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Schilham MGM, Somford DM, Küsters-Vandevelde HVN, Hermsen R, van Basten JPA, Hoekstra RJ, Scheenen TWJ, Gotthardt M, Sedelaar JPM, Rijpkema M. Prostate-Specific Membrane Antigen-Targeted Radioguided Pelvic Lymph Node Dissection in Newly Diagnosed Prostate Cancer Patients with a Suspicion of Locoregional Lymph Node Metastases: The DETECT Trial. J Nucl Med 2024; 65:423-429. [PMID: 38176721 DOI: 10.2967/jnumed.123.266495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 01/06/2024] Open
Abstract
Prostate-specific membrane antigen (PSMA)-targeted radioguided surgery (RGS) aims to optimize the peroperative detection and removal of PSMA-avid lymph node (LN) metastases (LNMs) and has been described in patients with recurrent prostate cancer (PCa). In newly diagnosed PCa patients undergoing pelvic LN dissections, PSMA RGS could guide the urologist toward PSMA-expressing LNMs as identified on preoperative 18F-PSMA PET/CT imaging. The objective was to evaluate the safety and feasibility of 111In-PSMA RGS in primary PCa patients with one or more suggestive LNs on preoperative 18F-PSMA PET/CT. Methods: This prospective, phase I/II study included 20 newly diagnosed PCa patients with at least 1 suggestive LN on preoperative 18F-PSMA PET/CT. PSMA RGS was performed 24 h after 111In-PSMA-I&T administration, and postoperative 18F-PSMA PET/CT was performed to verify successful removal of the suggestive lesions. The primary endpoint was determination of the safety and feasibility of 111In-PSMA RGS. Safety was assessed by monitoring adverse events. Feasibility was described as the possibility to peroperatively detect suggestive LNs as identified on preoperative imaging. Secondary outcomes included the accuracy of 111In-PSMA RGS compared with histopathology, tumor- and lesion-to-background ratios, and biochemical recurrence. Results: No tracer-related adverse events were reported. In 20 patients, 43 of 49 (88%) 18F-PSMA PET-suggestive lesions were successfully removed. 111In-PSMA RGS facilitated peroperative identification and resection of 29 of 49 (59%) RGS-target lesions, of which 28 (97%) contained LNMs. Another 14 of 49 (29%) resected LNs were not detected with 111In-PSMA RGS, of which 2 contained metastases. Conclusion: 111In-PSMA RGS is a safe and feasible procedure that allows peroperative detection of 18F-PSMA PET/CT-suggestive lesions in newly diagnosed PCa patients. The use of a radioactive PSMA tracer and a detection device (γ-probe) during surgery helps in identifying LNs that were suggestive of PCa metastases on the 18F-PSMA PET/CT before surgery and thus may improve the peroperative identification and removal of these LNs.
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Affiliation(s)
- Melline G M Schilham
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands;
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Diederik M Somford
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Rick Hermsen
- Department of Nuclear Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jean Paul A van Basten
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Robert J Hoekstra
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands; and
| | - Tom W J Scheenen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark Rijpkema
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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Riviere D, Aarntzen E, van Geenen E, Chang D, de Geus-Oei LF, Brosens L, van Laarhoven K, Gotthardt M, Hermans J. Qualitative flow metabolic phenotype of pancreatic cancer. A new prognostic biomarker? HPB (Oxford) 2024; 26:389-399. [PMID: 38114400 DOI: 10.1016/j.hpb.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/26/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Retrospective analysis to investigate the relationship between the flow-metabolic phenotype and overall survival (OS) of pancreatic ductal adenocarcinoma (PDAC) and its potential clinical utility. METHODS Patients with histopathologically proven PDAC between 2005 and 2014 using tumor attenuation on routine pre-operative CECT as a surrogate for the vascularity and [18F]FDG-uptake as a surrogate for metabolic activity on [18F]FDG-PET. RESULTS In total, 93 patients (50 male, 43 female, median age 63) were included. Hypoattenuating PDAC with high [18F]FDG-uptake has the poorest prognosis (median OS 7 ± 1 months), compared to hypoattenuating PDAC with low [18F]FDG-uptake (median OS 11 ± 3 months; p = 0.176), iso- or hyperattenuating PDAC with high [18F]FDG-uptake (median OS 15 ± 5 months; p = 0.004) and iso- or hyperattenuating PDAC with low [18F]FDG-uptake (median OS 23 ± 4 months; p = 0.035). In multivariate analysis, surgery combined with tumor differentiation, tumor stage, systemic therapy and flow metabolic phenotype remained independent predictors for overall survival. DISCUSSION The novel qualitative flow-metabolic phenotype of PDAC using a combination of CECT and [18F]FDG-PET features, predicted significantly worse survival for hypoattenuating-high uptake pancreatic cancers compared to the other phenotypes.
