Evaluation of glioma proliferation by 99mTc-Tetrofosmin

Synthesis and Biological Evaluation of 99mTc-Labeled Phenylpiperazine Derivatives as Selective Serotonin-7 Receptor Ligands for Brain Tumor Imaging

With a poor prognosis, glioblastoma multiforme is the most aggressive tumor of the central nervous system in humans. The aim of this study was to develop novel tracers for the tumor targeting and imaging of overexpressed serotonin-7 receptors (5-HT₇Rs) in U-87 MG glioma xenografted nude mice. Two phenylpiperazine derivatives named as PHH and MPHH were designed, and the corresponding radiotracers ^99mTc-PHH and ^99mTc-MPHH were synthesized in high radiochemical purity (>95%). ^99mTc-MPHH showed a higher affinity to 5-HT₇Rs on U-87 MG cells compared to ^99mTc-PHH. In biodistribution studies, the radiocomplexes showed good brain uptake at 15 min combined with good radioactivity retention in the brain for 240 min. Regional rabbit brain studies indicated a higher radioactivity concentration in the hippocampus and diencephalon than in the cerebellum. Compared to ^99mTc-MPHH, the ^99mTc-PHH exhibited a significantly increased tumor uptake at 15 and 60 min, but the rapid blood clearance of ^99mTc-MPHH led to enhanced tumor-to-muscle ratios at 240 min. A significant reduction in tumor uptake 60 min after an injection of pimozide (5-HT₇ receptor antagonist) confirms the tumor uptake was receptor-mediated specifically. The tumor-to-contralateral muscle tissue ratio of ^99mTc-PHH and ^99mTc-MPHH in nude mice with U-87 MG xenograft was measured (5.25 and 4.65) at 60 min as well as (6.25 and 6.76) at 240 min, respectively.

Synthesis and evaluation of 99mTc/Re-tricarbonyl complexes of the triphenylphosphonium cation for mitochondrial targeting

INTRODUCTION

Lipophilic delocalized cations accumulate in tumor cell mitochondria due to their higher transmembrane potential. In this work, this strategy was adopted for the development of ^99mTc tumor-targeted imaging agents.

METHODS

Two tridentate ligands containing the triphenylphosphonium cation, L1 (S-cysteinyl) and L2 (N-iminodiacetate) as well as the respective ^99mTc/ReL1 and ^99mTc/ReL2 tricarbonyl complexes were synthesized. The effect of the ligands and the Re complexes on cell growth in U-87 MG glioblastoma cells was assessed. In vitro stability studies and measurement of logP of the ^99mTc tracers was performed. The cellular and mitochondrial uptake of the ^99mTc tracers in U-87 MG cells was evaluated. Biodistribution of ^99mTcL1 and ^99mTcL2 were performed on SCID mice bearing U-87 MG tumors.

RESULTS

The ligands L1, L2 and the Re1 and ReL2 complexes were characterized spectroscopically. Single products ^99mTcL1 and ^99mTcL2, >90% stable in rat serum, were obtained. LogP was 0.40±0.14 for ^99mTcL1 and -0.02±0.07 for ^99mTcL2. L1, ReL1 and ReL2 caused no notable cytotoxicity and L2 was found to infer 40% inhibition of cellular growth at 10^-5M as well as 80% cell death in culture at 10^-4M. The cell uptake of ^99mTcL1 and ^99mTcL2 over 4h was 1.26±0.08% and 0.06±0.01% respectively, of which 13.41±3.63% and 18.61±6.19% was distributed in the mitochondria respectively. The initial tumor uptake in mice was found to be >1% ID/g for both ^99mTc tracers.

CONCLUSIONS

In vitro mitochondrial and in vivo tumor targeting was observed, better in ^99mTcL1, however these properties should be optimized in future studies. Advances in Knowledge and Implications for Patient Care: Continuous efforts in this direction may lead to a suitable mitochondrial-targeted ^99mTc imaging agent for tumor detection.

The emerging role of tumor-suppressive microRNA-218 in targeting glioblastoma stemness

Glioblastoma multiforme (GBM) is by far the most common and most aggressive malignant primary tumor in humans and has poor outcomes despite many advances in treatment using combinations of surgery, radiotherapy and chemotherapy. Recent studies demonstrate that GBM contains a subpopulation of cancer cells with stem cell characteristics, including self-renewal and multipotentiality, and that these cancer stem cells contribute to disease progression. MicroRNAs (miRNAs) are small non-coding regulatory RNA molecules that regulate a variety of cellular processes, including stem cell maintenance. An accumulating body of evidence shows that miR-218 may act as a tumor suppressor by inhibiting glioblastoma invasion, migration, proliferation and stemness through its different targets, indicating the great potential and relevance of miR-218 as a novel class of therapeutic target in glioblastoma.

Comparison of diffusion tensor, dynamic susceptibility contrast MRI and (99m)Tc-Tetrofosmin brain SPECT for the detection of recurrent high-grade glioma

INTRODUCTION

Treatment induced necrosis is a relatively frequent finding in patients treated for high-grade glioma. Differentiation by imaging modalities between glioma recurrence and treatment induced necrosis is not always straightforward. This is a comparative study of diffusion tensor imaging (DTI), dynamic susceptibility contrast MRI and (99m)Tc-Tetrofosmin brain single-photon emission computed tomography (SPECT) for differentiation of recurrent glioma from treatment induced necrosis.

