Holmium-166-DTPA as a liquid source for endovascular brachytherapy

Sol-gel-derived 58S bioactive glass containing holmium aiming brachytherapy applications: A dissolution, bioactivity, and cytotoxicity study

Bioactive glasses containing rare earth elements have been proposed as promising candidates for applications in brachytherapy of bone cancer. However, their safety relies on a proper dissolution to avoid radioactive materials in the human body, and desirable bioactive properties to regenerate the bone defect caused by the tumor. In this work, we proposed a new series of sol-gel-derived bioactive glasses containing holmium oxide, based on the system (100-x)(58SiO₂-33CaO-9P₂O₅)-xHo₂O₃ (x = 1.25, 2.5 and 5 wt%). The glasses were characterized regarding their dissolution behavior, bioactivity, and cytotoxicity with pre-osteoblastic cells. Also, in the dissolution experiments, the Arrhenius and Eyring equations were used to obtain some thermodynamic properties of glass dissolution. The results evidenced that the addition of holmium ions in the glass structure decreased the energy barrier of hydrolysis reactions, which favors glass dissolution in an early-stage. However, in the long-term, the strength of Si-O-Ho bonds may be the cause of more stable dissolution. Besides, glasses containing holmium were as bioactive as the 58S bioactive glasses, a highly bioactive composition. Cytotoxicity results showed that all glasses were not cytotoxic, and the composition containing 5 wt.% of Ho₂O₃ enhanced cell viability. Finally, these results suggest that these glasses are suitable materials for brachytherapy applications due to their proper dissolution behavior, high bioactivity, and high cell viability.

Feasibility of intratumoral 165Holmium siloxane delivery to induced U87 glioblastoma in a large animal model, the Yucatan minipig

Glioblastoma is the most aggressive primary brain tumor leading to death in most of patients. It comprises almost 50-55% of all gliomas with an incidence rate of 2-3 per 100,000. Despite its rarity, overall mortality of glioblastoma is comparable to the most frequent tumors. The current standard treatment combines surgical resection, radiotherapy and chemotherapy with temozolomide. In spite of this aggressive multimodality protocol, prognosis of glioblastoma is poor and the median survival remains about 12-14.5 months. In this regard, new therapeutic approaches should be developed to improve the life quality and survival time of the patient after the initial diagnosis. Before switching to clinical trials in humans, all innovative therapeutic methods must be studied first on a relevant animal model in preclinical settings. In this regard, we validated the feasibility of intratumoral delivery of a holmium (Ho) microparticle suspension to an induced U87 glioblastoma model. Among the different radioactive beta emitters, 166Ho emits high-energy β(-) radiation and low-energy γ radiation. β(-) radiation is an effective means for tumor destruction and γ rays are well suited for imaging (SPECT) and consequent dosimetry. In addition, the paramagnetic Ho nucleus is a good asset to perform MRI imaging. In this study, five minipigs, implanted with our glioblastoma model were used to test the injectability of 165Ho (stable) using a bespoke injector and needle. The suspension was produced in the form of Ho microparticles and injected inside the tumor by a technique known as microbrachytherapy using a stereotactic system. At the end of this trial, it was found that the 165Ho suspension can be injected successfully inside the tumor with absence or minimal traces of Ho reflux after the injections. This injection technique and the use of the 165Ho suspension needs to be further assessed with radioactive 166Ho in future studies.

The various therapeutic applications of the medical isotope holmium-166: a narrative review

Over the years, a broad spectrum of applications of the radionuclide holmium-166 as a medical isotope has been established. The isotope holmium-166 is attractive as it emits high-energy beta radiation which can be used for a therapeutic effect and gamma radiation which can be used for nuclear imaging purposes. Furthermore, holmium-165 can be visualized by MRI because of its paramagnetic properties and by CT because of its high density. Since holmium-165 has a natural abundance of 100%, the only by-product is metastable holmium-166 and no costly chemical purification steps are necessary for production of nuclear reactor derived holmium-166. Several compounds labelled with holmium-166 are now used in patients, such Ho¹⁶⁶-labelled microspheres for liver malignancies, Ho¹⁶⁶-labelled chitosan for hepatocellular carcinoma (HCC) and [¹⁶⁶Ho]Ho DOTMP for bone metastases. The outcomes in patients are very promising, making this isotope more and more interesting for applications in interventional oncology. Both drugs as well as medical devices labelled with radioactive holmium are used for internal radiotherapy. One of the treatment possibilities is direct intratumoural treatment, in which the radioactive compound is injected with a needle directly into the tumour. Numerous other applications have been developed, like patches for treatment of skin cancer and holmium labelled antibodies and peptides. The second major application that is currently clinically applied is selective internal radiation therapy (SIRT, also called radioembolization), a novel treatment option for liver malignancies. This review discusses medical drugs and medical devices based on the therapeutic radionuclide holmium-166.

