). For in vivo imaging studies, 111In-tilmanocept was injected into ApoE-KO (n = 8) and control (n = 8) mice intravenously (i.v.). The mice were scanned 90 min p.i. using a dedicated animal SPECT/CT. For testing the specificity of 111In-tilmanocept uptake in plaques, a group of ApoE-KO mice was co-injected with excess amount of non-labelled tilmanocept. For ex vivo imaging studies, the whole aortas (n = 9 from ApoE-KO and n = 4 from control mice) were harvested free from adventitial tissue for Sudan IV staining and autoradiography. Cryosections were prepared for immunohistochemistry (IHC). Results 111In radiolabelling of tilmanocept provided a yield of greater than 99%. After i.v. injection, 111In-tilmanocept accumulated in vivo in MR-expressing organs (i.e. liver and spleen) and showed only low residual blood signal 1 h p.i. MR-binding specificity in receptor-positive organs was demonstrated by a 1.5- to 3-fold reduced uptake of 111In-tilmanocept after co-injection of a blocking dose of non-labelled tilmanocept. Focal signal was detected in atherosclerotic plaques of ApoE-KO mice, whereas no signal was detected in the aortas of control mice. 111In-tilmanocept uptake was detected in atherosclerotic plaques on autoradiography correlating well with Sudan IV-positive areas and associating with subendothelial accumulations of MR-positive macrophages as demonstrated by IHC. Conclusions After i.v. injection, 111In-tilmanocept accumulated in MR-expressing organs and was associated with only low residual blood signal. In addition, 111In-tilmanocept uptake was detected in atherosclerotic plaques of mice containing MR-expressing macrophages suggesting that tilmanocept represents a promising tracer for the non-invasive detection of macrophages in atherosclerotic plaques.
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Affiliation(s)
- Zohreh Varasteh
- Department of Nuclear Medicine, Klinikum rechts der Isar der TUM, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Fabien Hyafil
- Department of Nuclear Medicine, Hôpital Bichat, Paris, France
| | - Nadège Anizan
- Fédération de Recherche en Imagerie Multimodalité, Université Paris Diderot, Paris, France
| | - Devy Diallo
- Fédération de Recherche en Imagerie Multimodalité, Université Paris Diderot, Paris, France
| | | | - Sarajo Mohanta
- Institute for Cardiovascular Prevention, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Yuanfang Li
- Institute for Cardiovascular Prevention, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Miriam Braeuer
- Department of Nuclear Medicine, Klinikum rechts der Isar der TUM, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, Technische Universität München, Munich, Germany
| | - Jonathan Vigne
- Department of Nuclear Medicine, Hôpital Bichat, Paris, France
| | - Zhengtao Qin
- UCSD Moores Cancer Center, University of California, San Diego, La Jolla, USA
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Klinikum rechts der Isar der TUM, Ismaningerstrasse 22, 81675, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Jean-Etienne Fabre
- INSERM U1148 Laboratory of Vascular Translational Science, Paris, France
| | - Yvonne Döring
- Institute for Cardiovascular Prevention, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | | | - Andreas Habenicht
- Institute for Cardiovascular Prevention, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - David R Vera
- UCSD Moores Cancer Center, University of California, San Diego, La Jolla, USA
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum rechts der Isar der TUM, Ismaningerstrasse 22, 81675, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
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16
