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Yue X, Stauff E, Boyapati S, Langhans SA, Xu W, Makrogiannis S, Okorie UJ, Okorie AM, Kandula VVR, Kecskemethy HH, Nikam RM, Averill LW, Shaffer TH. PET Imaging of Neurofibromatosis Type 1 with a Fluorine-18 Labeled Tryptophan Radiotracer. Pharmaceuticals (Basel) 2024; 17:685. [PMID: 38931352 PMCID: PMC11206478 DOI: 10.3390/ph17060685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
Neurofibromatosis type 1 (NF1) is a neurocutaneous disorder. Plexiform neurofibromas (PNFs) are benign tumors commonly formed in patients with NF1. PNFs have a high incidence of developing into malignant peripheral nerve sheath tumors (MPNSTs) with a 5-year survival rate of only 30%. Therefore, the accurate diagnosis and differentiation of MPNSTs from benign PNFs are critical to patient management. We studied a fluorine-18 labeled tryptophan positron emission tomography (PET) radiotracer, 1-(2-[18F]fluoroethyl)-L-tryptophan (L-[18F]FETrp), to detect NF1-associated tumors in an animal model. An ex vivo biodistribution study of L-[18F]FETrp showed a similar tracer distribution and kinetics between the wild-type and triple mutant mice with the highest uptake in the pancreas. Bone uptake was stable. Brain uptake was low during the 90-min uptake period. Static PET imaging at 60 min post-injection showed L-[18F]FETrp had a comparable tumor uptake with [1⁸F]fluorodeoxyglucose (FDG). However, L-[18F]FETrp showed a significantly higher tumor-to-brain ratio than FDG (n = 4, p < 0.05). Sixty-minute-long dynamic PET scans using the two radiotracers showed similar kidney, liver, and lung kinetics. A dysregulated tryptophan metabolism in NF1 mice was further confirmed using immunohistostaining. L-[18F]FETrp is warranted to further investigate differentiating malignant NF1 tumors from benign PNFs. The study may reveal the tryptophan-kynurenine pathway as a therapeutic target for treating NF1.
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Affiliation(s)
- Xuyi Yue
- Department of Radiology, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA; (E.S.); (S.B.); (W.X.); (V.V.R.K.); (H.H.K.); (R.M.N.); (L.W.A.)
- Diagnostic & Research PET/MR Center, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA;
| | - Erik Stauff
- Department of Radiology, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA; (E.S.); (S.B.); (W.X.); (V.V.R.K.); (H.H.K.); (R.M.N.); (L.W.A.)
- Diagnostic & Research PET/MR Center, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA;
| | - Shriya Boyapati
- Department of Radiology, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA; (E.S.); (S.B.); (W.X.); (V.V.R.K.); (H.H.K.); (R.M.N.); (L.W.A.)
| | - Sigrid A. Langhans
- Diagnostic & Research PET/MR Center, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA;
- Division of Neurology, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA
| | - Wenqi Xu
- Department of Radiology, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA; (E.S.); (S.B.); (W.X.); (V.V.R.K.); (H.H.K.); (R.M.N.); (L.W.A.)
- Diagnostic & Research PET/MR Center, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA;
| | - Sokratis Makrogiannis
- Division of Physics, Engineering, Mathematics, and Computer Science, Delaware State University, Dover, DE 19901, USA; (S.M.); (U.J.O.); (A.M.O.)
| | - Uchenna J. Okorie
- Division of Physics, Engineering, Mathematics, and Computer Science, Delaware State University, Dover, DE 19901, USA; (S.M.); (U.J.O.); (A.M.O.)
| | - Azubuike M. Okorie
- Division of Physics, Engineering, Mathematics, and Computer Science, Delaware State University, Dover, DE 19901, USA; (S.M.); (U.J.O.); (A.M.O.)
| | - Vinay V. R. Kandula
- Department of Radiology, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA; (E.S.); (S.B.); (W.X.); (V.V.R.K.); (H.H.K.); (R.M.N.); (L.W.A.)
| | - Heidi H. Kecskemethy
- Department of Radiology, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA; (E.S.); (S.B.); (W.X.); (V.V.R.K.); (H.H.K.); (R.M.N.); (L.W.A.)
- Diagnostic & Research PET/MR Center, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA;
| | - Rahul M. Nikam
- Department of Radiology, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA; (E.S.); (S.B.); (W.X.); (V.V.R.K.); (H.H.K.); (R.M.N.); (L.W.A.)
- Diagnostic & Research PET/MR Center, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA;
| | - Lauren W. Averill
- Department of Radiology, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA; (E.S.); (S.B.); (W.X.); (V.V.R.K.); (H.H.K.); (R.M.N.); (L.W.A.)
- Diagnostic & Research PET/MR Center, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA;
| | - Thomas H. Shaffer
- Nemours Biomedical Research, Nemours Children’s Health, Delaware, Wilmington, DE 19803, USA;
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Jiang H, Guo Y, Cai H, Viola N, Shields AF, Muzik O, Juhasz C. Automated radiosynthesis of 1-(2-[ 18 F]fluoroethyl)-L-tryptophan ([ 18 F]FETrp) for positron emission tomography (PET) imaging of cancer in humans. J Labelled Comp Radiopharm 2023; 66:180-188. [PMID: 37118900 PMCID: PMC10330273 DOI: 10.1002/jlcr.4027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 04/30/2023]
Abstract
The radiotracer 1-(2-[18 F]fluoroethyl)-L-tryptophan (L-[18 F]FETrp or [18 F]FETrp) is a substrate of indoleamine 2,3-dioxygenase, the initial and key enzyme of the kynurenine pathway associated with tumoral immune resistance. In preclinical positron emission tomography studies, [18 F]FETrp is highly accumulated in a wide range of primary and metastatic cancers, such as lung cancer, prostate cancer, and gliomas. However, the clinical translation of this radiotracer into the first-in-human trial has not been reported, partially due to its racemization during radiofluorination which renders the purification of the final product challenging. However, efficient purification is essential for human studies in order to assure radiochemical and enantiomeric purity. In this work, we report a fully automated radiosynthesis of [18 F]FETrp on a Synthra RNPlus research module, including a one-pot two steps radiosynthesis, dual independent chiral and reverse-phase semipreparative high-performance liquid chromatography purifications, and solid-phase extraction-assisted formulation. The presented approach has led to its Investigational New Drug application and approval that allows the testing of this tracer in humans.
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Affiliation(s)
- Huailei Jiang
- Cyclotron and Radiochemistry Core, Karmanos Cancer Institute, Detroit, MI, USA
- PET Center, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Yan Guo
- Cyclotron and Radiochemistry Core, Karmanos Cancer Institute, Detroit, MI, USA
- PET Center, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Hancheng Cai
- PET Radiochemistry Facility, Mayo Clinic, Jacksonville, FL, USA
| | - Nerissa Viola
- PET Center, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Anthony F. Shields
- PET Center, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Otto Muzik
- PET Center, Karmanos Cancer Institute, Detroit, MI, USA
- Departments of Pediatrics and Neurology, Wayne State University, Detroit, MI, USA
| | - Csaba Juhasz
- PET Center, Karmanos Cancer Institute, Detroit, MI, USA
- Departments of Pediatrics and Neurology, Wayne State University, Detroit, MI, USA
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Advanced Neuroimaging Approaches to Pediatric Brain Tumors. Cancers (Basel) 2022; 14:cancers14143401. [PMID: 35884462 PMCID: PMC9318188 DOI: 10.3390/cancers14143401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary After leukemias, brain tumors are the most common cancers in children, and early, accurate diagnosis is critical to improve patient outcomes. Beyond the conventional imaging methods of computed tomography (CT) and magnetic resonance imaging (MRI), advanced neuroimaging techniques capable of both structural and functional imaging are moving to the forefront to improve the early detection and differential diagnosis of tumors of the central nervous system. Here, we review recent developments in neuroimaging techniques for pediatric brain tumors. Abstract Central nervous system tumors are the most common pediatric solid tumors; they are also the most lethal. Unlike adults, childhood brain tumors are mostly primary in origin and differ in type, location and molecular signature. Tumor characteristics (incidence, location, and type) vary with age. Children present with a variety of symptoms, making early accurate diagnosis challenging. Neuroimaging is key in the initial diagnosis and monitoring of pediatric brain tumors. Conventional anatomic imaging approaches (computed tomography (CT) and magnetic resonance imaging (MRI)) are useful for tumor detection but have limited utility differentiating tumor types and grades. Advanced MRI techniques (diffusion-weighed imaging, diffusion tensor imaging, functional MRI, arterial spin labeling perfusion imaging, MR spectroscopy, and MR elastography) provide additional and improved structural and functional information. Combined with positron emission tomography (PET) and single-photon emission CT (SPECT), advanced techniques provide functional information on tumor metabolism and physiology through the use of radiotracer probes. Radiomics and radiogenomics offer promising insight into the prediction of tumor subtype, post-treatment response to treatment, and prognostication. In this paper, a brief review of pediatric brain cancers, by type, is provided with a comprehensive description of advanced imaging techniques including clinical applications that are currently utilized for the assessment and evaluation of pediatric brain tumors.
