Phase I clinical evaluation of 99mTc-labeled Affibody molecule for imaging HER2 expression in breast cancer

The determination of tumor human epidermal growth factor receptor type 2 (HER2) status is of increasing importance with the recent approval of more efficacious HER2-targeted treatments. There is a lack of suitable methods for clinical in vivo HER2 expression assessment. Affibody molecules are small affinity proteins ideal for imaging detection of receptors, which are engineered using a small (molecular weight 6.5 kDa) nonimmunoglobulin scaffold. Labeling of Affibody molecules with positron emitters enabled the development of sensitive and specific agents for molecular imaging. The development of probes for SPECT would permit the use of Affibody-based imaging in regions where PET is not available. In this first-in-human study, we evaluated the safety, biodistribution, and dosimetry of the 99mTc-ZHER2:41071 Affibody molecule developed for SPECT/CT imaging of HER2 expression. Methods: Thirty-one patients with primary breast cancer were enrolled and divided into three cohorts (injected with 500, 1000, or 1500 µg ZHER2:41071) comprising at least five patients with high (positive) HER2 tumor expression (IHC score 3+ or 2+ and ISH positive) and five patients with low (IHC score 2+ or 1+ and ISH negative) or absent HER2 tumor expression. Patients were injected with 451 ± 71 MBq 99mTc-ZHER2:4107. Planar scintigraphy was performed after 2, 4, 6 and 24 h, and SPECT/CT imaging followed planar imaging 2, 4 and 6 h after injection. Results: Injections of 99mTc-ZHER2:41071 were well tolerated and not associated with adverse events. Normal organs with the highest accumulation were the kidney and liver. The effective dose was 0.019 ± 0.004 mSv/MBq. Injection of 1000 µg provided the best standard discrimination between HER2-positive and HER2-low or HER2-negative tumors 2 h after injection (SUVmax 16.9 ± 7.6 vs. 3.6 ± 1.4, p < 0.005). The 99mTc-ZHER2:41071 uptake in HER2-positive lymph node metastases (SUVmax 6.9 ± 2.4, n = 5) was significantly (p < 0.05) higher than that in HER2-low/negative lymph nodes (SUVmax 3.5 ± 1.2, n = 4). 99mTc-ZHER2:41071 visualized hepatic metastases in a patient with liver involvement. Conclusions: Injections of 99mTc-ZHER2:41071 appear safe and exhibit favorable dosimetry. The protein dose of 1000 µg provides the best discrimination between HER2-positive and HER2-low/negative expression of HER2 according to the definition used for current HER2-targeting drugs.

P-672 Progestin primed ovarian stimulation: whether there is an effect on embryo euploidy and pregnancy rate in IVF programs with donor oocytes

Study question

Is there a difference in euploid embryo rates and pregnancy rates in IVF programs with donor oocytes after PPOS and GnRH-antagonist programs ?

Summary answer

We report no difference in euploid embryo rates and pregnancy rates in IVF programs with donor oocytes after PPOS and GnRH-antagonist programs.

What is known already

Before the advances in vitrification techniques, it was impossible to consider the feasibility of using steroids during controlled ovarian stimulation since it negatively impacts endometrial receptivity. Since it is possible to cryopreserve and thaw embryos, the frozen-embryo transfer has been widely used.

Progesterone soft gels have recently been shown to be an effective oral alternative for preventing premature LH surges during COH in normally ovulating women undergoing IVF/ICSI procedures with optimal pregnancy outcomes at transfer frozen-thawed embryos cycles. Thus, PPOs may be a priority choice for ovarian stimulation in the cycle of fertility preservation, oocyte donation, and preimplantation genetic testing.

Study design, size, duration

A retrospective cohort study of 201 IVF/ICSI programs with donor oocytes from January 2018 to September 2020.

Participants/materials, setting, methods

All programs were divided into 2 groups: 1 st group - 123 programs for the stimulation of oocyte donors with progestins primed ovarian stimulation, 2nd group - 93 programs with Cetrorelix as an LH peak blocker. We compared the number of mature oocytes, fertilization rate, blastulation rate, blastocyst and TQB quality, and euploid embryo rate after the preimplantation genetic screening with aCGH.