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Adesanya O, Hutchinson C. Designing a New Molecular Probe: The Potential Role for Tilmanocept (Lymphoseek ®) in the Assessment of Patients with Painful Hip and Knee Joint Prostheses. Open Orthop J 2017; 11:212-224. [PMID: 28458734 PMCID: PMC5388791 DOI: 10.2174/1874325001711010212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/04/2017] [Accepted: 01/20/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a long history of nuclear medicine developments in orthopaedics beginning in the early 20th century. Technetium-99m (99mTc) has a short half-life of six hours, emits 140 keV gamma rays and is the most widely used isotope, imaged with the Anger (gamma) camera. Gamma image quality and test sensitivity in painful prosthetic joints can be improved with single photon emission computed tomography (SPECT) and SPECT/CT. Positron Emission Tomography-Computed Tomography (PET-CT) with Sodium Fluoride (18F-NaF) and 18Fluorine-fluorodeoxyglucose (18F-FDG) PET have promising and limited roles respectively in the investigation of painful prosthetic joints. New SPECT/CT and PET-CT isotopes targeting activated macrophages with 99mTc Tilmanocept (Lymphoseek®) and 68Gallium labelled Tilmanocept respectively show potential as agents to demonstrate wear particles ingested by macrophages and multinucleated giant cells. An imaging algorithm using SPECT and/or PET agents is proffered as a cost effective way of speedily and accurately arriving a diagnosis. METHODS Review of the historical role of nuclear medicine in orthopaedics and research into the potential role of new radiopharmaceutical agents was undertaken. Guidelines and algorithms for the imaging of complicated joint prosthesis are provided. RESULTS There is an established role for nuclear medicine in orthopaedics and particularly in the investigation of complicated joint prostheses. Imaging with Tilmanocept provides new opportunities to shorten the time to diagnose loosened and infected joint prostheses. CONCLUSION There is a potential new role for Tilmanocept, which can be utilised with both PET-CT and SPECT-CT technologies. Tilmanocept is a relatively new radiopharmaceutical which has a potential role in the imaging assessment of painful joint prosthesis.
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Affiliation(s)
- O.O. Adesanya
- Radiology department UHCW, Clifford Bridge Road. Coventry CV2 2DX, United Kingdom
| | - C.E. Hutchinson
- Radiology department UHCW, Clifford Bridge Road. Coventry CV2 2DX, United Kingdom
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17
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Lee HJ, Barback CV, Hoh CK, Qin Z, Kader K, Hall DJ, Vera DR, Kane CJ. Fluorescence-Based Molecular Imaging of Porcine Urinary Bladder Sentinel Lymph Nodes. J Nucl Med 2017; 58:547-553. [PMID: 28153955 DOI: 10.2967/jnumed.116.178582] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/31/2016] [Indexed: 11/16/2022] Open
Abstract
The primary objective was to test the ability of a laparoscopic camera system to detect the fluorescent signal emanating from sentinel lymph nodes (SLNs) approximately 2 d after injection and imaging of a positron-emitting molecular imaging agent into the submucosa of the porcine urinary bladder. Methods: Three female pigs underwent a submucosal injection of the bladder with fluorescent-tagged tilmanocept, radiolabeled with both 68Ga and 99mTc. One hour after injection, a pelvic PET/CT scan was acquired for preoperative SLN mapping. Approximately 36 h later, robotic SLN mapping was performed using a fluorescence-capable camera system. After identification of the fluorescent lymph nodes, a pelvic lymph node dissection was completed with robotic assistance. All excised nodal packets (n = 36) were assayed for 99mTc activity, which established a lymph node as an SLN. 99mTc activity was also used to calculate the amount of dye within each lymph node. Results: All of the SLNs defined by the ex vivo γ-well assay of 99mTc activity were detected by fluorescence mode imaging. The time between injection and robotic SLN mapping ranged from 32 to 38 h. A total of 5 fluorescent lymph nodes were detected; 2 pigs had 2 fluorescent lymph nodes and 1 pig exhibited a single lymph node. Four of the 5 SLNs exhibited increased SUVs of 12.4-139.0 obtained from PET/CT. The dye content of the injection sites ranged from 371 to 1,441 pmol, which represented 16.5%-64.1% of the injected dose; the amount of dye within the SLNs ranged from 8.5 to 88 pmol, which was equivalent to 0.38%-3.91% of the administered dose. Conclusion: Fluorescent-labeled 68Ga-tilmanocept allows for PET imaging and real-time intraoperative detection of SLNs during robotic surgery.