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Goud NS, Bhattacharya A, Joshi RK, Nagaraj C, Bharath RD, Kumar P. Carbon-11: Radiochemistry and Target-Based PET Molecular Imaging Applications in Oncology, Cardiology, and Neurology. J Med Chem 2021; 64:1223-1259. [PMID: 33499603 DOI: 10.1021/acs.jmedchem.0c01053] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The positron emission tomography (PET) molecular imaging technique has gained its universal value as a remarkable tool for medical diagnosis and biomedical research. Carbon-11 is one of the promising radiotracers that can report target-specific information related to its pharmacology and physiology to understand the disease status. Currently, many of the available carbon-11 (t1/2 = 20.4 min) PET radiotracers are heterocyclic derivatives that have been synthesized using carbon-11 inserted different functional groups obtained from primary and secondary carbon-11 precursors. A spectrum of carbon-11 PET radiotracers has been developed against many of the upregulated and emerging targets for the diagnosis, prognosis, prediction, and therapy in the fields of oncology, cardiology, and neurology. This review focuses on the carbon-11 radiochemistry and various target-specific PET molecular imaging agents used in tumor, heart, brain, and neuroinflammatory disease imaging along with its associated pathology.
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Affiliation(s)
- Nerella Sridhar Goud
- Department of Neuroimaging and Interventional Radiology (NIIR), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560 029, India
| | - Ahana Bhattacharya
- Department of Neuroimaging and Interventional Radiology (NIIR), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560 029, India
| | - Raman Kumar Joshi
- Department of Neuroimaging and Interventional Radiology (NIIR), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560 029, India
| | - Chandana Nagaraj
- Department of Neuroimaging and Interventional Radiology (NIIR), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560 029, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology (NIIR), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560 029, India
| | - Pardeep Kumar
- Department of Neuroimaging and Interventional Radiology (NIIR), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560 029, India
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Juhász C, Mittal S. Molecular Imaging of Brain Tumor-Associated Epilepsy. Diagnostics (Basel) 2020; 10:diagnostics10121049. [PMID: 33291423 PMCID: PMC7762008 DOI: 10.3390/diagnostics10121049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is a common clinical manifestation and a source of significant morbidity in patients with brain tumors. Neuroimaging has a pivotal role in neuro-oncology practice, including tumor detection, differentiation, grading, treatment guidance, and posttreatment monitoring. In this review, we highlight studies demonstrating that imaging can also provide information about brain tumor-associated epileptogenicity and assist delineation of the peritumoral epileptic cortex to optimize postsurgical seizure outcome. Most studies focused on gliomas and glioneuronal tumors where positron emission tomography (PET) and advanced magnetic resonance imaging (MRI) techniques can detect metabolic and biochemical changes associated with altered amino acid transport and metabolism, neuroinflammation, and neurotransmitter abnormalities in and around epileptogenic tumors. PET imaging of amino acid uptake and metabolism as well as activated microglia can detect interictal or peri-ictal cortical increased uptake (as compared to non-epileptic cortex) associated with tumor-associated epilepsy. Metabolic tumor volumes may predict seizure outcome based on objective treatment response during glioma chemotherapy. Advanced MRI, especially glutamate imaging, can detect neurotransmitter changes around epileptogenic brain tumors. Recently, developed PET radiotracers targeting specific glutamate receptor types may also identify therapeutic targets for pharmacologic seizure control. Further studies with advanced multimodal imaging approaches may facilitate development of precision treatment strategies to control brain tumor-associated epilepsy.
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Affiliation(s)
- Csaba Juhász
- Departments of Pediatrics, Neurology, Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
- PET Center and Translational Imaging Laboratory, Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, USA
- Correspondence:
| | - Sandeep Mittal
- Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA;
- Carilion Clinic Neurosurgery, Roanoke, VA 24014, USA
- Fralin Biomedical Research Institute, Roanoke, VA 24016, USA
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Zlatopolskiy BD, Endepols H, Krasikova RN, Fedorova OS, Ermert J, Neumaier B. 11C- and 18F-labelled tryptophans as PET-tracers for imaging of altered tryptophan metabolism in age-associated disorders. RUSSIAN CHEMICAL REVIEWS 2020. [DOI: 10.1070/rcr4954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ageing of the world’s population is the result of increased life expectancy observed in almost all countries throughout the world. Consequently, a rising tide of ageing-associated disorders, like cancer and neurodegenerative diseases, represents one of the main global challenges of the 21st century. The ability of mankind to overcome these challenges is directly dependent on the capability to develop novel methods for therapy and diagnosis of age-associated diseases. One hallmark of age-related pathologies is an altered tryptophan metabolism. Numerous pathological processes including neurodegenerative and neurological diseases like epilepsy, Parkinson’s and Alzheimer’s diseases, cancer and diabetes exhibit marked changes in tryptophan metabolism. Visualization of key processes of tryptophan metabolic pathways, especially using positron emission tomography (PET) and related hybrid methods like PET/CT and PET/MRI, can be exploited to early detect the aforementioned disorders with considerable accuracy, allowing appropriate and timely treatment of patients. Here we review the published 11C- and 18F-labelled tryptophans with respect to the production and also preclinical and clinical evaluation as PET-tracers for visualization of different branches of tryptophan metabolism.
The bibliography includes 159 references.
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John F, Robinette NL, Amit-Yousif AJ, Bosnyák E, Barger GR, Shah KD, Mittal S, Juhász C. Multimodal Imaging of Nonenhancing Glioblastoma Regions. Mol Imaging 2020; 18:1536012119885222. [PMID: 31736437 PMCID: PMC6862774 DOI: 10.1177/1536012119885222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clinical glioblastoma treatment mostly focuses on the contrast-enhancing tumor mass. Amino acid positron emission tomography (PET) can detect additional, nonenhancing glioblastoma-infiltrated brain regions that are difficult to distinguish on conventional magnetic resonance imaging (MRI). We combined MRI with perfusion imaging and amino acid PET to evaluate such nonenhancing glioblastoma regions. METHODS Structural MRI, relative cerebral blood volume (rCBV) maps from perfusion MRI, and α-[11C]-methyl-l-tryptophan (AMT)-PET images were analyzed in 20 patients with glioblastoma. The AMT uptake and rCBV (expressed as tumor to normal [T/N] ratios) were compared in nonenhancing tumor portions showing increased signal on T2/fluid-attenuated inversion recovery (T2/FLAIR) images. RESULTS Thirteen (65%) tumors showed robust heterogeneity in nonenhancing T2/FLAIR hyperintense areas on AMT-PET, whereas the nonenhancing regions in the remaining 7 cases had homogeneous AMT uptake (low in 6, high in 1). AMT and rCBV T/N ratios showed only a moderate correlation in the nonenhancing regions (r = 0.41, P = .017), but regions with very low rCBV (<0.79 T/N ratio) had invariably low AMT uptake. CONCLUSIONS The findings demonstrate the metabolic and perfusion heterogeneity of nonenhancing T2/FLAIR hyperintense glioblastoma regions. Amino acid PET imaging of such regions can detect glioma-infiltrated brain for treatment targeting; however, very low rCBV values outside the contrast-enhancing tumor mass make increased AMT uptake in nonenhancing glioblastoma regions unlikely.