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Affiliation(s)
- Deniece Riviere
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Erik Aarntzen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Erwin van Geenen
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - David Chang
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Bearsden, Glasgow, Scotland, United Kingdom; West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lodewijk Brosens
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kees van Laarhoven
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - John Hermans
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
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Bol KF, Schreibelt G, Bloemendal M, van Willigen WW, Hins-de Bree S, de Goede AL, de Boer AJ, Bos KJH, Duiveman-de Boer T, Olde Nordkamp MAM, van Oorschot TGM, Popelier CJ, Pots JM, Scharenborg NM, van de Rakt MWMM, de Ruiter V, van Meeteren WS, van Rossum MM, Croockewit SJ, Koeneman BJ, Creemers JHA, Wortel IMN, Angerer C, Brüning M, Petry K, Dzionek A, van der Veldt AA, van Grünhagen DJ, Werner JEM, Bonenkamp JJ, Haanen JBAG, Boers-Sonderen MJ, Koornstra RHT, Boomsma MF, Aarntzen EHJ, Gotthardt M, Nagarajah J, de Witte TJM, Figdor CG, de Wilt JHW, Textor J, de Groot JWB, Gerritsen WR, de Vries IJM. Adjuvant dendritic cell therapy in stage IIIB/C melanoma: the MIND-DC randomized phase III trial. Nat Commun 2024; 15:1632. [PMID: 38395969 PMCID: PMC10891118 DOI: 10.1038/s41467-024-45358-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Autologous natural dendritic cells (nDCs) treatment can induce tumor-specific immune responses and clinical responses in cancer patients. In this phase III clinical trial (NCT02993315), 148 patients with resected stage IIIB/C melanoma were randomized to adjuvant treatment with nDCs (n = 99) or placebo (n = 49). Active treatment consisted of intranodally injected autologous CD1c+ conventional and plasmacytoid DCs loaded with tumor antigens. The primary endpoint was the 2-year recurrence-free survival (RFS) rate, whereas the secondary endpoints included median RFS, 2-year and median overall survival, adverse event profile, and immunological response The 2-year RFS rate was 36.8% in the nDC treatment group and 46.9% in the control group (p = 0.31). Median RFS was 12.7 months vs 19.9 months, respectively (hazard ratio 1.25; 90% CI: 0.88-1.79; p = 0.29). Median overall survival was not reached in both treatment groups (hazard ratio 1.32; 90% CI: 0.73-2.38; p = 0.44). Grade 3-4 study-related adverse events occurred in 5% and 6% of patients. Functional antigen-specific T cell responses could be detected in 67.1% of patients tested in the nDC treatment group vs 3.8% of patients tested in the control group (p < 0.001). In conclusion, while adjuvant nDC treatment in stage IIIB/C melanoma patients generated specific immune responses and was well tolerated, no benefit in RFS was observed.
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Affiliation(s)
- Kalijn F Bol
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
- Department of Medical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Gerty Schreibelt
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Martine Bloemendal
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
- Department of Medical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Wouter W van Willigen
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
- Department of Medical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Simone Hins-de Bree
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Anna L de Goede
- Department of Pharmacy, Radboud university medical center, Nijmegen, The Netherlands
| | - Annemiek J de Boer
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Kevin J H Bos
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Tjitske Duiveman-de Boer
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Michel A M Olde Nordkamp
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Tom G M van Oorschot
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Carlijn J Popelier
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Jeanne M Pots
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Nicole M Scharenborg
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Mandy W M M van de Rakt
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Valeska de Ruiter
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Wilmy S van Meeteren
- Department of Dermatology, Radboud university medical center, Nijmegen, The Netherlands
| | - Michelle M van Rossum
- Department of Dermatology, Radboud university medical center, Nijmegen, The Netherlands
| | - Sandra J Croockewit
- Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
| | - Bouke J Koeneman
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Jeroen H A Creemers
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Inge M N Wortel
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
- Department of Data Science, Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | | | | | | | | | - Astrid A van der Veldt
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Dirk J van Grünhagen
- Department Surgical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Johanna E M Werner
- Department Surgical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Johannes J Bonenkamp
- Department Surgical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - John B A G Haanen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Rutger H T Koornstra
- Department of Medical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Martijn F Boomsma
- Department of Radiology, Isala Oncology Center, Zwolle, The Netherlands
| | - Erik H J Aarntzen
- Department of Medical Imaging, Radboud university medical center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud university medical center, Nijmegen, The Netherlands
| | - James Nagarajah
- Department of Medical Imaging, Radboud university medical center, Nijmegen, The Netherlands
| | - Theo J M de Witte
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Carl G Figdor
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
| | - Johannes H W de Wilt
- Department Surgical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Johannes Textor
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands
- Department of Data Science, Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | | | - Winald R Gerritsen
- Department of Medical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - I Jolanda M de Vries
- Medical Biosciences, Radboud Institute for Medical Innovation, Radboud university medical center, Nijmegen, The Netherlands.
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Ambrosini V, Carrilho Vaz S, Ahmadi Bidakhvidi N, Chanchou M, Cysouw MCF, Serani F, Voltin CA, Kraeber-Bodere F, Deroose CM, De Geus-Oei LF, Eiber M, Gnanasegaran G, Gotthardt M, Kobe C, Konijnenberg MW, Nanni C, Oprea Lager DE, Rahbar K, Taieb D, Mottaghy FM, Goffin K, Herrmann K. How to attract young talent to nuclear medicine step 1: a survey conducted by the EANM Oncology and Theranostics Committee to understand the expectations of the next generation. Eur J Nucl Med Mol Imaging 2023; 51:3-11. [PMID: 37689611 PMCID: PMC10684400 DOI: 10.1007/s00259-023-06389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Affiliation(s)
- Valentina Ambrosini
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Massarenti 9, 40138, Bologna, Italy.
