1
|
Pu Y, Li L, Peng H, Liu L, Heymann D, Robert C, Vallette F, Shen S. Drug-tolerant persister cells in cancer: the cutting edges and future directions. Nat Rev Clin Oncol 2023; 20:799-813. [PMID: 37749382 DOI: 10.1038/s41571-023-00815-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/27/2023]
Abstract
Drug-tolerant persister (DTP) cell populations were originally discovered in antibiotic-resistant bacterial biofilms. Similar populations with comparable features have since been identified among cancer cells and have been linked with treatment resistance that lacks an underlying genomic alteration. Research over the past decade has improved our understanding of the biological roles of DTP cells in cancer, although clinical knowledge of the role of these cells in treatment resistance remains limited. Nonetheless, targeting this population is anticipated to provide new treatment opportunities. In this Perspective, we aim to provide a clear definition of the DTP phenotype, discuss the underlying characteristics of these cells, their biomarkers and vulnerabilities, and encourage further research on DTP cells that might improve our understanding and enable the development of more effective anticancer therapies.
Collapse
Affiliation(s)
- Yi Pu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Department of Burn Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Li
- Lung Cancer Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Haoning Peng
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Dominique Heymann
- Nantes Université, CNRS, UMR6286, US2B, Nantes, France
- Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Caroline Robert
- INSERM U981, Gustave Roussy Cancer Campus, Villejuif, France
- Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - François Vallette
- Institut de Cancérologie de l'Ouest, Saint-Herblain, France.
- Nantes Université, INSERM, U1307, CRCI2NA, Nantes, France.
| | - Shensi Shen
- Department of Thoracic Surgery and Institute of Thoracic Oncology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
2
|
Suilamo S, Li XG, Lankinen P, Oikonen V, Tolvanen T, Luoto P, Viitanen R, Saraste A, Seppänen M, Pirilä L, Hohenthal U, Roivainen A. 68Ga-Citrate PET of Healthy Men: Whole-Body Biodistribution Kinetics and Radiation Dose Estimates. J Nucl Med 2022; 63:1598-1603. [PMID: 35273093 PMCID: PMC9536698 DOI: 10.2967/jnumed.122.263884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
68Ga-citrate has one of the simplest chemical structures of all 68Ga-radiopharmaceuticals, and its clinical use is justified by the proven medical applications using its isotope-labeled compound 67Ga-citrate. To support broader application of 68Ga-citrate in medical diagnosis, further research is needed to gain clinical data from healthy volunteers. In this work, we studied the biodistribution of 68Ga-citrate and subsequent radiation exposure from it in healthy men. Methods: 68Ga-citrate was prepared with an acetone-based radiolabeling procedure compliant with good manufacturing practices. Six healthy men (age 41 ± 12 y, mean ± SD) underwent sequential whole-body PET/CT scans after an injection of 204 ± 8 MBq of 68Ga-citrate. Serial arterialized venous blood samples were collected during PET imaging, and the radioactivity concentration was measured with a γ-counter. Urinary voids were collected and measured. The MIRD bladder-voiding model with a 3.5-h voiding interval was used. A model using a 70-kg adult man and the MIRD schema was used to estimate absorbed doses in target organs and effective doses. Calculations were performed using OLINDA/EXM software, version 2.0. Results: Radioactivity clearance from the blood was slow, and relatively high radioactivity concentrations were observed over the whole of the 3-h measuring period. Although radioactivity excretion via urine was rather slow (biologic half-time, 69 ± 24 h), the highest decay-corrected concentrations in urinary bladder contents were measured at the 90- and 180-min time points. Moderate concentrations were also seen in kidneys, liver, and spleen. The source organs showing the largest residence times were muscle, liver, lung, and heart contents. The heart wall received the highest absorbed dose, 0.077 ± 0.008 mSv/MBq. The mean effective dose (International Commission on Radiological Protection publication 103) was 0.021 ± 0.001 mSv/MBq. Conclusion: PET imaging with 68Ga-citrate is associated with modest radiation exposure. A 200-MBq injection of 68Ga-citrate results in an effective radiation dose of 4.2 mSv, which is in the same range as other 68Ga-labeled tracers. This suggests the feasibility of clinical studies using 68Ga-citrate imaging in humans and the possibility of performing multiple scans in the same subjects across the course of a year.