Synthesis and application of a novel cysteine-based DTPA-NCS for targeted radioimmunotherapy

INTRODUCTION

For the development of safe and effective protein-based radiolabeled complexes such as radioimmunotherapy (RIT), the selection of the radionuclides and the chelating agents used for the radiolabeling of tumor-targeting molecules is a critical factor. We aim to synthesize a novel bifunctional chelating agent containing the isothiocyanate group for easy conjugation with antibodies having the characteristics of high stable chelation with therapeutic radionuclides.

METHODS

We have synthesized the DTPA analogue retaining L-cysteine as a core ligand of the thiol group. The chelating power of cysteine-based DTPA-NCS (cys-DTPA-NCS) was compared with that of commercial ρ-SCN-Bn-DTPA. In an application, the cetuximab was radioimmunoconjugated with (177)Lu using cys-DTPA-NCS. The affinity was tested in a cell line overexpressing EGFR. A therapy study was conducted in nude mice with subcutaneous HT-29 xenografts.

RESULTS

The cys-DTPA-NCS presents an excellent ability to chelate as compared to the ρ-SCN-Bn-DTPA. For mean ratio chemical labeling yields of 95%, the result was 0.97. (177)Lu-cys-DTPA-NCS-cetuximab was prepared under ambient condition with a high radiolabeling yield and the radiochemical purity was sustained for at least 6days. The IC50 value of the (177)Lu-labeled cetuximab was 10nM (95% confidence). The stability and therapeutic efficacy of the candidate radiopharmaceutical were verified.

CONCLUSION

The new DTPA derivative, cys-DTPA-NCS, is a good bifunctional chelating agent that can be used for protein-based radiopharmaceutical using lanthanides such as (177)Lu and (90)Y. The prepared (177)Lu-cys-DTPA-NCS-cetuximab can be used for the diagnosis and treatment of human colorectal tumor.

Isotopic tracer studies of chemical behavior of rare earth elements in environmental and biological sciences

Rare earth elements (REE), a group of elements with atomic numbers from 57 to 71, have been widely applied in recent years not only in industry but also in agriculture, forestry, animal husbandry and medicine. Numerous anthropogenic activities make REE to easily enter the environment and finally the human body via the food chain. Therefore, detailed studies on chemical behavior of these metals in environmental and biological systems are imperative. Isotopic tracer method is especially suited to such studies and has played an important role in assessing the environmental effects of REE. In this paper, some recent progress in the study of chemical behavior of REE in environmental and biological sciences made by the isotopic tracer method is outlined.

Effects of intraluminal irradiation with Holmium-166 for TIPS stenosis: experimental study in a swine model

OBJECTIVE

We wanted to evaluate the effectiveness of intraluminal irradiation with Holmium-166 ((166)Ho) for reducing the pseudointimal hyperplasia (PIH) in the transjugular intrahepatic portosystemic shunt (TIPS) tract in a swine model.

MATERIALS AND METHODS

TIPS was performed in 12 domestic pigs, after the creation of portal hypertension by intraportal injection of a mixture of N-butyl-2-cyanoacrylate (NBCA) and lipiodol. Five pigs first underwent intraluminal irradiation (30 Gy) in the parenchymal tract with using a (166)Ho solution-filled balloon catheter, and this was followed by the placement of a nitinol stent in the TIPS tract. For the seven control pigs, the balloon was filled with saline and contrast media mixture. Two weeks later, follow-up portography and histological analysis were performed.

RESULTS

TIPS was successfully performed in all twelve pigs with achieving artificially induced portal hypertension. Portography performed two weeks after TIPS showed the patent tracts in the TIPS tracts that were irradiated with (166)Ho (5/5, 100%), whereas either completely (5/6, 83.3%) or partially (1/6, 16.7%) occluded TIPS were seen in the seven pigs of the nonirradiated control group, except in one pig that experienced periprocedural death due to bleeding. Histological analysis showed a statistically significant difference for the maximal PIH (irradiated: 32.8%, nonirradiated: 76.0%, p < 0.001) between the two groups.

CONCLUSION

Intraluminal irradiation with 30 Gy of (166)Ho for TIPS significantly improved the TIPS patency in a swine model of portal hypertension during a 2-week period of follow-up.