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Sofia Carrilho Vaz
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Niloefar Ahmadi Bidakhvidi
- Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Marion Chanchou
- University Hospital Assistant in Biophysics and Nuclear Medicine, Jean Perrin Cancer Center, Clermont Auvergne University, UMR 1240 INSERM/IMoST UCA, Clermont-Ferrand, France
| | - Matthijs C F Cysouw
- Department of Radiology and Nuclear Medicine, Location VUmc, De Boelelaan 1117 1081 HV, Amsterdam, The Netherlands
| | - Francesca Serani
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Conrad-Amadeus Voltin
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Francoise Kraeber-Bodere
- INSERM, CNRS, CRCI2NA, Médecine Nucléaire, Nantes Université, Université Angers, CHU Nantes, F-44000, Nantes, France
| | - Christophe M Deroose
- Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Lioe-Fee De Geus-Oei
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
- Department of Radiation Science & Technology, Delft University of Technology, Delft, The Netherlands
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | | | - Martin Gotthardt
- Department of Medical Imaging, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mark W Konijnenberg
- Radiology & Nuclear Medicine Department, Erasmus MC, Rotterdam, The Netherlands
| | - Cristina Nanni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Daniela E Oprea Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - David Taieb
- Nuclear Medicine Diagnostic Imaging and Endoradiotherapy Center Aix-Marseille University CHU de La Timone, Marseille Cedex 5, Marseille, France
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Karolien Goffin
- Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Schilham MGM, Somford DM, Veltien A, Zamecnik P, Barentsz JO, Sedelaar MJPM, Kusters-Vandevelde HVN, Gotthardt M, Rijpkema M, Scheenen TWJ. Subnodal Correspondence of PSMA Expression and USPIO-MRI in Metastatic Pelvic Lymph Nodes in Prostate Cancer. Invest Radiol 2023:00004424-990000000-00174. [PMID: 37975702 DOI: 10.1097/rli.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Two advanced imaging modalities used to detect lymph node (LN) metastases in prostate cancer patients are prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography and ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI). As these modalities use different targets, a subnodal comparison is needed to interpret both their correspondence and their differences. The aim of this explorative study was to compare ex vivo 111In-PSMA μSPECT images with high-resolution 7 T USPIO μMR images and histopathology of resected LN specimens from prostate cancer patients to assess the degree of correspondence at subnodal level. MATERIALS AND METHODS Twenty primary prostate cancer patients who underwent pelvic LN dissection were included and received USPIO contrast and 111In-PSMA. A total of 41 LNs of interest (LNOIs) were selected for ex vivo imaging based on γ-probe detection or palpation. μSPECT and μMRI acquisition were performed immediately after resection. Overlay of μSPECT images on MR images was performed, and the level of correspondence (LoC) between μSPECT and μMR findings was assessed according to a 4-point Likert classification scheme. RESULTS Forty-one LNOIs could be matched to an LN on ex vivo μMRI. Coregistration of μSPECT and USPIO-enhanced water-selective multigradient echo MR images was successful for all 41 LNOIs. Ninety percent of the lesions showed excellent correspondence regarding the presence of metastatic tissue and affected subnodal site (LoC 4; 37/41). In only 1 of 41 LNOIs, a small metastasis was misclassified by both techniques. Three LNOIs were classified as LoC 3 (7%) and 1 LNOI as LoC 2. All LoC 2 and LoC 3 lesions had PSMA-expressing metastases on final histopathology. CONCLUSIONS Coregistration of μSPECT and USPIO-μMRI showed excellent subnodal correspondence in the majority (90%) of LNs. Ex vivo imaging may thus help localize small cancer deposits within resected LNs and could contribute to improved interpretation of in vivo imaging of LNs.
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Affiliation(s)
- Melline Gabrielle Maria Schilham
- From the Department of Medical Imaging-Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (M.G.M.S., A.V., P.Z., J.O.B., M.G., M.R., T.W.J.S.); Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, the Netherlands (D.M.S., J.P.M.S.); Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (D.M.S.); Andros Clinics, Medical Imaging, Arnhem, the Netherlands (J.O.B.); Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.M.S.); and Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (H.V.N.K.-V.)
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Drissen MMCM, Vos JR, Netea-Maier RT, Gotthardt M, Hoogerbrugge N. Detection and yield of thyroid cancer surveillance in adults with PTEN hamartoma tumour syndrome. Endocr Relat Cancer 2023; 30:e230009. [PMID: 37451289 DOI: 10.1530/erc-23-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/14/2023] [Indexed: 07/18/2023]
Abstract
Thyroid cancer surveillance (TCS) with ultrasound (US) is advised for PTEN hamartoma tumour syndrome (PHTS) patients due to increased thyroid cancer (TC) risk. However, data supporting TCS guidelines are scarce. We aimed to assess the detection and yield of annual TCS with US in adult PHTS patients without a TC history and to evaluate the impact of a reduced US interval on the TCS yield. A retrospective cohort study was conducted, including adult PHTS patients and medical record data between 2005 and 2021. The yield from annual TCS was compared with hypothetical biennial and triennial TCS after two initial US with annual interval by counting delayed detection of nodular growth, thyroid adenoma, and TC. During 279 follow-up years, 84 patients (median age 40 years) underwent 349 US. Thyroidectomy was performed in 6/84 (7%) patients, revealing a minimally invasive follicular TC in one patient aged 22 and a thyroid adenoma in two patients aged 21 and 53. Multiple thyroid nodules were diagnosed in 73/84 (87%) patients (median age 36 years). Nodular growth was detected in 9/56 (16%) patients, and its detection would have been delayed in 4-7% US rounds with biennial TCS, and in 2-6% US rounds with triennial TCS. US-based thyroiditis and indeterminate non-malignant lymph nodes were found in 8/74 (11%) and 7/72 (10%) patients, respectively. Following our findings combined with the literature, we propose starting TCS before age 18 and reducing the follow-up frequency after the initial two US from annual to biennial if no suspicious findings are detected.