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Affiliation(s)
- Flóra John
- Department of Pediatrics, Wayne State University and PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA
| | - Natasha L Robinette
- Department of Radiology, Wayne State University, Detroit, MI, USA.,Karmanos Cancer Institute, Detroit, MI, USA
| | - Alit J Amit-Yousif
- Department of Radiology, Wayne State University, Detroit, MI, USA.,Karmanos Cancer Institute, Detroit, MI, USA
| | - Edit Bosnyák
- Department of Pediatrics, Wayne State University and PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA
| | - Geoffrey R Barger
- Department of Neurology, Wayne State University, Detroit, MI, USA.,Karmanos Cancer Institute, Detroit, MI, USA
| | - Keval D Shah
- Department of Neurology, Wayne State University, Detroit, MI, USA
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA.,Karmanos Cancer Institute, Detroit, MI, USA.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Virginia Tech School of Neuroscience, Blacksburg, VA, USA
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University and PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA.,Department of Neurology, Wayne State University, Detroit, MI, USA.,Department of Neurosurgery, Wayne State University, Detroit, MI, USA.,Karmanos Cancer Institute, Detroit, MI, USA
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PET imaging of medulloblastoma with an 18F-labeled tryptophan analogue in a transgenic mouse model. Sci Rep 2020; 10:3800. [PMID: 32123231 PMCID: PMC7051973 DOI: 10.1038/s41598-020-60728-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/10/2020] [Indexed: 02/07/2023] Open
Abstract
In vivo positron emission tomography (PET) imaging is a key modality to evaluate disease status of brain tumors. In recent years, tremendous efforts have been made in developing PET imaging methods for pediatric brain tumors. Carbon-11 labelled tryptophan derivatives are feasible as PET imaging probes in brain tumor patients with activation of the kynurenine pathway, but the short half-life of carbon-11 limits its application. Using a transgenic mouse model for the sonic hedgehog (Shh) subgroup of medulloblastoma, here we evaluated the potential of the newly developed 1-(2-[18F]fluoroethyl)-L-tryptophan (1-L-[18F]FETrp) as a PET imaging probe for this common malignant pediatric brain tumor. 1-L-[18F]FETrp was synthesized on a PETCHEM automatic synthesizer with good chemical and radiochemical purities and enantiomeric excess values. Imaging was performed in tumor-bearing Smo/Smo medulloblastoma mice with constitutive actvation of the Smoothened (Smo) receptor using a PerkinElmer G4 PET-X-Ray scanner. Medulloblastoma showed significant and specific accumulation of 1-L-[18F]FETrp. 1-L-[18F]FETrp also showed significantly higher tumor uptake than its D-enantiomer, 1-D-[18F]FETrp. The uptake of 1-L-[18F]FETrp in the normal brain tissue was low, suggesting that 1-L-[18F]FETrp may prove a valuable PET imaging probe for the Shh subgroup of medulloblastoma and possibly other pediatric and adult brain tumors.
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Automated production of 1-(2-[ 18F]fluoroethyl)-l-tryptophan for imaging of tryptophan metabolism. Appl Radiat Isot 2020; 156:109022. [PMID: 32056678 DOI: 10.1016/j.apradiso.2019.109022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/18/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022]
Abstract
Automated production of an fluorine-18 labeled tryptophan analogue, 1-(2-[18F]fluoroethyl)-l-tryptophan (1-L-[18F]FETrp) in a current Good Manufacturing Practice facility was achieved. 1-L-[18F]FETrp was produced by a one-pot, two-step strategy with an overall synthesis time of approximately 100 min, a radiochemical yield of 20 ± 5% (decay corrected), radiochemical purity and enantiomeric excess over 90%, and a molar activity of 103 ± 15 GBq/μmol at the end of synthesis (EOS). The dose mass of 1-L-FETrp in four consecutive batches was less than 5 μg. The radiopharmaceutical product met all quality control criteria for clinical use.
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Qiao Z, Mardon K, Stimson DHR, Migotto MA, Reutens DC, Bhalla R. Synthesis and evaluation of 6-[18F]fluoro-3-(pyridin-3-yl)-1H-indole as potential PET tracer for targeting tryptophane 2, 3-dioxygenase (TDO). Nucl Med Biol 2020; 84-85:1-10. [PMID: 31927462 DOI: 10.1016/j.nucmedbio.2019.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The increase in expression of tryptophan 2, 3-dioxygenases (TDO) and indoleamine 2,3-dioxygenase (IDO) have been reported as potential tumor biomarkers. TDO and IDO are enzymes that catalyze the first and rate-limiting step of the kynurenine pathway. Positron emitting tomography (PET) tracers investigating the kynurenine pathway may allow for the detection of different disease pathologies in vivo including cancer. However, current PET tracers being developed for TDO and IDO have suffered from either multi-step low yielding syntheses or de-fluorination of the tracer in vivo. RESULTS TDO inhibitors based on 6-fluoroindole with C3 substituents are a class of small molecules that have been shown to bind to TDO effectively, restore tryptophan concentration and decrease the production of immunosuppressive metabolites. The compound 6-fluoro-3-(pyridine-3-yl)-1H-indole has been reported to have high in vitro affinity for TDO. Herein we report the fully automated radiosynthesis of 6-[18F]fluoro-3-(pyridine-3-yl)-1H-indole [18F]4 using a copper-mediated nucleophilic 18F-fluorination resulting in a non-corrected yield of 5 to 6% of the tracer with a radiochemical purity of >99% after 4 h. Small animal dynamic PET/CT imaging of [18F]4 intravenously injected into normal C57BL/6 mice revealed rapid accumulation in heart and brain, reaching maximum occupancy in heart (10.9% ID/g) and brain (8.1% ID/g) at 1.75 min and 2.25 min, respectively. Furthermore, these in vivo studies revealed no de-fluorination of the tracer, as evidence by the absence of [18F]fluoride accumulation in bone. CONCLUSION In vitro studies demonstrate that 4 has good affinity for hTDO and the radiolabeled analogue [18F]4 can be synthesized with suitable radiochemical yields. [18F]4 demonstrates good uptake in the brain and the radiolabeled compound shows no de-fluorination in vivo in C57BL/6 mice.
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Affiliation(s)
- Zheng Qiao
- Centre for Advanced Imaging, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia
| | - Karine Mardon
- Centre for Advanced Imaging, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia; National Imaging Facility, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia
| | - Damion H R Stimson
- Centre for Advanced Imaging, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia
| | - Mary-Anne Migotto
- Centre for Advanced Imaging, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia
| | - David C Reutens
- Centre for Advanced Imaging, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia
| | - Rajiv Bhalla
- Centre for Advanced Imaging, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia.
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The Emerging Role of Amino Acid PET in Neuro-Oncology. Bioengineering (Basel) 2018; 5:bioengineering5040104. [PMID: 30487391 PMCID: PMC6315339 DOI: 10.3390/bioengineering5040104] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 12/12/2022] Open
Abstract
Imaging plays a critical role in the management of the highly complex and widely diverse central nervous system (CNS) malignancies in providing an accurate diagnosis, treatment planning, response assessment, prognosis, and surveillance. Contrast-enhanced magnetic resonance imaging (MRI) is the primary modality for CNS disease management due to its high contrast resolution, reasonable spatial resolution, and relatively low cost and risk. However, defining tumor response to radiation treatment and chemotherapy by contrast-enhanced MRI is often difficult due to various factors that can influence contrast agent distribution and perfusion, such as edema, necrosis, vascular alterations, and inflammation, leading to pseudoprogression and pseudoresponse assessments. Amino acid positron emission tomography (PET) is emerging as the method of resolving such equivocal lesion interpretations. Amino acid radiotracers can more specifically differentiate true tumor boundaries from equivocal lesions based on their specific and active uptake by the highly metabolic cellular component of CNS tumors. These therapy-induced metabolic changes detected by amino acid PET facilitate early treatment response assessments. Integrating amino acid PET in the management of CNS malignancies to complement MRI will significantly improve early therapy response assessment, treatment planning, and clinical trial design.