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Affiliation(s)
- Hak J Lee
- Department of Urology, University of California, San Diego, La Jolla, California
| | - Christopher V Barback
- Department of Radiology, University of California, San Diego, La Jolla, California; and.,UCSD Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Carl K Hoh
- Department of Radiology, University of California, San Diego, La Jolla, California; and.,UCSD Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Zhengtao Qin
- Department of Radiology, University of California, San Diego, La Jolla, California; and.,UCSD Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Kareem Kader
- Department of Urology, University of California, San Diego, La Jolla, California
| | - David J Hall
- Department of Radiology, University of California, San Diego, La Jolla, California; and.,UCSD Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - David R Vera
- Department of Radiology, University of California, San Diego, La Jolla, California; and .,UCSD Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Christopher J Kane
- Department of Urology, University of California, San Diego, La Jolla, California
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18
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A tri-modal molecular imaging agent for sentinel lymph node mapping. Nucl Med Biol 2015; 42:917-22. [DOI: 10.1016/j.nucmedbio.2015.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/12/2015] [Accepted: 07/29/2015] [Indexed: 11/17/2022]
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19
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Seiler SMF, Baumgartner C, Hirschberger J, Beer AJ, Brühschwein A, Kreutzmann N, Laberke S, Wergin MC, Meyer-Lindenberg A, Brandl J, von Thaden AK, Farrell E, Schwaiger M. Comparative Oncology: Evaluation of 2-Deoxy-2-[18F]fluoro-D-glucose (FDG) Positron Emission Tomography/Computed Tomography (PET/CT) for the Staging of Dogs with Malignant Tumors. PLoS One 2015; 10:e0127800. [PMID: 26068641 PMCID: PMC4466332 DOI: 10.1371/journal.pone.0127800] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 04/20/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction 2-Deoxy-2-[18F]fluoro-D-glucose PET/CT is a well-established imaging method for staging, restaging and therapy-control in human medicine. In veterinary medicine, this imaging method could prove to be an attractive and innovative alternative to conventional imaging in order to improve staging and restaging. The aim of this study was both to evaluate the effectiveness of this image-guided method in canine patients with spontaneously occurring cancer as well as to illustrate the dog as a well-suited animal model for comparative oncology. Methods Ten dogs with various malignant tumors were included in the study and underwent a whole body FDG PET/CT. One patient has a second PET-CT 5 months after the first study. Patients were diagnosed with histiocytic sarcoma (n = 1), malignant lymphoma (n = 2), mammary carcinoma (n = 4), sertoli cell tumor (n = 1), gastrointestinal stromal tumor (GIST) (n = 1) and lung tumor (n = 1). PET/CT data were analyzed with the help of a 5-point scale in consideration of the patients’ medical histories. Results In seven of the ten dogs, the treatment protocol and prognosis were significantly changed due to the results of FDG PET/CT. In the patients with lymphoma (n = 2) tumor extent could be defined on PET/CT because of increased FDG uptake in multiple lymph nodes. This led to the recommendation for a therapeutic polychemotherapy as a treatment. In one of the dogs with mammary carcinoma (n = 4) and in the patient with the lung tumor (n = 1), surgery was cancelled due to the discovery of multiple metastasis. Consequently no treatment was recommended. Conclusion FDG PET/CT offers additional information in canine patients with malignant disease with a potential improvement of staging and restaging. The encouraging data of this clinical study highlights the possibility to further improve innovative diagnostic and staging methods with regard to comparative oncology. In the future, performing PET/CT not only for staging but also in therapy control could offer a significant improvement in the management of dogs with malignant tumors.