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Affiliation(s)
- Meggie M C M Drissen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janet R Vos
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Romana T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Laarhuis BI, Janssen MJR, Simons M, van Kalmthout LWM, van der Doelen MJ, Peters SMB, Westdorp H, van Oort IM, Litjens G, Gotthardt M, Nagarajah J, Mehra N, Privé BM. Tumoral Ki67 and PSMA Expression in Fresh Pre-PSMA-RLT Biopsies and Its Relation With PSMA-PET Imaging and Outcomes of PSMA-RLT in Patients With mCRPC. Clin Genitourin Cancer 2023; 21:e352-e361. [PMID: 37164814 DOI: 10.1016/j.clgc.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/13/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Prostate specific membrane antigen (PSMA) directed radioligand therapy (RLT) is a novel therapy for metastatic castration-resistant prostate cancer (mCRPC) patients. However, it is still poorly understood why approximately 40% of the patients does not respond to PSMA-RLT. The aims of this study were to evaluate the pretreatment PSMA expression on immunohistochemistry (IHC) and PSMA uptake on PET/CT imaging in mCRPC patients who underwent PSMA-RLT. We correlated these parameters and a cell proliferation marker (Ki67) to the therapeutic efficacy of PSMA-RLT. PATIENTS AND METHODS In this retrospective study, mCRPC patients who underwent PSMA-RLT were analyzed. Patients biopsies were scored for immunohistochemical Ki67 expression, PSMA staining intensity and percentage of cells with PSMA expression. Moreover, the PSMA tracer uptake of the tumor lesion(s) and healthy organs on PET/CT imaging was assessed. The primary outcome was to evaluate the association between histological PSMA protein expression of tumor in pre-PSMA-RLT biopsies and the PSMA uptake on PSMA PET/CT imaging of the biopsied lesion. Secondary outcomes were to assess the relationship between PSMA expression and Ki67 on IHC and the progression free survival (PFS) and overall survival (OS) following PSMA-RLT. RESULTS In total, 22 mCRPC patients were included in this study. Nineteen (86%) patients showed a high and homogenous PSMA expression of >80% on IHC. Three (14%) patients had low PSMA expression on IHC. Although there was limited PSMA uptake on PET/CT imaging, these 3 patients had lower PSMA uptake on PET/CT imaging compared to the patients with high PSMA expression on IHC. Yet, no correlation was found between PSMA uptake on PET/CT imaging and PSMA expression on IHC (SUVmax: R2 = 0.046 and SUVavg: R2 = 0.036). The 3 patients had a shorter PFS compared to the patients with high PSMA expression on IHC (HR: 4.76, 95% CI: 1.14-19.99; P = .033). Patients with low Ki67 expression had a longer PFS and OS compared to patients with a high Ki67 expression (HR: 0.40, 95% CI: 0.15-1.06; P = .013) CONCLUSION: The PSMA uptake on PSMA-PET/CT generally followed the PSMA expression on IHC. However, heterogeneity may be missed on PSMA-PET/CT. Immunohistochemical PSMA and Ki67 expression in fresh tumor biopsies, may contribute to predict treatment efficacy of PSMA-RLT in mCRPC patients. This needs to be further explored in prospective cohorts.
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Affiliation(s)
- Babette I Laarhuis
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel J R Janssen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel Simons
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Maarten J van der Doelen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Steffie M B Peters
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harm Westdorp
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert Litjens
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - James Nagarajah
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan M Privé
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
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8
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van Lith SAM, Pruis IJ, Tolboom N, Snijders TJ, Henssen D, Ter Laan M, Te Dorsthorst M, Leenders WPJ, Gotthardt M, Nagarajah J, Robe PA, De Witt Hamer P, Hendrikse H, Oprea-Lager DE, Yaqub M, Boellaard R, Wesseling P, Balvers RK, Verburg FA, Harteveld AA, Smits M, van den Bent M, van Zanten SEMV, van de Giessen E. PET Imaging and Protein Expression of Prostate-Specific Membrane Antigen in Glioblastoma: A Multicenter Inventory Study. J Nucl Med 2023; 64:1526-1531. [PMID: 37652540 DOI: 10.2967/jnumed.123.265738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/31/2023] [Indexed: 09/02/2023] Open
Abstract
Upregulation of prostate-specific membrane antigen (PSMA) in neovasculature has been described in glioblastoma multiforme (GBM), whereas vasculature in nonaffected brain shows hardly any expression of PSMA. It is unclear whether PSMA-targeting tracer uptake on PET is based on PSMA-specific binding to neovasculature or aspecific uptake in tumor. Here, we quantified uptake of various PSMA-targeting tracers in GBM and correlated this with PSMA expression in tumor biopsy samples from the same patients. Methods: Fourteen patients diagnosed with de novo (n = 8) or recurrent (n = 6) GBM underwent a preoperative PET scan after injection of 1.5 MBq/kg [68Ga]Ga-PSMA-11 (n = 7), 200 MBq of [18F]DCFpyl (n = 3), or 200 MBq of [18F]PSMA-1007 (n = 4). Uptake in tumor and tumor-to-background ratios, with contralateral nonaffected brain as background, were determined. In a subset of patients, PSMA expression levels from different regions in the tumor tissue samples (n = 40), determined using immunohistochemistry (n = 35) or RNA sequencing (n = 13), were correlated with tracer uptake on PET. Results: Moderate to high (SUVmax, 1.3-20.0) heterogeneous uptake was found in all tumors irrespective of the tracer type used. Uptake in nonaffected brain was low, resulting in high tumor-to-background ratios (6.1-359.0) calculated by dividing SUVmax of tumor by SUVmax of background. Immunohistochemistry showed variable PSMA expression on endothelial cells of tumor microvasculature, as well as on dispersed individual cells (of unknown origin), and granular staining of the neuropil. No correlation was found between in vivo uptake and PSMA expression levels (for immunohistochemistry, r = -0.173, P = 0.320; for RNA, r = -0.033, P = 0.915). Conclusion: Our results indicate the potential use of various PSMA-targeting tracers in GBM. However, we found no correlation between PSMA expression levels on immunohistochemistry and uptake intensity on PET. Whether this may be explained by methodologic reasons, such as the inability to measure functionally active PSMA with immunohistochemistry, tracer pharmacokinetics, or the contribution of a disturbed blood-brain barrier to tracer retention, should still be investigated.