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Sun A, Liu X, Tang G. Carbon-11 and Fluorine-18 Labeled Amino Acid Tracers for Positron Emission Tomography Imaging of Tumors. Front Chem 2018; 5:124. [PMID: 29379780 PMCID: PMC5775220 DOI: 10.3389/fchem.2017.00124] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/12/2017] [Indexed: 12/12/2022] Open
Abstract
Tumor cells have an increased nutritional demand for amino acids (AAs) to satisfy their rapid proliferation. Positron-emitting nuclide labeled AAs are interesting probes and are of great importance for imaging tumors using positron emission tomography (PET). Carbon-11 and fluorine-18 labeled AAs include the [1-11C] AAs, labeling alpha-C- AAs, the branched-chain of AAs and N-substituted carbon-11 labeled AAs. These tracers target protein synthesis or amino acid (AA) transport, and their uptake mechanism mainly involves AA transport. AA PET tracers have been widely used in clinical settings to image brain tumors, neuroendocrine tumors, prostate cancer, breast cancer, non-small cell lung cancer (NSCLC) and hepatocellular carcinoma. This review focuses on the fundamental concepts and the uptake mechanism of AAs, AA PET tracers and their clinical applications.
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Affiliation(s)
- Aixia Sun
- Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiang Liu
- Department of Anesthesiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ganghua Tang
- Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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13
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Michelhaugh SK, Muzik O, Guastella AR, Klinger NV, Polin LA, Cai H, Xin Y, Mangner TJ, Zhang S, Juhász C, Mittal S. Assessment of Tryptophan Uptake and Kinetics Using 1-(2-18F-Fluoroethyl)-l-Tryptophan and α-11C-Methyl-l-Tryptophan PET Imaging in Mice Implanted with Patient-Derived Brain Tumor Xenografts. J Nucl Med 2016; 58:208-213. [PMID: 27765857 DOI: 10.2967/jnumed.116.179994] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022] Open
Abstract
Abnormal tryptophan metabolism via the kynurenine pathway is involved in the pathophysiology of a variety of human diseases including cancers. α-11C-methyl-l-tryptophan (11C-AMT) PET imaging demonstrated increased tryptophan uptake and trapping in epileptic foci and brain tumors, but the short half-life of 11C limits its widespread clinical application. Recent in vitro studies suggested that the novel radiotracer 1-(2-18F-fluoroethyl)-l-tryptophan (18F-FETrp) may be useful to assess tryptophan metabolism via the kynurenine pathway. In this study, we tested in vivo organ and tumor uptake and kinetics of 18F-FETrp in patient-derived xenograft mouse models and compared them with 11C-AMT uptake. METHODS Xenograft mouse models of glioblastoma and metastatic brain tumors (from lung and breast cancer) were developed by subcutaneous implantation of patient tumor fragments. Dynamic PET scans with 18F-FETrp and 11C-AMT were obtained for mice bearing human brain tumors 1-7 d apart. The biodistribution and tumoral SUVs for both tracers were compared. RESULTS 18F-FETrp showed prominent uptake in the pancreas and no bone uptake, whereas 11C-AMT showed higher uptake in the kidneys. Both tracers showed uptake in the xenograft tumors, with a plateau of approximately 30 min after injection; however, 18F-FETrp showed higher tumoral SUV than 11C-AMT in all 3 tumor types tested. The radiation dosimetry for 18F-FETrp determined from the mouse data compared favorably with the clinical 18F-FDG PET tracer. CONCLUSION 18F-FETrp tumoral uptake, biodistribution, and radiation dosimetry data provide strong preclinical evidence that this new radiotracer warrants further studies that may lead to a broadly applicable molecular imaging tool to examine abnormal tryptophan metabolism in human tumors.
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Affiliation(s)
| | - Otto Muzik
- Department of Pediatrics, Wayne State University, Detroit, Michigan.,Department of Radiology, Wayne State University, Detroit, Michigan.,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Anthony R Guastella
- Department of Neurosurgery, Wayne State University, Detroit, Michigan.,Department of Oncology, Wayne State University, Detroit, Michigan.,Karmanos Cancer Institute, Detroit, Michigan
| | - Neil V Klinger
- Department of Neurosurgery, Wayne State University, Detroit, Michigan
| | - Lisa A Polin
- Department of Oncology, Wayne State University, Detroit, Michigan.,Karmanos Cancer Institute, Detroit, Michigan
| | - Hancheng Cai
- Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern, Dallas, Texasand
| | - Yangchun Xin
- Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern, Dallas, Texasand
| | - Thomas J Mangner
- Department of Radiology, Wayne State University, Detroit, Michigan.,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Shaohui Zhang
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University, Detroit, Michigan.,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan.,Karmanos Cancer Institute, Detroit, Michigan.,Department of Neurology, Wayne State University, Detroit, Michigan
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, Detroit, Michigan .,Department of Oncology, Wayne State University, Detroit, Michigan.,Karmanos Cancer Institute, Detroit, Michigan
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14
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Juhász C, Bosnyák E. PET and SPECT studies in children with hemispheric low-grade gliomas. Childs Nerv Syst 2016; 32:1823-32. [PMID: 27659825 PMCID: PMC5120676 DOI: 10.1007/s00381-016-3125-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
Molecular imaging is playing an increasing role in the pretreatment evaluation of low-grade gliomas. While glucose positron emission tomography (PET) can be helpful to differentiate low-grade from high-grade tumors, PET imaging with amino acid radiotracers has several advantages, such as better differentiation between tumors and non-tumorous lesions, optimized biopsy targeting, and improved detection of tumor recurrence. This review provides a brief overview of single-photon emission computed tomography (SPECT) studies followed by a more detailed review of the clinical applications of glucose and amino acid PET imaging in low-grade hemispheric gliomas. We discuss key differences in the performance of the most commonly utilized PET radiotracers and highlight the advantage of PET/MRI fusion to obtain optimal information about tumor extent, heterogeneity, and metabolism. Recent data also suggest that simultaneous acquisition of PET/MR images and the combination of advanced MRI techniques with quantitative PET can further improve the pretreatment and post-treatment evaluation of pediatric brain tumors.
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Affiliation(s)
- Csaba Juhász
- Departments of Pediatrics, Wayne State University, Detroit, MI, USA. .,Departments of Neurology, Wayne State University, Detroit, MI, USA. .,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Street, Detroit, MI, 48201, USA. .,Karmanos Cancer Institute, Detroit, MI, USA.
| | - Edit Bosnyák
- Department of Pediatrics, Wayne State University, Detroit, MI, USA,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA
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15
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Abstract
A previous review published in 2012 demonstrated the role of clinical PET for diagnosis and management of brain tumors using mainly FDG, amino acid tracers, and 18F-fluorothymidine. This review provides an update on clinical PET studies, most of which are motivated by prediction of prognosis and planning and monitoring of therapy in gliomas. For FDG, there has been additional evidence supporting late scanning, and combination with 13N ammonia has yielded some promising results. Large neutral amino acid tracers have found widespread applications mostly based on 18F-labeled compounds fluoroethyltyrosine and fluorodopa for targeting biopsies, therapy planning and monitoring, and as outcome markers in clinical trials. 11C-alpha-methyltryptophan (AMT) has been proposed as an alternative to 11C-methionine, and there may also be a role for cyclic amino acid tracers. 18F-fluorothymidine has shown strengths for tumor grading and as an outcome marker. Studies using 18F-fluorocholine (FCH) and 68Ga-labeled compounds are promising but have not yet clearly defined their role. Studies on radiotherapy planning have explored the use of large neutral amino acid tracers to improve the delineation of tumor volume for irradiation and the use of hypoxia markers, in particular 18F-fluoromisonidazole. Many studies employed the combination of PET with advanced multimodal MR imaging methods, mostly demonstrating complementarity and some potential benefits of hybrid PET/MR.