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Affiliation(s)
- Stefanie M F Seiler
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, Ludwig, Maximilians Universität, 80539, Munich, Germany; Center of Preclinical Research, Technische Universität München, 81675, Munich, Germany
| | - Christine Baumgartner
- Center of Preclinical Research, Technische Universität München, 81675, Munich, Germany
| | - Johannes Hirschberger
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, Ludwig, Maximilians Universität, 80539, Munich, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Technische Universität München, 81675, Munich, Germany
| | - Andreas Brühschwein
- Clinic for Small Animal Surgery and Reproduction, Veterinary Faculty, Ludwig, Maximilians Universität, 80539, Munich, Germany
| | - Nina Kreutzmann
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, Ludwig, Maximilians Universität, 80539, Munich, Germany
| | - Silja Laberke
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, Ludwig, Maximilians Universität, 80539, Munich, Germany
| | - Melanie C Wergin
- Clinic of Small Animal Medicine, Center for Clinical Veterinary Medicine, Ludwig, Maximilians Universität, 80539, Munich, Germany
| | - Andrea Meyer-Lindenberg
- Clinic for Small Animal Surgery and Reproduction, Veterinary Faculty, Ludwig, Maximilians Universität, 80539, Munich, Germany
| | - Johanna Brandl
- Center of Preclinical Research, Technische Universität München, 81675, Munich, Germany
| | | | - Eliane Farrell
- Department of Nuclear Medicine, Technische Universität München, 81675, Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, 81675, Munich, Germany
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20
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Morais M, Campello MPC, Xavier C, Heemskerk J, Correia JDG, Lahoutte T, Caveliers V, Hernot S, Santos I. Radiolabeled Mannosylated Dextran Derivatives Bearing an NIR-Fluorophore for Sentinel Lymph Node Imaging. Bioconjug Chem 2014; 25:1963-70. [DOI: 10.1021/bc500336a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Maurício Morais
- Centro
de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal
| | - Maria P. C. Campello
- Centro
de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal
| | - Catarina Xavier
- In
Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Johannes Heemskerk
- Nuclear
Medicine Department, Universitair Ziekenhuis, 1090 Brussels, Belgium
| | - João D. G. Correia
- Centro
de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal
| | - Tony Lahoutte
- In
Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, 1050 Brussels, Belgium
- Nuclear
Medicine Department, Universitair Ziekenhuis, 1090 Brussels, Belgium
| | - Vicky Caveliers
- In
Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, 1050 Brussels, Belgium
- Nuclear
Medicine Department, Universitair Ziekenhuis, 1090 Brussels, Belgium
| | - Sophie Hernot
- In
Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Isabel Santos
- Centro
de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal
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21
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Eo JS, Kim HK, Kim S, Lee YS, Jeong JM, Choi YH. Gallium-68 Neomannosylated Human Serum Albumin-Based PET/CT Lymphoscintigraphy for Sentinel Lymph Node Mapping in Non-small Cell Lung Cancer. Ann Surg Oncol 2014; 22:636-41. [DOI: 10.1245/s10434-014-3986-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Indexed: 12/15/2022]
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22
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Liss MA, Stroup SP, Qin Z, Hoh CK, Hall DJ, Vera DR, Kane CJ. Robotic-assisted fluorescence sentinel lymph node mapping using multimodal image guidance in an animal model. Urology 2014; 84:982.e9-14. [PMID: 25139676 DOI: 10.1016/j.urology.2014.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/11/2014] [Accepted: 06/13/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate positron emission tomography/computed tomography (PET/CT) preoperative imaging and intraoperative detection of a fluorescent-labeled receptor-targeted radiopharmaceutical in a prostate cancer animal model. MATERIALS AND METHODS Three male beagle dogs underwent an intraprostatic injection of fluorescent-tagged tilmanocept, radiolabeled with both gallium Ga-68 and technetium Tc-99m. One hour after injection, a pelvic PET/CT scan was performed for preoperative sentinel lymph node (SLN) mapping. The definition of SLN was a standardized uptake value that exceeded 5% of the lymph node with the highest standardized uptake value. Thirty-six hours later, we performed robotic-assisted SLN dissection using a fluorescence-capable camera system. Fluorescent lymph nodes were clipped, the abdomen was opened, and the pelvic and retroperitoneal nodes were excised. All excised nodal packets were assayed by in vitro nuclear counting and reported as the percentage of injected dose. RESULTS Preoperative PET/CT imaging identified a median of 3 SLNs per animal. All SLNs (100%) identified by the PET/CT were fluorescent during robotic-assisted lymph node dissection. Of all fluorescent nodes visualized by the camera system, 9 of 12 nodes (75%) satisfied the 5% rule defined by the PET/CT scan. The 2 lymph nodes that did not qualify accumulated <0.002% of the injected dose. CONCLUSION Fluorescent-labeled tilmanocept has optimal logistic properties to obtain preoperative PET/CT and subsequent real-time intraoperative confirmation during robotic-assisted SLN dissection.