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Affiliation(s)
- Sanne A M van Lith
- Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilanah J Pruis
- Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Nelleke Tolboom
- Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tom J Snijders
- Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dylan Henssen
- Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark Ter Laan
- Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - William P J Leenders
- Biochemistry, Radboud University Medical Center, Nijmegen, The Netherlands
- Predica Diagnostics, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - James Nagarajah
- Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pierre A Robe
- Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Harry Hendrikse
- Radiology and Nuclear Medicine, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | | | - Maqsood Yaqub
- Radiology and Nuclear Medicine, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Radiology and Nuclear Medicine, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - Pieter Wesseling
- Pathology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
- Pathology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Anita A Harteveld
- Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Marion Smits
- Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands; and
| | - Martin van den Bent
- Brain Tumor Center at Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
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9
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Dorst D, Smeets EMM, Klein C, Frielink C, Geijs D, Trajkovic-Arsic M, Cheung PFY, Stommel MWJ, Gotthardt M, Siveke JT, Aarntzen EHJG, van Lith SAM. Fibroblast Activation Protein-Targeted Photodynamic Therapy of Cancer-Associated Fibroblasts in Murine Models for Pancreatic Ductal Adenocarcinoma. Mol Pharm 2023; 20:4319-4330. [PMID: 37485886 PMCID: PMC10410663 DOI: 10.1021/acs.molpharmaceut.3c00453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
Patients with pancreatic ductal adenocarcinoma (PDAC) have a dismal 5 year survival of 9%. One important limiting factor for treatment efficacy is the dense tumor-supporting stroma. The cancer-associated fibroblasts in this stroma deposit excessive amounts of extracellular matrix components and anti-inflammatory mediators, which hampers the efficacy of chemo- and immunotherapies. Systemic depletion of all activated fibroblasts is, however, not feasible nor desirable and therefore a local approach should be pursued. Here, we provide a proof-of-principle of using fibroblast activation protein (FAP)-targeted photodynamic therapy (tPDT) to treat PDAC. FAP-targeting antibody 28H1 and irrelevant control antibody DP47GS were conjugated to the photosensitizer IRDye700DX (700DX) and the chelator diethylenetriaminepentaacetic acid. In vitro binding and cytotoxicity were evaluated using the fibroblast cell-line NIH-3T3 stably transfected with FAP. Biodistribution of 111In-labeled antibody-700DX constructs was determined in mice carrying syngeneic tumors of the murine PDAC cell line PDAC299, and in a genetically engineered PDAC mouse model (CKP). Then, tPDT was performed by exposing the subcutaneous or the spontaneous PDAC tumors to 690 nm light. Induction of apoptosis after treatment was assessed using automated analyses of immunohistochemistry for cleaved caspase-3. 28H1-700DX effectively bound to 3T3-FAP cells and induced cytotoxicity upon exposure to 690 nm light, whereas no binding or cytotoxic effects were observed for DP47GS-700DX. Although both 28H1-700DX and DP47GS-700DX accumulated in subcutaneous PDAC299 tumors, autoradiography demonstrated that only 28H1-700DX reached the tumor core. On the contrary, control antibody DP47GS-700DX was only present at the tumor rim. In CKP mice, both antibodies accumulated in the tumor, but tumor-to-blood ratios of 28H1-700DX were higher than that of the control. Notably, in vivo FAP-tPDT caused upregulation of cleaved caspase-3 staining in both subcutaneous and in spontaneous tumors. In conclusion, we have shown that tPDT is a feasible approach for local depletion of FAP-expressing stromal cells in murine models for PDAC.
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Affiliation(s)
- Daphne
N. Dorst
- Department
of Medical Imaging, Radboud University Medical
Center, 6525 GA Nijmegen, The Netherlands
| | - Esther M. M. Smeets
- Department
of Medical Imaging, Radboud University Medical
Center, 6525 GA Nijmegen, The Netherlands
| | - Christian Klein
- Roche
Pharma Research and Early Development, Innovation
Center Zurich, 8952 Schlieren, Switzerland
| | - Cathelijne Frielink
- Department
of Medical Imaging, Radboud University Medical
Center, 6525 GA Nijmegen, The Netherlands
| | - Daan Geijs
- Department
of Pathology, Radboud University Medical
Center, 6525 GA Nijmegen, The Netherlands
| | - Marija Trajkovic-Arsic
- Bridge
Institute of Experimental Tumour Therapy, West German Cancer Center,
University Hospital Essen, University of
Duisburg-Essen, 47057 Essen, Germany
- Division
of Solid Tumour Translational Oncology, German Cancer Consortium (DKTK Partner Site Essen) and German Cancer
Research Center, DKFZ, 69120 Heidelberg, Germany
| | - Phyllis F. Y. Cheung
- Bridge
Institute of Experimental Tumour Therapy, West German Cancer Center,
University Hospital Essen, University of
Duisburg-Essen, 47057 Essen, Germany
- Division
of Solid Tumour Translational Oncology, German Cancer Consortium (DKTK Partner Site Essen) and German Cancer
Research Center, DKFZ, 69120 Heidelberg, Germany
| | - Martijn W. J. Stommel
- Department
of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department
of Medical Imaging, Radboud University Medical
Center, 6525 GA Nijmegen, The Netherlands
| | - Jens T. Siveke
- Bridge
Institute of Experimental Tumour Therapy, West German Cancer Center,
University Hospital Essen, University of
Duisburg-Essen, 47057 Essen, Germany
- Division
of Solid Tumour Translational Oncology, German Cancer Consortium (DKTK Partner Site Essen) and German Cancer
Research Center, DKFZ, 69120 Heidelberg, Germany
| | - Erik H. J. G. Aarntzen
- Department
of Medical Imaging, Radboud University Medical
Center, 6525 GA Nijmegen, The Netherlands
| | - Sanne A. M. van Lith
- Department
of Medical Imaging, Radboud University Medical
Center, 6525 GA Nijmegen, The Netherlands
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10
