Cardiovascular applications: current status of immunoscintigraphy in the detection of myocardial necrosis using antimyosin (R11D10) and deep venous thrombosis using antifibrin (T2G1s)

An indium:calcium phosphate colloid that specifically targets fibrin

The ability of indium to target fibrin in vitro was evaluated. The radionuclide (114m)Indium (114mIn) was prepared as a soluble and colloidal (In:In) form, as well as, a mixed indium:calcium phosphate (In:CaP) colloid. Soluble 114mIn was prepared by maintaining acid pH (50 mM HCl). Colloidal 114mIn (In:In) was prepared under slightly basic conditions (50 mM Tris-Cl, pH 7.6). The mixed In:CaP colloid was prepared by incubation of 114mIn with calcium (10 mM) and phosphate (250 microM) under slightly basic conditions (50 mM Tris-Cl, pH 7.6). To assess fibrin binding, the three 114mIn preparations were mixed with diluted human plasma (source of fibrinogen). Fibrin polymerization was initiated by addition of calcium (5 mM) and thrombin (0.5 U/ml). Following incubation (15 min, 37 degrees C), the fibrin matrix was condensed, removed from the reaction mixture, and washed briefly. Fibrin uptake of 114mIn (soluble, colloidal, or In:CaP) was determined by gamma counting. Results demonstrated that soluble 114mIn exclusively bound a plasma protein electrophoretically and immunologically identified as transferrin. Although both colloidal 114mIn and 114mIn:CaP bound fibrin, the mixed 114mIn:CaP colloid demonstrated substantially higher fibrin binding activity (about 2-fold). The target of indium binding was confirmed as fibrin due to the presence of characteristic cross-linked gamma-gamma dimers (100 kDa) and beta-monomers (58 kDa) by SDS-PAGE. 114mIn colloid and the mixed 114mIn:CaP colloid demonstrated no ability to bind fibrin's precursor, fibrinogen. 114mIn:CaP fibrin binding was associated with formation of CaP, as evidenced by its dependence on phosphate concentration. The biocompatibility of CaP including its ability to bind 114mIn and specifically target fibrin may be of potential value for diagnostic imaging studies to identify regions of occult vascular stenosis (i.e., atherosclerotic plaques, deep vein thrombosis, pulmonary embolus).

Current status of radionuclide tracer imaging of thrombi and atheroma

The imaging of thrombi and atherosclerotic plaques has great potential for decision making in the management of patients with all types of disease within the circulatory system. This importance is owing to the developments showing that areas of moderate stenosis with underlying atheroma are physiologically reactive and capable of causing reversible clinical symptoms that can progress to irreversible end-organ damage if not effectively treated. Identifying and quantifying areas of smaller vulnerable plaque and areas of acute thrombosis will assist in identification of patients at risk and help determine when and how to treat these patients. Initial efforts in this area used nonspecific constituents of thrombi and atheroma that were radiolabeled using long-lived isotopes, which had high background activity that required imaging over 48 to 72 hours. Newer approaches have focused on the use of small antibody fragments or small peptides, so-called molecular recognition units, that specifically target antigens present only in areas of thrombosis or active atherogenesis. These compounds are labeled Technetium-99 m (99mTc) and provide excellent images. Efforts to image thrombi have been directed at the IIB/IIIA receptor, which is present in low concentration on the cell membrane of circulating quiescent platelets, but on stimulation and active thrombosis, more than 80,000 potential binding sites per platelet appear. One such peptide has been clinically approved for imaging of deep vein thrombophlebitis. Parallel efforts are being made for imaging areas of active atherogenesis by targeting smooth muscle cells and other constituents unique for vulnerable plaques. Efforts in developing these modalities are important to expand the applications to new areas in nuclear cardiology.

Investigational Radioimmunopharmaceuticals: Pharmaceutical Care Responsibilities and Opportunities

A recent survey of biotechnology-derived medicines and vaccines under development showed that the largest fraction of these were monoclonal antibodies for the detection and/or treatment of cancer. This article describes the role and function of the nuclear pharmacist in the initiation, development, and conduct of a prototype clinical trial in which a radiolabeledmonoclonal antibody (MAb) is used as a diagnostic imaging agent to detect the site of a tumor in a patient who is being managed in a hospital outpatient setting. Examples are used to illustrate selected pharmaceutical care issues in this investigational environment.