Collapse
Affiliation(s)
- Sami Suilamo
- Department of Medical Physics, Turku University Hospital, Turku, Finland
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Xiang-Guo Li
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Chemistry, University of Turku, Turku, Finland
- InFLAMES Research Flagship Center, University of Turku, Turku, Finland
| | - Petteri Lankinen
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Vesa Oikonen
- Turku PET Centre, University of Turku, Turku, Finland
| | - Tuula Tolvanen
- Department of Medical Physics, Turku University Hospital, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Pauliina Luoto
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | | | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | - Marko Seppänen
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Laura Pirilä
- Department of Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital; Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland; and
| | - Ulla Hohenthal
- Department of Infectious Diseases, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Anne Roivainen
- Turku PET Centre, University of Turku, Turku, Finland;
- InFLAMES Research Flagship Center, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
| |
Collapse
|
3
|
Wang Z, Hou Y, Cai L, Chen Y. The Evaluation of 68Ga-Citrate PET/CT Imaging for Dihydroartemisinin in the Treatment of Rheumatoid Arthritis. Mol Imaging Biol 2021; 23:30-37. [PMID: 32840716 DOI: 10.1007/s11307-020-01534-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/28/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We aimed to use 68Ga-citrate, a labeled product of gallium (iron analog), combined with positron emission tomography/computed tomography (PET/CT) to non-invasively evaluate the potential of the iron-responsive product dihydroartemisinin (DHA) in the treatment of rheumatoid arthritis. PROCEDURES From the establishment of chicken II collagen-induced arthritis (CIA) rat model over 40 days, 20 rats with one-to-one corresponding arthritis index (AI) scores were randomly divided into two groups. One group received oral DHA (at a dose of 1.5 ml/(kg day), containing 20 mg DHA per 1 ml) for 15 days; the other group received stroke-physiological saline solution (SSS, 1.5 ml/(kg day) for 15 days. 68Ga-citrate micro-PET/CT imaging was performed on day 0 (D0), day 5 (D5), day 10 (D10), and day 15 (D15) of oral administration. After data reconstruction, the cross-sectional length "d" of the ankle joint of each rat was measured on the transverse CT, and the SUVmax of the ankle joint and muscle background was measured for statistical analysis. After micro-PET/CT collection, the ankle joint tissue was observed by HE staining. RESULTS The ankle joint swelling in the DHA group was significantly suppressed, but the SSS group showed no significant suppression. 68Ga-citrate micro-PET/CT imaging results and microscope observation confirmed this finding. Statistical analysis indicated that the time tendency of AI score (Binteraction = 0.495, P < 0.001) and T/NT (Binteraction = 1.345, P < 0.001) were discrepant between DHA and SSS groups. The AI score and T/NT of the DHA group gradually increased with time, while the SSS group score gradually decreased. Furthermore, the Spearman correlation coefficient was used to describe the relationship between "d" and T/NT, which was positively correlated (r = 0.855, P < 0.001). CONCLUSIONS This study showed that the anti-inflammatory effect of the iron-responsive product DHA in arthritis can be monitored by an iron-like radioactive tracer (68Ga-citrate).
Collapse
Affiliation(s)
- Zi Wang
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University/Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Faculty of Chinese Medicine, Macau University of Science and Technology and State Key Laboratory of Quality Research in Chinese Medicine (Macau University of Science and Technology), Taipa, Macau, People's Republic of China
| | - Yu Hou
- Department of Neurosurgery, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Liang Cai
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University/Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
- Faculty of Chinese Medicine, Macau University of Science and Technology and State Key Laboratory of Quality Research in Chinese Medicine (Macau University of Science and Technology), Taipa, Macau, People's Republic of China
| | - Yue Chen
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University/Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China.
| |
Collapse
|
4
|
Seo Y, Khalighi MM, Wangerin KA, Deller TW, Wang YH, Jivan S, Kohi MP, Aggarwal R, Flavell RR, Behr SC, Evans MJ. Quantitative and Qualitative Improvement of Low-Count [ 68Ga]Citrate and [ 90Y]Microspheres PET Image Reconstructions Using Block Sequential Regularized Expectation Maximization Algorithm. Mol Imaging Biol 2020; 22:208-216. [PMID: 30993558 PMCID: PMC6800603 DOI: 10.1007/s11307-019-01347-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE There are several important positron emission tomography (PET) imaging scenarios that require imaging with very low photon statistics, for which both quantitative accuracy and visual quality should not be neglected. For example, PET imaging with the low photon statistics is closely related to active efforts to significantly reduce radiation exposure from radiopharmaceuticals. We investigated two examples of low-count PET imaging: (a) imaging [90Y]microsphere radioembolization that suffers the very small positron emission fraction of Y-90's decay processes, and (b) cancer imaging with [68Ga]citrate with uptake time of 3-4 half-lives, necessary for visualizing tumors. In particular, we investigated a type of penalized likelihood reconstruction algorithm, block sequential regularized expectation maximization (BSREM), for improving both image quality and quantitative accuracy of these low-count PET imaging cases. PROCEDURES The NEMA/IEC Body phantom filled with aqueous solution of Y-90 or Ga-68 was scanned to mimic the low-count scenarios of corresponding patient data acquisitions on a time-of-flight (TOF) PET/magnetic resonance imaging system. Contrast recovery, background variation, and signal-to-noise ratio were evaluated in different sets of count densities using both conventional TOF ordered subset expectation (TOF-OSEM) and TOF-BSREM algorithms. The regularization parameter, beta, in BSREM that controls the tradeoff between image noise and resolution was evaluated to find a value for improved confidence in image interpretation. Visual quality assessment of the images obtained from patients administered with [68Ga]citrate (n = 6) was performed. We also made preliminary visual image quality assessment for one patient with [90Y]microspheres. In Y-90 imaging, the effect of 511-keV energy window selection for minimizing the number of random events was also evaluated. RESULTS Quantitatively, phantom images reconstructed with TOF-BSREM showed improved contrast recovery, background variation, and signal-to-noise ratio values over images reconstructed with TOF-OSEM. Both phantom and patient studies of delayed imaging of [68Ga]citrate show that TOF-BSREM with beta = 500 gives the best tradeoff between image noise and image resolution based on visual assessment by the readers. The NEMA-IQ phantom study with [90Y]microspheres shows that the narrow energy window (460-562 keV) recovers activity concentrations in small spheres better than the regular energy window (425-650 keV) with the beta value of 2000 using the TOF-BSREM algorithm. For the images obtained from patients with [68Ga]citrate using TOF-BSREM with beta = 500, the visual analogue scale (VAS) was improved by 17 % and the Likert score was increased by 1 point on average, both in comparison to corresponding scores for images reconstructed using TOF-OSEM. CONCLUSION Our investigation shows that the TOF-BSREM algorithm improves the image quality and quantitative accuracy in low-count PET imaging scenarios. However, the beta value in this algorithm needed to be adjusted for each radiopharmaceutical and counting statistics at the time of scans.