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Affiliation(s)
- Karl Herholz
- The University of Manchester, Division of Neuroscience and Experimental Psychology Wolfson Molecular Imaging Centre, Manchester, England, United Kingdom.
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16
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Guastella AR, Michelhaugh SK, Klinger NV, Kupsky WJ, Polin LA, Muzik O, Juhász C, Mittal S. Tryptophan PET Imaging of the Kynurenine Pathway in Patient-Derived Xenograft Models of Glioblastoma. Mol Imaging 2016; 15:15/0/1536012116644881. [PMID: 27151136 PMCID: PMC4887573 DOI: 10.1177/1536012116644881] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/18/2016] [Indexed: 11/17/2022] Open
Abstract
Increasing evidence demonstrates the immunosuppressive kynurenine pathway's (KP) role in the pathophysiology of human gliomas. To study the KP in vivo, we used the noninvasive molecular imaging tracer α-[(11)C]-methyl-l-tryptophan (AMT). The AMT-positron emission tomography (PET) has shown high uptake in high-grade gliomas and predicted survival in patients with recurrent glioblastoma (GBM). We generated patient-derived xenograft (PDX) models from dissociated cells, or tumor fragments, from 5 patients with GBM. Mice bearing subcutaneous tumors were imaged with AMT-PET, and tumors were analyzed to detect the KP enzymes indoleamine 2,3-dioxygenase (IDO) 1, IDO2, tryptophan 2,3-dioxygenase, kynureninase, and kynurenine 3-monooxygenase. Overall, PET imaging showed robust tumoral AMT uptake in PDX mice with prolonged tracer accumulation over 60 minutes, consistent with AMT trapping seen in humans. Immunostained tumor tissues demonstrated positive detection of multiple KP enzymes. Furthermore, intracranial implantation of GBM cells was performed with imaging at both 9 and 14 days postimplant, with a marked increase in AMT uptake at 14 days and a corresponding high level of tissue immunostaining for KP enzymes. These results indicate that our PDX mouse models recapitulate human GBM, including aberrant tryptophan metabolism, and offer an in vivo system for development of targeted therapeutics for patients with GBM.
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Affiliation(s)
- Anthony R Guastella
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA Department of Oncology, Wayne State University, Detroit, MI, USA
| | | | - Neil V Klinger
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA
| | - William J Kupsky
- Department of Pathology, Wayne State University, Detroit, MI, USA Karmanos Cancer Institute, Detroit, MI, USA
| | - Lisa A Polin
- Department of Pathology, Wayne State University, Detroit, MI, USA Karmanos Cancer Institute, Detroit, MI, USA
| | - Otto Muzik
- Department of Pediatrics, Wayne State University, Detroit, MI, USA Department of Radiology, Wayne State University, Detroit, MI, USA PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA
| | - Csaba Juhász
- Karmanos Cancer Institute, Detroit, MI, USA Department of Pediatrics, Wayne State University, Detroit, MI, USA PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA Department of Neurology, Wayne State University, Detroit, MI, USA
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA Department of Oncology, Wayne State University, Detroit, MI, USA Karmanos Cancer Institute, Detroit, MI, USA
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17
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Bosnyák E, Kamson DO, Behen ME, Barger GR, Mittal S, Juhász C. Imaging cerebral tryptophan metabolism in brain tumor-associated depression. EJNMMI Res 2015; 5:56. [PMID: 26475140 PMCID: PMC4608955 DOI: 10.1186/s13550-015-0136-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/09/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Depression in patients with brain tumors is associated with impaired quality of life and shorter survival. Altered metabolism of tryptophan to serotonin and kynurenine metabolites may play a role in tumor-associated depression. Our recent studies with alpha[(11)C]methyl-L-tryptophan (AMT)-PET in brain tumor patients indicated abnormal tryptophan metabolism not only in the tumor mass but also in normal-appearing contralateral brain. In the present study, we explored if tryptophan metabolism in such brain regions is associated with depression. METHODS Twenty-one patients (mean age: 57 years) with a brain tumor (10 meningiomas, 8 gliomas, and 3 brain metastases) underwent AMT-PET scanning. MRI and AMT-PET images were co-registered, and AMT kinetic parameters, including volume of distribution (VD', an estimate of net tryptophan transport) and K (unidirectional uptake, related to tryptophan metabolism), were measured in the tumor mass and in unaffected cortical and subcortical regions contralateral to the tumor. Depression scores (based on the Beck Depression Inventory-II [BDI-II]) were correlated with tumor size, grade, type, and AMT-PET variables. RESULTS The mean BDI-II score was 12 ± 10 (range: 2-33); clinical levels of depression were identified in seven patients (33 %). High BDI-II scores were most strongly associated with high thalamic AMT K values both in the whole group (Spearman's rho = 0.63, p = 0.004) and in the subgroup of 18 primary brain tumors (r = 0.68, p = 0.004). Frontal and striatal VD' values were higher in the depressed subgroup than in non-depressed patients (p < 0.05); the group difference was even more robust when moderately/severely depressed patients were compared to patients with no/mild depression (frontal: p = 0.005; striatal: p < 0.001). Tumor size, grade, and tumor type were not related to depression scores. CONCLUSIONS Abnormalities of tryptophan transport and metabolism in the thalamus, striatum, and frontal cortex, measured by PET, are associated with depression in patients with brain tumor. These changes may indicate an imbalance between the serotonin and kynurenine pathways and serve as a molecular imaging marker of brain tumor-associated depression. TRIAL REGISTRATION ClinicalTrials.gov NCT02367469.
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Affiliation(s)
- Edit Bosnyák
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
| | - David O Kamson
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
| | - Michael E Behen
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
| | - Geoffrey R Barger
- Department of Neurology, Wayne State University, 4201 St. Antoine, Detroit, MI, 48201, USA.
- Karmanos Cancer Institute, Detroit, MI, USA.
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, 4160 John R., Suite 930, Detroit, MI, 48201, USA.
- Department of Oncology, Wayne State University, Detroit, MI, USA.
- Karmanos Cancer Institute, Detroit, MI, USA.
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- Department of Neurology, Wayne State University, 4201 St. Antoine, Detroit, MI, 48201, USA.
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
- Karmanos Cancer Institute, Detroit, MI, USA.
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18
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Bosnyák E, Kamson DO, Guastella AR, Varadarajan K, Robinette NL, Kupsky WJ, Muzik O, Michelhaugh SK, Mittal S, Juhász C. Molecular imaging correlates of tryptophan metabolism via the kynurenine pathway in human meningiomas. Neuro Oncol 2015; 17:1284-92. [PMID: 26092774 DOI: 10.1093/neuonc/nov098] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/06/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Increased tryptophan metabolism via the kynurenine pathway (KP) is a key mechanism of tumoral immune suppression in gliomas. However, details of tryptophan metabolism in meningiomas have not been elucidated. In this study, we evaluated in vivo tryptophan metabolism in meningiomas and compared it with gliomas using α-[(11)C]-methyl-L-tryptophan (AMT)-PET. We also explored expression patterns of KP enzymes in resected meningiomas. METHODS Forty-seven patients with MRI-detected meningioma (n = 16) and glioma (n = 31) underwent presurgical AMT-PET scanning. Tumoral AMT uptake and tracer kinetic parameters (including K and k3' evaluating unidirectional uptake and trapping, respectively) were measured, correlated with meningioma grade, and compared between meningiomas and gliomas. Patterns of KP enzyme expression were assessed by immunohistochemistry in all meningiomas. RESULTS Meningioma grade showed a positive correlation with AMT k3' tumor/cortex ratio (r = 0.75, P = .003), and this PET parameter distinguished grade I from grade II/III meningiomas with 92% accuracy. Kinetic AMT parameters could differentiate meningiomas from both low-grade gliomas (97% accuracy by k3' ratios) and high-grade gliomas (83% accuracy by K ratios). Among 3 initial KP enzymes (indoleamine 2,3-dioxygenase 1/2, and tryptophan 2,3-dioxygenase 2 [TDO2]), TDO2 showed the strongest immunostaining, particularly in grade I meningiomas. TDO2 also showed a strong negative correlation with AMT k3' ratios (P = .001). CONCLUSIONS PET imaging of tryptophan metabolism can provide quantitative imaging markers for differentiating grade I from grade II/III meningiomas. TDO2 may be an important driver of in vivo tryptophan metabolism in these tumors. These results can have implications for pharmacological targeting of the KP in meningiomas.