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Affiliation(s)
- Michael A Liss
- Department of Urology, UC San Diego Health System, San Diego, CA; UCSD Moores Cancer Center, La Jolla, CA
| | | | - Zhengtao Qin
- Department of Radiology, University of California, San Diego, La Jolla, CA; UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, CA; Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA
| | - Carl K Hoh
- UCSD Moores Cancer Center, La Jolla, CA; Department of Radiology, University of California, San Diego, La Jolla, CA; UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, CA; Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA
| | - David J Hall
- UCSD Moores Cancer Center, La Jolla, CA; Department of Radiology, University of California, San Diego, La Jolla, CA; UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, CA
| | - David R Vera
- UCSD Moores Cancer Center, La Jolla, CA; Department of Radiology, University of California, San Diego, La Jolla, CA; UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, CA; Department of Surgery, University of California, San Diego, La Jolla, CA
| | - Christopher J Kane
- Department of Urology, UC San Diego Health System, San Diego, CA; UCSD Moores Cancer Center, La Jolla, CA; Department of Surgery, University of California, San Diego, La Jolla, CA.
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The Role of Indocyanine Green for Robotic Partial Nephrectomy: Early Results, Limitations and Future Directions. ROBOTICS 2014. [DOI: 10.3390/robotics3030281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Liss MA, Farshchi-Heydari S, Qin Z, Hickey SA, Hall DJ, Kane CJ, Vera DR. Preclinical evaluation of robotic-assisted sentinel lymph node fluorescence imaging. J Nucl Med 2014; 55:1552-6. [PMID: 25024425 DOI: 10.2967/jnumed.114.140871] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED An ideal substance to provide convenient and accurate targeting for sentinel lymph node (SLN) mapping during robotic-assisted surgery has yet to be found. We used an animal model to determine the ability of the FireFly camera system to detect fluorescent SLNs after administration of a dual-labeled molecular imaging agent. METHODS We injected the footpads of New Zealand White rabbits with 1.7 or 8.4 nmol of tilmanocept labeled with (99m)Tc and a near-infrared fluorophore, IRDye800CW. One and 36 h after injection, popliteal lymph nodes, representing the SLNs, were dissected with the assistance of the FireFly camera system, a fluorescence-capable endoscopic imaging system. After excision of the paraaortic lymph nodes, which represented non-SLNs, we assayed all lymph nodes for radioactivity and fluorescence intensity. RESULTS Fluorescence within all popliteal lymph nodes was easily detected by the FireFly camera system. Fluorescence within the lymph channel could be imaged during the 1-h studies. When compared with the paraaortic lymph nodes, the popliteal lymph nodes retain greater than 95% of the radioactivity at both 1 and 36 h after injection. At both doses (1.7 and 8.4 nmol), the popliteal nodes had higher (P < 0.050) optical fluorescence intensity than the paraaortic nodes at the 1- and 36-h time points. CONCLUSION The FireFly camera system can easily detect tilmanocept labeled with a near-infrared fluorophore at least 36 h after administration. This ability will permit image acquisition and subsequent verification of fluorescence-labeled SLNs during robotic-assisted surgery.