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Derks YHW, Schilham MGM, Rijpkema M, Smeets EMM, Amatdjais-Groenen HIV, Kip A, van Lith SAM, van de Kamp J, Sedelaar JPM, Somford DM, Simons M, Laverman P, Gotthardt M, Löwik DWPM, Heskamp S, Lütje S. Imaging and photodynamic therapy of prostate cancer using a theranostic PSMA-targeting ligand. Eur J Nucl Med Mol Imaging 2023; 50:2872-2884. [PMID: 37060367 PMCID: PMC10317872 DOI: 10.1007/s00259-023-06224-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/04/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE Incomplete resection of prostate cancer (PCa) results in increased risk of disease recurrence. Combined fluorescence-guided surgery with tumor-targeted photodynamic therapy (tPDT) may help to achieve complete tumor eradication. We developed a prostate-specific membrane antigen (PSMA) ligand consisting of a DOTA chelator for 111In labeling and a fluorophore/photosensitizer IRDye700DX (PSMA-N064). We evaluated the efficacy of PSMA-tPDT using PSMA-N064 in cell viability assays, a mouse xenograft model and in an ex vivo incubation study on fresh human PCa tissue. METHODS In vitro, therapeutic efficacy of PSMA-N064 was evaluated using PSMA-positive LS174T cells and LS174T wild-type cells. In vivo, PSMA-N064-mediated tPDT was tested in immunodeficient BALB/c mice-bearing PSMA-positive LS174T xenografts. Tumor growth and survival were compared to control mice that received either NIR light or ligand injection only. Ex vivo tPDT efficacy was evaluated in excised fresh human PCa tissue incubated with PSMA-N064. RESULTS In vitro, tPDT led to a PSMA-specific light- and ligand dose-dependent loss in cell viability. In vivo, tPDT-induced tumor cell apoptosis, delayed tumor growth, and significantly improved survival (p = 0.004) of the treated PSMA-positive tumor-bearing mice compared with the controls. In fresh ex vivo human PCa tissue, apoptosis was significantly increased in PSMA-tPDT-treated samples compared to non-treated control samples (p = 0.037). CONCLUSION This study showed the feasibility of PSMA-N064-mediated tPDT in cell assays, a xenograft model and excised fresh human PCa tissue. This paves the way to investigate the impact of in vivo PSMA-tPDT on surgical outcome in PCa patients.
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Affiliation(s)
- Yvonne H W Derks
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands.
| | - Melline G M Schilham
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
| | - Mark Rijpkema
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | - Esther M M Smeets
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | - Helene I V Amatdjais-Groenen
- Institute for Molecules and Materials, Systems Chemistry, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Annemarie Kip
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | - Sanne A M van Lith
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | - Jill van de Kamp
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
| | - Diederik M Somford
- Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Michiel Simons
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Laverman
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | - Dennis W P M Löwik
- Institute for Molecules and Materials, Systems Chemistry, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Sandra Heskamp
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
| | - Susanne Lütje
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, The Netherlands
- Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
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11
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Joosten L, Frielink C, Jansen TJP, Lobeek D, Andreae F, Konijnenberg M, Heskamp S, Gotthardt M, Brom M. New Radiolabeled Exendin Analogues Show Reduced Renal Retention. Mol Pharm 2023. [PMID: 37265006 DOI: 10.1021/acs.molpharmaceut.3c00117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PET imaging of the glucagon-like peptide-1 receptor (GLP-1R) using radiolabeled exendin is a promising imaging method to detect insulinomas. However, high renal accumulation of radiolabeled exendin could hamper the detection of small insulinomas in proximity to the kidneys and limit its use as a radiotherapeutic agent. Here, we report two new exendin analogues for GLP-1R imaging and therapy, designed to reduce renal retention by incorporating a cleavable methionine-isoleucine (Met-Ile) linker. We examined the renal retention and insulinoma targeting properties of these new exendin analogues in a nude mouse model bearing subcutaneous GLP-1R-expressing insulinomas. NOTA or DOTA was conjugated via a methionine-isoleucine linker to the C-terminus of exendin-4 (NOTA-MI-exendin-4 or DOTA-MI-exendin-4). NOTA- and DOTA-exendin-4 without the linker were used as references. The affinity for GLP-1R was determined in a competitive binding assay using GLP-1R transfected cells. Biodistribution of [68Ga]Ga-NOTA-exendin-4, [68Ga]Ga-NOTA-MI-exendin-4, [177Lu]Lu-DOTA-exendin-4, and [177Lu]Lu-DOTA-MI-exendin-4 was determined in INS-1 tumor-bearing BALB/c nude mice, and PET/CT was acquired to visualize renal retention and tumor targeting. For all tracers, dosimetric calculations were performed to determine the kidney self-dose. The affinity for GLP-1R was in the low nanomolar range (<11 nM) for all peptides. In vivo biodistribution revealed a significantly lower kidney uptake of [68Ga]Ga-NOTA-MI-exendin-4 at 4 h post-injection (p.i.) (34.2 ± 4.2 %IA/g), compared with [68Ga]Ga-NOTA-exendin-4 (128 ± 10 %IA/g). Accumulation of [68Ga]Ga-NOTA-MI-exendin-4 in the tumor was 25.0 ± 8.0 %IA/g 4 h p.i., which was similar to that of [68Ga]Ga-NOTA-exendin-4 (24.9 ± 9.3 %IA/g). This resulted in an improved tumor-to-kidney ratio from 0.2 ± 0.0 to 0.8 ± 0.3. PET/CT confirmed the findings in the biodistribution studies. The kidney uptake of [177Lu]Lu-DOTA-MI-exendin-4 was 39.4 ± 6.3 %IA/g at 24 h p.i. and 13.0 ± 2.5 %IA/g at 72 h p.i., which were significantly lower than those for [177Lu]Lu-DOTA-exendin-4 (99.3 ± 9.2 %IA/g 24 h p.i. and 45.8 ± 3.9 %IA/g 72 h p.i.). The uptake in the tumor was 7.8 ± 1.5 and 11.3 ± 2.0 %IA/g 24 h p.i. for [177Lu]Lu-DOTA-MI-exendin-4 and [177Lu]Lu-DOTA-exendin-4, respectively, resulting in improved tumor-to-kidney ratios for [177Lu]Lu-DOTA-MI-exendin-4. The new exendin analogues with a Met-Ile linker showed 2-3-fold reduced renal retention and improved tumor-to-kidney ratios compared with their reference without the Met-Ile linker. Future studies should demonstrate whether [68Ga]Ga-NOTA-MI-exendin-4 results in improved detection of small insulinomas in close proximity to the kidneys with PET/CT. [177Lu]Lu-DOTA-MI-exendin-4 might open a window of opportunity for exendin-based radionuclide therapy.