Collapse
Affiliation(s)
- Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA.
- Department of Radiation Oncology, University of California, San Francisco, CA, USA.
- UC Berkeley - UCSF Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, California, CA, USA.
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
| | - Mohammad Mehdi Khalighi
- GE Healthcare, Waukesha, WI, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | | | | | | | - Salma Jivan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA
| | - Rahul Aggarwal
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, USA
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA
| | - Michael J Evans
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, USA
| |
Collapse
|
5
|
Metal-Based Complexes as Pharmaceuticals for Molecular Imaging of the Liver. Pharmaceuticals (Basel) 2019; 12:ph12030137. [PMID: 31527492 PMCID: PMC6789861 DOI: 10.3390/ph12030137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022] Open
Abstract
This article reviews the use of metal complexes as contrast agents (CA) and radiopharmaceuticals for the anatomical and functional imaging of the liver. The main focus was on two established imaging modalities: magnetic resonance imaging (MRI) and nuclear medicine, the latter including scintigraphy and positron emission tomography (PET). The review provides an overview on approved pharmaceuticals like Gd-based CA and 99mTc-based radiometal complexes, and also on novel agents such as 68Ga-based PET tracers. Metal complexes are presented by their imaging modality, with subsections focusing on their structure and mode of action. Uptake mechanisms, metabolism, and specificity are presented, in context with advantages and limitations of the diagnostic application and taking into account the respective imaging technique.
Collapse
|
6
|
Behr SC, Villanueva-Meyer JE, Li Y, Wang YH, Wei J, Moroz A, Lee JK, Hsiao JC, Gao KT, Ma W, Cha S, Wilson DM, Seo Y, Nelson SJ, Chang SM, Evans MJ. Targeting iron metabolism in high-grade glioma with 68Ga-citrate PET/MR. JCI Insight 2018; 3:93999. [PMID: 30385712 DOI: 10.1172/jci.insight.93999] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/27/2018] [Indexed: 11/17/2022] Open
Abstract
Noninvasive tools that target tumor cells could improve the management of glioma. Cancer generally has a high demand for Fe(III), an essential nutrient for a variety of biochemical processes. We tested whether 68Ga-citrate, an Fe(III) biomimetic that binds to apo-transferrin in blood, detects glioma in preclinical models and patients using hybrid PET/MRI. Mouse PET/CT studies showed that 68Ga-citrate accumulates in subcutaneous U87MG xenografts in a transferrin receptor-dependent fashion within 4 hours after injection. Seventeen patients with WHO grade III or IV glioma received 3.7-10.2 mCi 68Ga-citrate and were imaged with PET/MR 123-307 minutes after injection to establish that the radiotracer can localize to human tumors. Multiple contrast-enhancing lesions were PET avid, and tumor to adjacent normal white matter ratios were consistently greater than 10:1. Several contrast-enhancing lesions were not PET avid. One minimally enhancing lesion and another tumor with significantly reduced enhancement following bevacizumab therapy were PET avid. Advanced MR imaging analysis of one patient with contrast-enhancing glioblastoma showed that metabolic hallmarks of viable tumor spatially overlaid with 68Ga-citrate accumulation. These early data underscore that high-grade glioma may be detectable with a radiotracer that targets Fe(III) transport.
Collapse
Affiliation(s)
- Spencer C Behr
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | | | - Yan Li
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Yung-Hua Wang
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Junnian Wei
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Anna Moroz
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA.,Skolkovo Institute of Science and Technology, Skolkovo Innovation Center, Moscow, Russia
| | - Julia Kl Lee
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Jeffrey C Hsiao
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Kenneth T Gao
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Wendy Ma
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Sarah J Nelson
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA.,Helen Diller Family Comprehensive Cancer Center.,Department of Bioengineering and Therapeutic Sciences
| | - Susan M Chang
- Helen Diller Family Comprehensive Cancer Center.,Department of Neurological Surgery, and
| | - Michael J Evans
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA.,Helen Diller Family Comprehensive Cancer Center.,Department of Pharmaceutical Chemistry, UCSF, San Francisco, California, USA
| |
Collapse
|