METHODS

A prospective study was made of 30 patients treated for high-grade glioma who had suspected recurrent tumor on follow-up MRI. All had been treated by surgical resection of the tumor followed by standard postoperative radiotherapy with chemotherapy. No residual tumor had been found on brain imaging immediately after the initial treatment. All the patients were studied with dynamic susceptibility contrast brain MRI and, within a week, (99m)Tc-Tetrofosmin brain SPECT.

RESULTS

Both (99m)Tc-Tetrofosmin brain SPECT and dynamic susceptibility contrast MRI could discriminate between tumor recurrence and treatment induced necrosis with 100% sensitivity and 100% specificity. An apparent diffusion coefficient (ADC) ratio cut-off value of 1.27 could differentiate recurrence from treatment induced necrosis with 65% sensitivity and 100% specificity and a fractional anisotropy (FA) ratio cut-off value of 0.47 could differentiate recurrence from treatment induced necrosis with 57% sensitivity and 100% specificity. A significant correlation was demonstrated between (99m)Tc-Tetrofosmin uptake ratio and rCBV (P=0.003).

CONCLUSIONS

Dynamic susceptibility contrast MRI and brain SPECT with (99m)Tc-Tetrofosmin had the same accuracy and may be used to detect recurrent tumor following treatment for glioma. DTI also showed promise for the detection of recurrent tumor, but was inferior to both dynamic susceptibility contrast MRI and brain SPECT.

Correlation of diffusion tensor, dynamic susceptibility contrast MRI and (99m)Tc-Tetrofosmin brain SPECT with tumour grade and Ki-67 immunohistochemistry in glioma

OBJECTIVE

Assessment of the grade and type of glioma is of paramount importance for prognosis. Tumour proliferative potentials may provide additional information on the behaviour of the tumour, its response to treatment and prognosis. The purpose of this study was to investigate the correlation between diffusion tensor imaging (DTI), dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) and (99m)Tc-Tetrofosmin brain single-photon emission computed tomography (SPECT), and the tumour grade and Ki-67 labelling index in newly diagnosed gliomas.

METHODS

Study was made of patients with suspected glioma on brain MRI between December 2010 and January 2012, by DTI, DSC MRI and (99m)Tc-Tetrofosmin brain SPECT. The proliferative activity of each tumour was measured by deriving the Ki-67 proliferation index from immunohistochemical staining of tumour specimens.

RESULTS

Glioma was newly diagnosed in 25 patients (17 men, 8 women, aged 19-79 years, median 55 years). The Ki-67 index ranged from 1% to 80% (mean 19.4%). On evaluation of the relationship between the (99m)Tc-Tetrofosmin tumour uptake by gliomas was found to be significantly correlated with cellular proliferation (rho=0.924, p<0.0001). Regarding DTI, significant negative correlation was demonstrated between the apparent diffusion coefficient (ADC) ratio and the Ki-67 index (rho=-0.545, p=0.0087). Significant correlation was also observed between the fractional anisotropy (FA) ratio and the Ki-67 index (rho=0.489, p=0.02). Strong correlation was found between relative cerebral blood volume (rCBV) and Ki-67 index (rho=0.853, p<0.0001), and between the (99m)Tc-Tetrofosmin lesion-to-normal (L/N) uptake ratio and rCBV (rho=0.808, p ≤ 0.0001). Significant negative correlation was demonstrated between the (99m)Tc-Tetrofosmin L/N ratio and ADC ratio (rho=-0.513, p=0.014). These imaging techniques were able to distinguish between low-grade and high-grade gliomas.

CONCLUSIONS

Findings on DSC MRI and brain SPECT with (99m)Tc-Tetrofosmin metrics were more closely correlated with glioma cellular proliferation.

Relation between (99m)Tc-tetrofosmin thyroid scintigraphy and mitogen-activated protein kinase in papillary thyroid cancer patients

PURPOSE

The aim of this study was to investigate the relation between (99m)Tc-tetrofosmin uptake and extracellular signal-regulated kinase mitogen-activated protein kinase (ERK MAPK) expression in papillary thyroid cancer patients.

MATERIALS AND METHODS

Our study population consisted of 14 patients. The histopathological findings for all patients were confirmed by surgery. Patients were administ 740 MBq of (99m)Tc-tetrofosmin. The tumor/background (T/B) ratios in regions of interest (ROIs) were measured at 10 min, 1 h, and 3 h to determine the uptake by papillary cancer. Immunohistopathological staining was performed, and the expression of phospho-ERK MAPK in papillary cancer was investigated. The relation between the expression of phospho-ERK MAPK and the T/B ratio was examined using the Mann-Whitney U-test.

RESULTS

(99m)Tc-tetrofosmin uptake was positive in all patients. There was a statistically significant relation between the T/B ratio (at 3 h) and the expression of phospho-ERK MAPK but not with the T/B ratio at 10 min or 1 h: T/B ratio at 10 min (P = 0.32), at 1 h (P = 0.62), and at 3 h (P = 0.0072).

CONCLUSION

Our results suggest that the relation between (99m)Tc-tetrofosmin uptake (3 h T/B ratio) may lead us to assume cell proliferation of papillary cancer.

Assessment of glioma proliferation using imaging modalities

The assessment of glioma proliferation rate is important to predict tumor behavior, response to therapy and prognosis. Various methods, largely involving immunohistological markers in tissue samples, have been proposed to this aim; however, they all require tissue removal through a biopsy or during a surgical procedure. Consequently, non-invasive imaging modalities that could reliably assess the proliferative potential of intracranial space-occupying lesions in vivo would be of obvious significance. In the present study we review the contribution of MRI, positron emission tomography and single-photon emission CT for the assessment of the proliferative potential of gliomas.