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Affiliation(s)
- Edit Bosnyák
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - David O Kamson
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Anthony R Guastella
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Kaushik Varadarajan
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Natasha L Robinette
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - William J Kupsky
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Otto Muzik
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Sharon K Michelhaugh
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Sandeep Mittal
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Department of Neurology, Wayne State University, Detroit, Michigan (C.J.); Department of Neurosurgery, Wayne State University, Detroit, Michigan (A.R.G., K.V., S.K.M., S.M.); Department of Oncology, Wayne State University, Detroit, Michigan (A.R.G., S.M.); Department of Radiology, Wayne State University, , Detroit, Michigan (N.L.R., O.M.); Department of Pathology, Wayne State University, Detroit, Michigan (W.J.K.); PET Center, Children's Hospital of Michigan, Detroit, Michigan (E.B., D.O.K., O.M., C.J.); Karmanos Cancer Institute, Detroit, Michigan (N.L.R., W.J.K., S.M., C.J.)
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Platten M, Weller M, Wick W. Shaping the glioma immune microenvironment through tryptophan metabolism. CNS Oncol 2015; 1:99-106. [PMID: 25054303 DOI: 10.2217/cns.12.6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The metabolism of the essential amino acid tryptophan is a key microenvironmental factor shaping the immunobiology of many tumor types. The current concept suggests that in the tumor microenvironment, tryptophan is metabolized by specialized dioxygenases, chiefly indoleamine-2,3-dioxygenase (IDO), which is expressed by tumor cells and antigen-presenting cells. High IDO activity leads to the depletion of tryptophan from the local microenvironment, while immediate tryptophan metabolites, particularly kynurenine, accumulate to high micromolar levels. Both the depletion of tryptophan and the accumulation of kynurenine lead to profound suppression of T-cell responses. Orally active IDO inhibitors are currently being explored in clinical trials for their efficacy in enhancing antitumor immune responses. Recent evidence points at alternative routes of tryptophan catabolism via tryptophan-2,3-dioxygenase, which is particularly expressed in malignant gliomas resulting in the production of high amounts of kynurenine. Tryptophan-2,3-dioxygenase-derived kynurenine in turn leads to the promotion of glioma growth and invasiveness and the suppression of antitumor immune responses by binding to the aryl hydrocarbon receptor expressed in glioma cells and glioma-infiltrating T cells. These new data open up novel therapeutic approaches to alleviate glioma-mediated immunosuppression. This review summarizes the current view on the relevance of tryptophan metabolism as an important immunosuppressive, proinvasive and growth-promoting metabolic pathway in malignant glioma.
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Affiliation(s)
- Michael Platten
- Department of Neurooncology, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
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20
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Juhász C, Dwivedi S, Kamson DO, Michelhaugh SK, Mittal S. Comparison of amino acid positron emission tomographic radiotracers for molecular imaging of primary and metastatic brain tumors. Mol Imaging 2015; 13. [PMID: 24825818 DOI: 10.2310/7290.2014.00015] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Positron emission tomography (PET) is an imaging technology that can detect and characterize tumors based on their molecular and biochemical properties, such as altered glucose, nucleoside, or amino acid metabolism. PET plays a significant role in the diagnosis, prognostication, and treatment of various cancers, including brain tumors. In this article, we compare uptake mechanisms and the clinical performance of the amino acid PET radiotracers (l-[methyl-11C]methionine [MET], 18F-fluoroethyl-tyrosine [FET], 18F-fluoro-l-dihydroxy-phenylalanine [FDOPA], and 11C-alpha-methyl-l-tryptophan [AMT]) most commonly used for brain tumor imaging. First, we discuss and compare the mechanisms of tumoral transport and accumulation, the basis of differential performance of these radioligands in clinical studies. Then we summarize studies that provided direct comparisons among these amino acid tracers and to clinically used 2-deoxy-2[18F]fluoro-d-glucose [FDG] PET imaging. We also discuss how tracer kinetic analysis can enhance the clinical information obtained from amino acid PET images. We discuss both similarities and differences in potential clinical value for each radioligand. This comparative review can guide which radiotracer to favor in future clinical trials aimed at defining the role of these molecular imaging modalities in the clinical management of brain tumor patients.
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Henrottin J, Zervosen A, Lemaire C, Sapunaric F, Laurent S, Van den Eynde B, Goldman S, Plenevaux A, Luxen A. N (1)-Fluoroalkyltryptophan Analogues: Synthesis and in vitro Study as Potential Substrates for Indoleamine 2,3-Dioxygenase. ACS Med Chem Lett 2015; 6:260-5. [PMID: 25815143 DOI: 10.1021/ml500385d] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/25/2015] [Indexed: 12/18/2022] Open
Abstract
Indoleamine 2,3-dioxygenase (hIDO) is an enzyme that catalyzes the oxidative cleavage of the indole ring of l-tryptophan through the kynurenine pathway, thereby exerting immunosuppressive properties in inflammatory and tumoral tissues. The syntheses of 1-(2-fluoroethyl)-tryptophan (1-FETrp) and 1-((1-(2-fluoroethyl)-1H-1,2,3-triazol-4-yl)methyl)-tryptophan, two N (1)-fluoroalkylated tryptophan derivatives, are described here. In vitro enzymatic assays with these two new potential substrates of hIDO show that 1-FETrp is a good and specific substrate of hIDO. Therefore, its radioactive isotopomer, 1-[(18)F]FETrp, should be a molecule of choice to visualize tumoral and inflammatory tissues and/or to validate new potential inhibitors.
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Affiliation(s)
- Jean Henrottin
- Cyclotron
Research Center, ‡Department of Chemistry, and §Macromolécules Biologiques, Center for Protein
Engineering, Université de Liège, Sart-Tilman, B-4000 Liège, Belgium
| | - Astrid Zervosen
- Cyclotron
Research Center, ‡Department of Chemistry, and §Macromolécules Biologiques, Center for Protein
Engineering, Université de Liège, Sart-Tilman, B-4000 Liège, Belgium
| | - Christian Lemaire
- Cyclotron
Research Center, ‡Department of Chemistry, and §Macromolécules Biologiques, Center for Protein
Engineering, Université de Liège, Sart-Tilman, B-4000 Liège, Belgium
| | | | | | - Benoit Van den Eynde
- Ludwig
Institute for Cancer Research, Brussels Branch and de Duve Institute, Université Catholique de Louvain, B-1200 Brussels, Belgium
| | - Serge Goldman
- PET/Biomedical
Cyclotron Unit and Department of Nuclear Medicine, Erasme Hospital, Université Libre de Bruxelles, B-1070 Brussels, Belgium
- Center for Microscopy and Molecular Imaging, Rue Adrienne Bolland 8, B-6041 Gosselies, Belgium
| | - Alain Plenevaux
- Cyclotron
Research Center, ‡Department of Chemistry, and §Macromolécules Biologiques, Center for Protein
Engineering, Université de Liège, Sart-Tilman, B-4000 Liège, Belgium
| | - André Luxen
- Cyclotron
Research Center, ‡Department of Chemistry, and §Macromolécules Biologiques, Center for Protein
Engineering, Université de Liège, Sart-Tilman, B-4000 Liège, Belgium
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Palumbo B, Buresta T, Nuvoli S, Spanu A, Schillaci O, Fravolini ML, Palumbo I. SPECT and PET serve as molecular imaging techniques and in vivo biomarkers for brain metastases. Int J Mol Sci 2014; 15:9878-93. [PMID: 24897023 PMCID: PMC4100127 DOI: 10.3390/ijms15069878] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 12/28/2022] Open
Abstract
Nuclear medicine techniques (single photon emission computerized tomography, SPECT, and positron emission tomography, PET) represent molecular imaging tools, able to provide in vivo biomarkers of different diseases. To investigate brain tumours and metastases many different radiopharmaceuticals imaged by SPECT and PET can be used. In this review the main and most promising radiopharmaceuticals available to detect brain metastases are reported. Furthermore the diagnostic contribution of the combination of SPECT and PET data with radiological findings (magnetic resonance imaging, MRI) is discussed.