Main results and the role of chance

In our study, there were no statistically significant differences in the dose of gonadotropins in the groups, but the number of injections in the α group was less due to the exclusion of parenteral administration of antagonists and agonists, which improved the quality of life of donors during stimulation. There were no cases of stimulation complications in any group. The number of mature oocytes in both groups of oocyte donors did not differ (80 vs. 81%, respectively p ∠0.001.). The percentage of fertilization (80.8% in the 1st group and 77.5% in the 2nd group) and the frequency of blastulation (51.4% in the 1st group and 53.5% in the 2nd group) did not have significant differences both in the group with Utrozhestan and in the group with Cetrorelix. . The number of TQBs (68.8% vs. 66.4%) p∠0.001. and the level of euploid embryos in both groups was the same (51% vs. 59%) p ∠0.05.

The pregnancy rate in both groups also did not differ significantly (50.7% in the 1st group versus 41.5% in the 2nd group p∠ 0.001.).

Limitations, reasons for caution

The limitations are related to the study design. More research is also needed.

Wider implications of the findings

Thus, the progesterone protocol is effective, safe, convenient for oocyte donation, for patients with spontaneous ovulation in previous stimulation protocols, for patients with confirmed follicular luteinization in previous stimulation protocols.

PPOS does not worsen the pregnancy rate and the number of euploid embryos in the program with donor oocytes.

Trial registration number

not applicable

P-373 T657C SYCP3 mutation increases the risk of recurrent miscarriage: a meta-analysis

Study question

Is the carrying the unfavorable SYCP3 mutation T657C polymorphism increase risk of recurrent miscarriage?

Summary answer

We showed that carrying the T657C polymorphism of the SYCP3 mutation of the synaptonemal complex contributes among the genetic causes of recurrent miscarriage.

What is known already

Recurrent pregnancy loss (RPL) is one of the most common reproductive problems. RPL occurs in 0.5-3% of married couples. The causes of RNP are varied. One of the reasons may be the carriage of an unfavorable polymorphism T657C mutation SYCP3. However, previous studies show conflicting results on mutation rates in women with RPL.

Study design, size, duration

Recurrent pregnancy loss (RPL) is one of the most common reproductive problems. RPL occurs in 0.5-3% of married couples. The causes of RNP are varied. One of the reasons may be the carriage of an unfavorable polymorphism T657C mutation SYCP3. However, previous studies show conflicting results on mutation rates in women with RPL.

Participants/materials, setting, methods

We performed a meta-analysis to determine the strength of the evidence supporting the contribution of carrying the unfavorable SYCP3 mutation T657C polymorphism to recurrent miscarriage. We searched 2 databases (PubMed, Google Scholar) for studies reporting the impact of T657C SYCP3 mutation on recurrent miscarriage up to 20 October 2021. We built a funnel plot to assess the presence of publication bias.The odd ratio (OR) and its 95% confidence interval (95% CI) served as pooled results.

Main results and the role of chance

The review included four studies with 1161 patients: 529 patients with RPL and 632 healthy women. Compared with the control group of healthy women, the risk of recurrent miscarriage increased by 2.37 times with the T657C SYCP3 mutation (RR 2.37, 95% CI 1.39, 4.01, P  &lt;0.001).

Limitations, reasons for caution

The review included studies on different ethnic groups, patients were of different ages, which could affect the results of the studies.

Wider implications of the findings

Determining whether women with recurrent miscarriage belong to the carriers of the unfavorable polymorphism T657C of the SYCP3 mutation in the population will help in accumulating knowledge and understanding the processes of pregnancy loss.

Trial registration number

not avaliable

Phase I Clinical Trial Using [99mTc]Tc-1-thio-D-glucose for Diagnosis of Lymphoma Patients

Similar to [¹⁸F]-FDG, [^99mTc]Tc-1-thio-D-glucose ([^99mTc]Tc-TG) also binds to GLUT receptors. The aim of this Phase I study was to evaluate the safety, biodistribution and dosimetry of [^99mTc]Tc-TG. Twelve lymphoma patients were injected with 729 ± 102 MBq [^99mTc]Tc-TG. Whole-body planar imaging was performed in 10 patients at 2, 4, 6 and 24 h after injection. In all 12 patients, SPECT/CT (at 2 h) and SPECT (at 4 and 6 h) imaging was performed. Vital signs and possible side effects were monitored during imaging and up to 7 days after injection. [^99mTc]Tc-TG injections were well-tolerated and no side effects or alterations in blood and urine analyses data were observed. The highest absorbed dose was in the kidneys and urinary bladder wall, followed by the adrenals, prostate, bone marrow, lungs, myocardium, ovaries, uterus, liver and gall bladder wall. [^99mTc]Tc-TG SPECT/CT revealed foci of high activity uptake in the lymph nodes of all nine patients with known nodal lesions. Extranodal lesions were detected in all nine cases. In one patient, a lesion in the humerus head, which was not detected by CT, was visualized using [^99mTc]Tc-TG. Potentially, [^99mTc]Tc-TG can be considered as an additional diagnostic method for imaging GLUT receptors in lymphoma patients.