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Affiliation(s)
- Lieke Joosten
- Department of Medical Imaging, Nuclear Medicineof Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Cathelijne Frielink
- Department of Medical Imaging, Nuclear Medicineof Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Theodorus J P Jansen
- Department of Medical Imaging, Nuclear Medicineof Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Daphne Lobeek
- Department of Medical Imaging, Nuclear Medicineof Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Fritz Andreae
- Forschungs- und Entwicklungs GmbH, piCHEM, Parkring 3, 8074 Grambach, Austria
| | - Mark Konijnenberg
- Department of Medical Imaging, Nuclear Medicineof Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Sandra Heskamp
- Department of Medical Imaging, Nuclear Medicineof Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Nuclear Medicineof Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Maarten Brom
- Department of Medical Imaging, Nuclear Medicineof Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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12
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Jansen T, Stikkelbroeck N, van de Ven A, van Engen-van Grunsven I, Janssen M, Bonenkamp H, Gotthardt M, Netea-Maier RT. Clinical Characteristics, Diagnostic Approach and Outcome of Thyroid Incidental Findings vs. Clinically Overt Thyroid Nodules: An Observational Single-Centre Study. Cancers (Basel) 2023; 15:cancers15082350. [PMID: 37190278 DOI: 10.3390/cancers15082350] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Context: Thyroid nodules are common and can present as clinically overt nodules (visible, palpable or symptomatic nodules) and so-called incidentalomas (coincidental findings on imaging techniques). The majority are benign but recognizing clinically relevant nodules remains a challenge. Current Dutch guidelines recommend to refrain from additional diagnostic testing in incidentalomas other than FDG-PET-incidentalomas, unless there are suspicious clinical and/or sonographic features. However, there is no consensus on the further approach and no "real-life" data on the outcome of such an approach. Objective: To compare clinical characteristics, diagnostic approaches and clinical outcome between patients referred with thyroid incidentalomas and non-incidentalomas at one academic referral thyroid clinic. Methods: Clinical and demographical characteristics, diagnostic and therapeutic approaches and outcome were retrospectively obtained from the files of all patients newly referred because of thyroid incidentalomas or non-incidentalomas to our institution (between March 2011 and January 2017). Subsequently, the data were compared between both groups. Results: In total, 351 patients (64.3%) were referred because of non-incidentalomas and 195 (35.7%) because of incidentalomas. Incidentalomas were smaller (48.7% <2 cm) than non-incidentalomas (23.4% <2 cm). Furthermore, incidentalomas were less often symptomatic (15.9 vs. 42.7% p < 0.001). Fine-needle aspiration was performed in a similar percentage of the patients in the two groups (62.6% of incidentalomas vs. 69.8% in non-incidentaloma, p = 0.08). Significantly less malignancies were found among incidentalomas compared to non-incidentalomas (5.1% vs. 11.1%, p = 0.019). Moreover, significantly more malignancies occurred in PET-incidentalomas than non-PET-incidentalomas (11.8% vs. 2.8%, p = 0.023). In fact, the proportion of malignancies in PET-incidentalomas and non-incidentalomas was similar (11.8% vs. 11.1%, p = 0.895). Stability or decrease in size was observed in 96.5% of nodules receiving ultrasound follow-up. Conclusions: Patients with small asymptomatic thyroid incidentalomas represent an important proportion of the patients referred for additional diagnostic evaluation. The risk of malignancy in these patients is lower than in those with symptomatic palpable lesions, particularly in the patients with incidentalomas discovered on CT, MRI or US. Our findings support the current recommendations from the Dutch guidelines to not indiscriminately perform additional analysis and treatment on all incidentalomas, but prioritize this to FDG-PET-incidentalomas and clinically relevant non-PET-incidentalomas. Moreover, US features can further refine the selection of the patients who require immediate FNAC and/or surgery.
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Affiliation(s)
- Tom Jansen
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Nike Stikkelbroeck
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Annenienke van de Ven
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Ilse van Engen-van Grunsven
- Department of Pathology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Marcel Janssen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Han Bonenkamp
- Department of Surgery, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Romana T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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13
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Jansen TJP, Buitinga M, Boss M, Nijhoff MF, Brom M, de Galan BE, van der Graaf M, van Koeverden S, Vantyghem MC, Beron A, Pattou F, Engelse MA, Velikyan I, Eriksson O, de Koning EJP, Gotthardt M. Monitoring beta cell survival after intrahepatic islet transplantation using dynamic exendin PET imaging: a proof-of-concept study in individuals with type 1 diabetes. Diabetes 2023:148679. [PMID: 37068261 DOI: 10.2337/db22-0884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/03/2023] [Indexed: 04/19/2023]
Abstract
Intrahepatic transplantation of islets of Langerhans (ITx) is a treatment option for individuals with complicated type 1 diabetes and profoundly unstable glycemic control, but its therapeutic success is hampered by deterioration of graft function over time. To improve ITx strategies, technologies to non-invasively monitor the fate and survival of transplanted islets over time, are of great potential value. We used [68Ga]Ga-NODAGA-exendin-4 (68Ga-exendin) positron emission tomography/computed tomography (PET/CT) imaging to demonstrate the feasibility to quantify beta cell mass in intrahepatic islet grafts in 13 individuals with type 1 diabetes, 9 after ITx with functional islet grafts and 4 non-transplanted controls. Beta cell function was measured by mixed-meal tolerance test. With dynamic 68Ga-exendin PET/CT images, we determined tracer accumulation in hepatic hotspots, and intrahepatic fat was assessed using magnetic resonance imaging and spectroscopy. Quantification of hepatic hotspots showed a significantly higher uptake of 68Ga-exendin in the ITx group compared to controls (0.55 [0.51-0.63] vs. 0.43 [0.42-0.45]). GLP-1 receptor expression was found in transplanted islets by immunohistochemistry. Intrahepatic fat was not detected in the majority of the individuals. Our study provides the first clinical evidence that radiolabeled exendin imaging can be used to monitor viable transplanted islets after intraportal ITx. (ClinicalTrials.gov number: NCT03785236).