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Affiliation(s)
- Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia 06100, Italy.
| | - Tommaso Buresta
- Section of Nuclear Medicine and Health Physics, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia 06100, Italy.
| | - Susanna Nuvoli
- Section of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Sassari, Sassari 07100, Italy.
| | - Angela Spanu
- Section of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Sassari, Sassari 07100, Italy.
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma 00133, Italy.
| | | | - Isabella Palumbo
- Section of Radiotherapy Department of Surgical and Biomedical Sciences, University of Perugia, Perugia 06100, Italy.
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Abstract
Brain tumors are one of the most challenging disorders encountered, and early and accurate diagnosis is essential for the management and treatment of these tumors. In this article, diagnostic modalities including single-photon emission computed tomography, positron emission tomography, magnetic resonance imaging, and optical imaging are reviewed. We mainly focus on the newly emerging, specific imaging probes, and their potential use in animal models and clinical settings.
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Affiliation(s)
- Huile Gao
- Key Laboratory of Smart Drug Delivery, Ministry of Education & PLA, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China
| | - Xinguo Jiang
- Key Laboratory of Smart Drug Delivery, Ministry of Education & PLA, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China
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Kamson DO, Mittal S, Buth A, Muzik O, Kupsky WJ, Robinette NL, Barger GR, Juhász C. Differentiation of glioblastomas from metastatic brain tumors by tryptophan uptake and kinetic analysis: a positron emission tomographic study with magnetic resonance imaging comparison. Mol Imaging 2013; 12:327-337. [PMID: 23759373 PMCID: PMC3804119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Differentiating high-grade gliomas from solitary brain metastases is often difficult by conventional magnetic resonance imaging (MRI); molecular imaging may facilitate such discrimination. We tested the accuracy of α[11C]methyl-l-tryptophan (AMT)-positron emission tomography (PET) to differentiate newly diagnosed glioblastomas from brain metastases. AMT-PET was performed in 36 adults with suspected brain malignancy. Tumoral AMT accumulation was measured by standardized uptake values (SUVs). Tracer kinetic analysis was also performed to separate tumoral net tryptophan transport (by AMT volume of distribution [VD]) from unidirectional uptake rates using dynamic PET and blood input function. Differentiating the accuracy of these PET variables was evaluated and compared to conventional MRI. For glioblastoma/metastasis differentiation, tumoral AMT SUV showed the highest accuracy (74%) and the tumor/cortex VD ratio had the highest positive predictive value (82%). The combined accuracy of MRI (size of contrast-enhancing lesion) and AMT-PET reached up to 93%. For ring-enhancing lesions, tumor/cortex SUV ratios were higher in glioblastomas than in metastatic tumors and could differentiate these two tumor types with > 90% accuracy. These results demonstrate that evaluation of tryptophan accumulation by PET can enhance pretreatment differentiation of glioblastomas and metastatic brain tumors. This approach may be particularly useful in patients with a newly diagnosed solitary ring-enhancing mass.
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Affiliation(s)
- David O. Kamson
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University
- The Karmanos Cancer Institute, Detroit, Michigan
| | - Amy Buth
- Department of Neurosurgery, Wayne State University
| | - Otto Muzik
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan
- Department of Pediatrics, Wayne State University
- Department of Radiology, Wayne State University
| | - William J. Kupsky
- The Karmanos Cancer Institute, Detroit, Michigan
- Department of Pathology, Wayne State University
| | - Natasha L. Robinette
- The Karmanos Cancer Institute, Detroit, Michigan
- Department of Radiology, Wayne State University
| | - Geoffrey R. Barger
- The Karmanos Cancer Institute, Detroit, Michigan
- Department of Neurology, Wayne State University
| | - Csaba Juhász
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan
- The Karmanos Cancer Institute, Detroit, Michigan
- Department of Pediatrics, Wayne State University
- Department of Neurology, Wayne State University
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Kamson DO, Mittal S, Buth A, Muzik O, Kupsky WJ, Robinette NL, Barger GR, Juhász C. Differentiation of Glioblastomas from Metastatic Brain Tumors by Tryptophan Uptake and Kinetic Analysis: A Positron Emission Tomographic Study with Magnetic Resonance Imaging Comparison. Mol Imaging 2013. [DOI: 10.2310/7290.2013.00048] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- David O. Kamson
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Sandeep Mittal
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Amy Buth
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Otto Muzik
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - William J. Kupsky
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Natasha L. Robinette
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Geoffrey R. Barger
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Csaba Juhász
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
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Zitron IM, Kamson DO, Kiousis S, Juhász C, Mittal S. In vivo metabolism of tryptophan in meningiomas is mediated by indoleamine 2,3-dioxygenase 1. Cancer Biol Ther 2013; 14:333-9. [PMID: 23358471 DOI: 10.4161/cbt.23624] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Expression and activity of indoleamine 2,3-dioxygenase (IDO), the first and rate-limiting step of the kynurenine pathway of tryptophan catabolism, can enable tumor cells to effectively evade the host's immune response. The potential role of this system was investigated in meningiomas. Surgical specimens from 22 patients with meningiomas were used for cellular, immunological and molecular techniques (immunofluorescence, western blotting, RT-PCR and biochemical assay of enzyme activity) to investigate the expression and activity of IDO. In addition, PET imaging was obtained preoperatively in 10 patients using the tracer α-[ ( 11) C]methyl-L-tryptophan (AMT) which interrogates the uptake and metabolism of tryptophan. Strong AMT accumulation was noted in all meningiomas by PET imaging indicating in vivo tryptophan uptake. Freshly-resected meningiomas expressed both LAT1, the tryptophan transporter system and IDO, demonstrating an active kynurenine pathway. Dissociated meningioma cells lost IDO expression. Following exposure to interferon-γ (IFNγ), IDO expression was reinduced and could be blocked by a selective IDO1 inhibitor. IDO activity may represent an element of local self-protection by meningiomas and could be targeted by emerging IDO1 inhibitors.
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Affiliation(s)
- Ian M Zitron
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA
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Tryptophan PET in pretreatment delineation of newly-diagnosed gliomas: MRI and histopathologic correlates. J Neurooncol 2013; 112:121-32. [PMID: 23299463 DOI: 10.1007/s11060-013-1043-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
Pretreatment delineation of infiltrating glioma volume remains suboptimal with current neuroimaging techniques. Gadolinium-enhanced T1-weighted (T1-Gad) MR images often underestimate the true extent of the tumor, while T2-weighted images preferentially highlight peritumoral edema. Accumulation of α-[(11)C]methyl-L-tryptophan (AMT) on positron emission tomography (PET) has been shown in gliomas. To determine whether increased uptake on AMT-PET would detect tumor-infiltrated brain tissue outside the contrast-enhancing region and differentiate it from peritumoral vasogenic edema, volumes and spatial concordance of T1-Gad and T2 MRI abnormalities as well as AMT-PET abnormalities were analyzed in 28 patients with newly-diagnosed WHO grade II-IV gliomas. AMT-accumulating grade I meningiomas were used to define an AMT uptake cutoff threshold that detects the tumor but excludes peri-meningioma vasogenic edema. Tumor infiltration in AMT-accumulating areas was studied in stereotactically-resected specimens from patients with glioblastoma. In the 28 gliomas, mean AMT-PET-defined tumor volumes were greater than the contrast-enhancing volume, but smaller than T2 abnormalities. Volume of AMT-accumulating tissue outside MRI abnormalities increased with higher tumor proliferative index and was the largest in glioblastomas. Tumor infiltration was confirmed by histopathology from AMT-positive regions outside contrast-enhancing glioblastoma mass, while no or minimal tumor cells were found in AMT-negative specimens. These results demonstrate that increased AMT accumulation on PET detects glioma-infiltrated brain tissue extending beyond the contrast-enhanced tumor mass. While tryptophan uptake is low in peritumoral vasogenic edema, AMT-PET can detect tumor-infiltrated brain outside T2-lesions. Thus, AMT-PET may assist pretreatment delineation of tumor infiltration, particularly in high-grade gliomas.