Production of 166Ho through 164Dy(n,γ)165Dy(n, γ)166Dy(β−)166Ho and separation of 166Ho

After irradiation with thermal neutrons 164Dy produces 166Ho through the nuclear reaction: 164Dy(n, gamma) 165Dy(n, gamma) 166Dy beta- --> 166Ho. 166Ho has been separated from the bulk dysprosium target with the help of HPLC using Aminex A7 ion exchanger resin and alpha-hydroxyisobutyric acid (alpha-HIBA) as the mobile phase. The separation was quantitative and without any contamination from the dysprosium target. Method has also been developed to produce holmium free of alpha-HIBA ligands. Attempts have been made to produce no-carrier-added recoiled 166Ho and 165Dy in water.

The availability of contrast media in the application of Holmium-166-DTPA for vascular brachytherapy

Since coronary angioplasty using a liquid radiation source is performed with computed tomography(CT) angiography, use of a CT contrast agent is a good alternative to see if the balloon has close contact with the blood vessel wall for the delivery of a sufficient radiation dose to the stenotic artery. In order to examine the usefulness of the CT contrast agent as a diluent of a liquid radiation source, various physicochemical studies and in vivo stability studies using animals were implemented using (166)Ho-DTPA for vascular brachytherapy and a PTCA balloon catheter. For this study, three CT contrast agents, Hexabrix (320)(Rx), Iomeron (350)(Rx) and Visipaque (320)(Rx) were used. Results showed that (166)Ho radiolabeled component of Hexabrix (320)(Rx) and the (166)Ho-complex was proposed to be (166)Ho-EDTA. However, in the case of Iomeron (350)(Rx) and Visipaque (320)(Rx), no other (166)Ho-complex was formed except the desired (166)Ho-DTPA. In the case where (166)Ho-EDTA (>98% radiolabeling yield) was administrated to rabbits, only 10% of the administered dose was excreted through the urinary track 30 min after injection. However, in the animal experiment where Hexabrix (320)(Rx) was added to the (166)Ho-DTPA vial with the volume ratio of 1:1, over 80% of the administrated dose accumulated into the bladder within 30 min after injection. Therefore, Hexabrix (320)(Rx) is applicable when it is used as a diluent of a (166)Ho-based liquid radiation source and its volume is applied in a minimal manner to visualize the balloon catheter. In conclusion, the use of a CT contrast agent in the clinical application of a liquid radiation source has beneficiary effects such as visualization of both the position and shape of the balloon are possible and most importantly, whether or not there is a formation of a void volume of liquid inside the balloon as well as the detection of radiation leakage on a real-time basis, on site during the angioplasty.

Intracoronary 166Holmium brachytherapy combined with cutting balloon angioplasty for the treatment of in-stent restenosis

BACKGROUND

Brachytherapy is the only effective treatment for in-stent restenosis (ISR). The preliminary data regarding cutting balloon angioplasty (CBA) are encouraging and suggest a possible additive effect of CBA with combination with vascular brachytherapy. Hence, in this study, we evaluated the efficacy, feasibility and safety of cutting balloon angioplasty followed by intracoronary Holmium (166Ho) brachytherapy for the treatment of in-stent restenosis.

METHODS AND MATERIALS

Fifty-six patients with in-stent restenosis were treated with cutting balloon angioplasty and intracoronary 166Ho brachytherapy. For irradiation, a balloon approximately 10 mm longer than the initially deployed stent was filled with liquid 166Ho and placed at the in-stent restenosis lesion. The patients were followed angiographically at 6 months and clinically for 19.0+/-9.8 months.

RESULTS

The initial procedures were successful in all of the patients. The preprocedural average minimal luminal diameter (MLD) and stenosis rate were 0.57+/-0.30 mm and 80.2+/-11.6%, respectively. The MLD and residual stenosis immediately after the procedure was 2.43+/-0.37 and 13.8+/-9.9%, respectively. Thirty-nine (69.6%) patients have completed their angiographic follow-up at 6 months. The MLD, late loss and loss index at follow-up were 1.97+/-0.79 mm, 0.72+/-0.69 mm and 0.36+/-0.34, respectively. The target lesion restenosis rate was 20.5% and the target lesion revascularization rate was 3.6%. None of these patients presented with adverse coronary events such as MI, sudden cardiac death or stent thrombosis during the follow up period.

CONCLUSION

The combination therapy using cutting balloon angioplasty and intracoronary 166Ho brachytherapy may be an effective new treatment modality for in-stent restenosis.

166Ho-coated balloon for vascular brachytherapy

A simple procedure was developed for coating the surface of a conventional percutaneous transluminal coronary angioplasty balloon angioplasty catheter with 166Ho. The absorbed dose delivered by the surface-coated catheter is twice that of a similar catheter filled with a solution containing the same activity of 166Ho. Leakage tests show that <0.6% of the coated activity is removable from the surface of the catheter. The coated catheter removes the risk of release of the 166Ho into the body as a result of rupture of the balloon, and also reduces the radiation exposure to staff.