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Affiliation(s)
- Michael A Liss
- Department of Urology, University of California, San Diego, La Jolla, California UCSD Moores Cancer Center. University of California, San Diego, La Jolla, California
| | - Salman Farshchi-Heydari
- Department of Radiology, University of California, San Diego, La Jolla, California UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, California
| | - Zhengtao Qin
- Department of Radiology, University of California, San Diego, La Jolla, California UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, California Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, California; and
| | - Sean A Hickey
- Department of Surgery, University of California, San Diego, La Jolla, California
| | - David J Hall
- Department of Radiology, University of California, San Diego, La Jolla, California UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, California
| | - Christopher J Kane
- Department of Urology, University of California, San Diego, La Jolla, California UCSD Moores Cancer Center. University of California, San Diego, La Jolla, California Department of Surgery, University of California, San Diego, La Jolla, California
| | - David R Vera
- UCSD Moores Cancer Center. University of California, San Diego, La Jolla, California Department of Radiology, University of California, San Diego, La Jolla, California UCSD In Vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, California Department of Surgery, University of California, San Diego, La Jolla, California
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Nichols B, Qin Z, Yang J, Vera DR, Devaraj NK. 68Ga chelating bioorthogonal tetrazine polymers for the multistep labeling of cancer biomarkers. Chem Commun (Camb) 2014; 50:5215-5217. [PMID: 24589653 PMCID: PMC4119763 DOI: 10.1039/c3cc49530b] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We have developed a (68)Ga metal chelating bioorthogonal tetrazine dextran probe that is highly reactive with trans-cyclooctene modified monoclonal antibodies for multistep imaging applications. Confocal microscopy and positron emission tomography (PET) were used to characterize the dextran probe in vitro and in vivo.
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Affiliation(s)
- Brandon Nichols
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Zhengtao Qin
- Department of Radiology, UCSD in vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Jun Yang
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - David R. Vera
- Department of Radiology, UCSD in vivo Cancer and Molecular Imaging Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Neal K. Devaraj
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, 92093, USA
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Qin Z, Hall DJ, Liss MA, Hoh CK, Kane CJ, Wallace AM, Vera DR. Optimization via specific fluorescence brightness of a receptor-targeted probe for optical imaging and positron emission tomography of sentinel lymph nodes. JOURNAL OF BIOMEDICAL OPTICS 2013; 18:101315. [PMID: 23958947 PMCID: PMC3745642 DOI: 10.1117/1.jbo.18.10.101315] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/05/2013] [Accepted: 06/27/2013] [Indexed: 05/20/2023]
Abstract
The optical properties of a receptor-targeted probe designed for dual-modality mapping of the sentinel lymph node (SLN) was optimized. Specific fluorescence brightness was used as the design criterion, which was defined as the fluorescence brightness per mole of the contrast agent. Adjusting the molar ratio of the coupling reactants, IRDye 800CW-NHS-ester and tilmanocept, enabled us to control the number of fluorescent molecules attached to each tilmanocept, which was quantified by H1 nuclear magnetic resonance spectroscopy. Quantum yields and molar absorptivities were measured for unconjugated IRDye 800CW and IRDye 800CW-tilmanocept (800CW-tilmanocept) preparations at 0.7, 1.5, 2.3, 2.9, and 3.8 dyes per tilmanocept. Specific fluorescence brightness was calculated by multiplication of the quantum yield by the molar absorptivity and the number of dyes per tilmanocept. It predicted that the preparation with 2.3 dyes per tilmanocept would exhibit the brightest signal, which was confirmed by fluorescence intensity measurements using three optical imaging systems. When radiolabeled with Ga68 and injected into the footpads of mice, the probe identified SLNs by both fluorescence and positron emission tomography (PET) while maintaining high percent extraction by the SLN. These studies demonstrated the feasibility of 800CW-tilmanocept for multimodal SLN mapping via fluorescence and PET-computed tomography imaging.