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28
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Quantitative PET imaging of tryptophan accumulation in gliomas and remote cortex: correlation with tumor proliferative activity. Clin Nucl Med 2012; 37:838-42. [PMID: 22889771 DOI: 10.1097/rlu.0b013e318251e458] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE PET studies with α[C-11]methyl-L-tryptophan (AMT) have shown decreased serotonin synthesis based on a decrease of the unidirectional uptake rate (K-complex) in neuropsychiatric conditions such as autism and depression. Increased AMT K-complex in tumors can indicate increased tryptophan metabolism via the immunosuppressive kynurenine pathway. Moreover, apparent AMT volume of distribution (VD') reflects net tryptophan transport from blood to tissue. We evaluated if kinetic parameters (K-complex, VD') of AMT, measured by PET, can predict the proliferative activity of glioma, and if these AMT parameters are altered in the remote cortex. METHODS We evaluated dynamic AMT PET images of 30 adult patients with grade 2 to 4 gliomas according to the World Health Organization's classification to determine tumoral AMT VD' and K-complex values, which were correlated with tumor proliferative activity as assessed by the Ki-67 labeling index in resected tumor specimens. We also compared cortical VD' and K-complex values between patients with glioma and healthy controls. RESULTS Both VD' and K-complex values were significantly higher in gliomas than in the contralateral cortex (VD', P < 0.001; K-complex, P < 0.001). Tumoral VD' values and tumor/cortex VD' ratios, but not the K-complex, showed strong positive correlations with the proliferative activity of glioma (P ≤ 0.001). The contralateral frontal cortex showed decreased AMT VD' and K-complex in patients with glioma compared with those in controls (P ≤ 0.01). CONCLUSIONS Increased net amino acid transport into tumor tissue, quantified by PET, can serve as an imaging marker of the proliferative activity of glioma. The data also suggest a glioma-induced down-regulation of cortical serotonin synthesis, likely mediated by shunting of tryptophan from serotonin synthesis to kynurenine metabolism.
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Alkonyi B, Barger GR, Mittal S, Muzik O, Chugani DC, Bahl G, Robinette NL, Kupsky WJ, Chakraborty PK, Juhász C. Accurate differentiation of recurrent gliomas from radiation injury by kinetic analysis of α-11C-methyl-L-tryptophan PET. J Nucl Med 2012; 53:1058-64. [PMID: 22653792 DOI: 10.2967/jnumed.111.097881] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED PET of amino acid transport and metabolism may be more accurate than conventional neuroimaging in differentiating recurrent gliomas from radiation-induced tissue changes. α-(11)C-methyl-l-tryptophan ((11)C-AMT) is an amino acid PET tracer that is not incorporated into proteins but accumulates in gliomas, mainly because of tumoral transport and metabolism via the immunomodulatory kynurenine pathway. The aim of this study was to evaluate the usefulness of (11)C-AMT PET supplemented by tracer kinetic analysis for distinguishing recurrent gliomas from radiation injury. METHODS Twenty-two (11)C-AMT PET scans were obtained in adult patients who presented with a lesion suggestive of tumor recurrence on conventional MRI 1-6 y (mean, 3 y) after resection and postsurgical radiation of a World Health Organization grade II-IV glioma. Lesional standardized uptake values were calculated, as well as lesion-to-contralateral cortex ratios and 2 kinetic (11)C-AMT PET parameters (volume of distribution [VD], characterizing tracer transport, and unidirectional uptake rate [K]). Tumor was differentiated from radiation-injured tissue by histopathology (n = 13) or 1-y clinical and MRI follow-up (n = 9). Accuracy of tumor detection by PET variables was assessed by receiver-operating-characteristic analysis. RESULTS All (11)C-AMT PET parameters were higher in tumors (n = 12) than in radiation injury (n = 10) (P ≤ 0.012 in all comparisons). The lesion-to-cortex K-ratio most accurately identified tumor recurrence, with highly significant differences both in the whole group (P < 0.0001) and in lesions with histologic verification (P = 0.006); the area under the receiver-operating-characteristic curve was 0.99. A lesion-to-cortex K-ratio threshold of 1.39 (i.e., a 39% increase) correctly differentiated tumors from radiation injury in all but 1 case (100% sensitivity and 91% specificity). In tumors that were high-grade initially (n = 15), a higher lesion-to-cortex K-ratio threshold completely separated recurrent tumors (all K-ratios ≥ 1.70) from radiation injury (all K-ratios < 1.50) (100% sensitivity and specificity). CONCLUSION Kinetic analysis of dynamic (11)C-AMT PET images may accurately differentiate between recurrent World Health Organization grade II-IV infiltrating gliomas and radiation injury. Separation of unidirectional uptake rates from transport can enhance the differentiating accuracy of (11)C-AMT PET. Applying the same approach to other amino acid PET tracers might also improve their ability to differentiate recurrent gliomas from radiation injury.
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Affiliation(s)
- Bálint Alkonyi
- PET Center, Children's Hospital of Michigan, Detroit, MI, USA
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Alkonyi B, Mittal S, Zitron I, Chugani DC, Kupsky WJ, Muzik O, Chugani HT, Sood S, Juhász C. Increased tryptophan transport in epileptogenic dysembryoplastic neuroepithelial tumors. J Neurooncol 2011; 107:365-72. [PMID: 22048879 DOI: 10.1007/s11060-011-0750-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/24/2011] [Indexed: 12/26/2022]
Abstract
Dysembryoplastic neuroepithelial tumors (DNTs) are typically hypometabolic but can show increased amino acid uptake on positron emission tomography (PET). To better understand mechanisms of amino acid accumulation in epileptogenic DNTs, we combined quantitative α-[(11)C]methyl-L: -tryptophan (AMT) PET with tumor immunohistochemistry. Standardized uptake values (SUVs) of AMT and glucose were measured in 11 children with temporal lobe DNT. Additional quantification for AMT transport and metabolism was performed in 9 DNTs. Tumor specimens were immunostained for the L: -type amino acid transporter 1 (LAT1) and indoleamine 2,3-dioxygenase (IDO), a key enzyme of the immunomodulatory kynurenine pathway. All 11 tumors showed glucose hypometabolism, while mean AMT SUVs were higher than normal cortex in eight DNTs. Further quantification showed increased AMT transport in seven and high AMT metabolic rates in three DNTs. Two patients showing extratumoral cortical increases of AMT SUV had persistent seizures despite complete tumor resection. Resected DNTs showed moderate to strong LAT1 and mild to moderate IDO immunoreactivity, with the strongest expression in tumor vessels. These results indicate that accumulation of tryptophan in DNTs is driven by high amino acid transport, mediated by LAT1, which can provide the substrate for tumoral tryptophan metabolism through the kynurenine pathway, that can produce epileptogenic metabolites. Increased AMT uptake can extend to extratumoral cortex, and presence of such cortical regions may increase the likelihood of recurrent seizures following surgical excision of DNTs.
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Affiliation(s)
- Bálint Alkonyi
- PET Center, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
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