P–317 Uterine cavity in patients with repeated implantation failure (RIF) and before the first IVFprogram

Study question

What is the frequency of uterine pathology and histological analysis of chronic endometritis in the RIF group and in patients before the first IVF program?

Summary answer

We report a lower incidence of chronic endometritis in the group of patients just preparing for the first IVF program and higher effectiveness

What is known already

Chronic endometritis (CE) is one of the reasons for implantation failures in IVF cycles. The presence of chronic inflammation in the endometrium changes its susceptibility, resulting in failed implantations and loss of pregnancy. CE diagnostics is rather complicated. Visual examination during hysteroscopy allows one to suspect CE in 20–70%, routine histology - in 10–20%. The new gold standard is immunohistochemistry (IHC).

Study design, size, duration

A continuous study of 2003 hysteroscopies was carried out, conducted in 1944 patients from May 2018 to January 2020. All patients were divided into 2 groups: 1 - 650 patients preparing for IVF for the first time; 2 - 1294 with repeated implantation failures.

Participants/materials, setting, methods

All included patients had diagnostic office hysteroscopy (OH) with biopsy and IHC CD 138, CD 20, and CD 8. We compared the frequency of CE detection by visual examination during hysteroscopy, routine histology and IHC of the two groups, as well as the effectiveness of 1 course of antibiotic therapy with CE.

Main results and the role of chance

In group 1 of women preparing for IVF for the first time, during visual examination by hysteroscopy, CE was detected in 17% (110/650), in group 2 RIF - in 27% (349/1294), p &lt; 0.001. Routine histology also more often detected CE in the RIF group, 42% (543/1294) compared with group 1 - 23% (149/650), p &lt; 0.001. IHC markers of CE were detected in 81.8% (1058/1294) of samples from RIP group than in group 1 - 71.4% (464/650), p &lt; 0.001. At the same time, IHC mild CE was more common in group 1 in 320/650 (49.2%), p &lt; 0.001. In the second group, mild, moderate and severe CE occurred with the same frequency (33.2%, 36.5%, 30.3%, respectively). The frequency of CE detection by IHC in the groups after 1 course of antibiotic therapy with fluoroquinolones was 31.2% (145/464) and 43.2% (457/1058), respectively, p &lt; 0.001. The pregnancy rate (PR) also differed and was the lowest in the RIF group: in group 1 after treatment with CE PR = 42.7% (198/464), in group 2 after treatment with CE PR = 27.2% (288 / 1058), p &lt; 0.05.

Limitations, reasons for caution

The limitations are related to study design. More research is also needed.

Wider implications of the findings: The question of overdiagnosis of CE using IHC remains open. Therefore, well-designed prospective studies or RCTs should be conducted to clarify possible correlations between ChE and poor reproductive outcomes and the effectiveness of endometrial interventions and treatments.

Trial registration number

not avaliable

MODERN METHODS OF DIAGNOSIS AND TREATMENT OF CHRONIC ENDOMETRITIS, IN PREPARING PATIENTS FOR ASSISTED REPRODUCTIVE TREATMENT TECHNOLOGIES (LIT ERATURE REVIEW)

Since the chronic endometritis often leads to impaired reproductive function causing infertility, failed IVF attempts, miscarriage, and complicated pregnancy and childbirth, it has become not only medically relevant but also socially significant. For successful embryo implantation, the thickness of the endometrium should be at least 7 cm. Even though there is always a chance for embryo implantation, despite the endometrial hypoplasia, the attachment may be fragile, and such pregnancy may cease its development further on. Recently, in connection with an increase in the rate of developing allergic reactions, dysbacteriosis, and the emergence of drug-resistant strains of microorganisms, a search for new treatment methods to avoid these complications has begun. One of such methods in treating chronic endometritis, satisfying several requirements (efficiency, comfort, accessibility, safety), is the ultrasonic cavitation of the uterine cavity.

Monitoring hydroquinone–quinone redox cycling by single molecule fluorescence spectroscopy

Current research in the field of single-molecule chemistry is increasingly focused on the development of reliable experimental approaches for investigating chemical processes on a molecular level using single-molecule fluorescence spectroscopy (SMFS).