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Affiliation(s)
- Zhengtao Qin
- University of California, San Diego, Department of Chemistry, La Jolla, California 92093
- University of California, San Diego, Moores Cancer Center, La Jolla, California 92093
- University of California, San Diego, Department of Radiology, La Jolla, California 92093
- University of California, San Diego, In Vivo Cancer and Molecular Imaging Center, La Jolla, California 92093
| | - David J. Hall
- University of California, San Diego, Moores Cancer Center, La Jolla, California 92093
- University of California, San Diego, Department of Radiology, La Jolla, California 92093
- University of California, San Diego, In Vivo Cancer and Molecular Imaging Center, La Jolla, California 92093
| | - Michael A. Liss
- University of California, San Diego, Moores Cancer Center, La Jolla, California 92093
- University of California, San Diego, Department of Surgery, La Jolla, California 92093
| | - Carl K. Hoh
- University of California, San Diego, Moores Cancer Center, La Jolla, California 92093
- University of California, San Diego, Department of Radiology, La Jolla, California 92093
- University of California, San Diego, In Vivo Cancer and Molecular Imaging Center, La Jolla, California 92093
| | - Christopher J. Kane
- University of California, San Diego, Moores Cancer Center, La Jolla, California 92093
- University of California, San Diego, Department of Surgery, La Jolla, California 92093
| | - Anne M. Wallace
- University of California, San Diego, Moores Cancer Center, La Jolla, California 92093
- University of California, San Diego, Department of Surgery, La Jolla, California 92093
| | - David R. Vera
- University of California, San Diego, Moores Cancer Center, La Jolla, California 92093
- University of California, San Diego, Department of Radiology, La Jolla, California 92093
- University of California, San Diego, In Vivo Cancer and Molecular Imaging Center, La Jolla, California 92093
- University of California, San Diego, Department of Surgery, La Jolla, California 92093
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Liss MA, Kane CJ. Editorial comment from Dr Liss and Dr Kane to lymphocele after extraperitoneal robot-assisted radical prostatectomy: a propensity score-matching study. Int J Urol 2013; 20:1177. [PMID: 23586475 DOI: 10.1111/iju.12163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael A Liss
- Department of Urology, UC San Diego Moores Cancer Center, La Jolla, California, USA.
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Wallace AM, Han LK, Povoski SP, Deck K, Schneebaum S, Hall NC, Hoh CK, Limmer KK, Krontiras H, Frazier TG, Cox C, Avisar E, Faries M, King DW, Christman L, Vera DR. Comparative evaluation of [(99m)tc]tilmanocept for sentinel lymph node mapping in breast cancer patients: results of two phase 3 trials. Ann Surg Oncol 2013; 20:2590-9. [PMID: 23504141 PMCID: PMC3705144 DOI: 10.1245/s10434-013-2887-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) surgery is used worldwide for staging breast cancer patients and helps limit axillary lymph node dissection. [(99m)Tc]Tilmanocept is a novel receptor-targeted radiopharmaceutical evaluated in 2 open-label, nonrandomized, within-patient, phase 3 trials designed to assess the lymphatic mapping performance. METHODS A total of 13 centers contributed 148 patients with breast cancer. Each patient received [(99m)Tc]tilmanocept and vital blue dye (VBD). Lymph nodes identified intraoperatively as radioactive and/or blue stained were excised and histologically examined. The primary endpoint, concordance (lower boundary set point at 90 %), was the proportion of nodes detected by VBD and [(99m)Tc]tilmanocept. RESULTS A total of 13 centers contributed 148 patients who were injected with both agents. Intraoperatively, 207 of 209 nodes detected by VBD were also detected by [(99m)Tc]tilmanocept for a concordance rate of 99.04 % (p < 0.0001). [(99m)Tc]tilmanocept detected a total of 320 nodes, of which 207 (64.7 %) were detected by VBD. [(99m)Tc]Tilmanocept detected at least 1 SLN in more patients (146) than did VBD (131, p < 0.0001). In 129 of 131 patients with ≥1 blue node, all blue nodes were radioactive. Of 33 pathology-positive nodes (18.2 % patient pathology rate), [(99m)Tc]tilmanocept detected 31 of 33, whereas VBD detected only 25 of 33 (p = 0.0312). No pathology-positive SLNs were detected exclusively by VBD. No serious adverse events were attributed to [(99m)Tc]tilmanocept. CONCLUSION [(99m)Tc]Tilmanocept demonstrated success in detecting a SLN while meeting the primary endpoint. Interestingly, [(99m)Tc]tilmanocept was additionally noted to identify more SLNs in more patients. This localization represented a higher number of metastatic breast cancer lymph nodes than that of VBD.
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Affiliation(s)
- Anne M Wallace
- Divisions of Surgical Oncology and Plastic Surgery, UCSD Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA.
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