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Affiliation(s)
- Theodorus J P Jansen
- Department of Medical Imaging, Radboud university medical center, Nijmegen, The Netherlands
| | - Mijke Buitinga
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marti Boss
- Department of Medical Imaging, Radboud university medical center, Nijmegen, The Netherlands
| | - Michiel F Nijhoff
- Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten Brom
- Department of Medical Imaging, Radboud university medical center, Nijmegen, The Netherlands
| | - Bastiaan E de Galan
- Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Internal Medicine, Maxima Medical Center, Veldhoven, The Netherlands
| | | | | | - Marie-Christine Vantyghem
- Endocrinology, CHU Lille, Lille, France
- U1190 Translational Research for Diabetes, Univ Lille, CHU Lille, Inserm, Institut Pasteur Lille, Lille, France
| | | | - François Pattou
- U1190 Translational Research for Diabetes, Univ Lille, CHU Lille, Inserm, Institut Pasteur Lille, Lille, France
| | - Marten A Engelse
- Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Irina Velikyan
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Olof Eriksson
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Eelco J P de Koning
- Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud university medical center, Nijmegen, The Netherlands
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14
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Janssen L, Hopman MTE, Swaans GJA, Allard NAE, Boss M, Lobeek D, Gotthardt M, Schirris TJJ, Blijlevens NMA, Timmers S. Impact of tyrosine kinase inhibitors on glucose control and insulin regulation in patients with chronic myeloid leukemia. Am J Physiol Endocrinol Metab 2023; 324:E209-E216. [PMID: 36696600 DOI: 10.1152/ajpendo.00163.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Treatment with tyrosine kinase inhibitors (TKIs), especially nilotinib, often results in hyperglycemia, which may further increase cardiovascular disease risk in patients with chronic myeloid leukemia (CML). The mechanism underlying the TKI-induced glucose dysregulation is not clear. TKIs are suggested to affect insulin secretion but also insulin sensitivity of peripheral tissue has been proposed to play a role in the pathogenesis of TKI-induced hyperglycemia. Here, we aimed to assess whether skeletal muscle glucose uptake and insulin responses are altered in nondiabetic patients with CML receiving TKI treatment. After a glycogen-depleted exercise bout, an intravenous glucose bolus (0.3 g/kg body weight) was administered to monitor 2-h glucose tolerance and insulin response in 14 patients with CML receiving nilotinib, 14 patients with CML receiving imatinib, and 14 non-CML age- and gender-matched controls. A dynamic [18F]-FDG PET scan during a hyperinsulinemic-euglycemic clamp was performed in a subgroup of 12 male patients with CML to assess m. quadriceps glucose uptake. We showed that patients with CML treated with nilotinib have an increased insulin response to intravenous glucose administration after muscle glycogen-depleted exercise. Despite the increased insulin response to glucose administration in patients with CML receiving nilotinib, glucose disappearance rates were significantly slower in nilotinib-treated patients when compared with controls in the first 15 min after glucose administration. Although [18F]-FDG uptake in m. quadriceps was not different, patients receiving nilotinib showed a trend toward decreased glucose infusion rates during euglycemic clamping when compared with patients receiving imatinib. Together, these findings indicate disturbed skeletal muscle glucose handling in patients with CML receiving nilotinib therapy.NEW & NOTEWORTHY In this study, we have shown that non-diabetic patients with CML receiving nilotinib therapy show early signs of disturbed skeletal muscle glucose handling, which was not observed in imatinib-treated patients. These observations in nilotinib users may reflect decreased muscle insulin sensitivity, which could serve as a potential target to counteract glycemic dysregulation, and is of clinical importance since these patients have an increased cardiovascular disease risk.
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Affiliation(s)
- Lando Janssen
- Radboud Institute for Health Sciences, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Greetje J A Swaans
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Neeltje A E Allard
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marti Boss
- Radboud Institute for Health Sciences, Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daphne Lobeek
- Radboud Institute for Health Sciences, Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Radboud Institute for Health Sciences, Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom J J Schirris
- Radboud Institute for Molecular Life Sciences, Department of Pharmacology and Toxicology, Radboud Centre for Mitochondrial Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole M A Blijlevens
- Radboud Institute for Health Sciences, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Silvie Timmers
- Human and Animal Physiology, Wageningen University, Wageningen, The Netherlands
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15
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Schilham MGM, Rijpkema M, Scheenen T, Hermsen R, Barentsz JO, Sedelaar JPM, Kusters-Vandevelde H, Kerkmeijer LGW, Somford DM, Gotthardt M. Reply to Francesco Montorsi, Simone Scuderi, Alberto Briganti, and Giorgio Gandaglia's Letter to the Editor re: Melline G.M. Schilham, Mark Rijpkema, Tom Scheenen, et al. How Advanced Imaging Will Guide Therapeutic Strategies for Patients with Newly Diagnosed Prostate Cancer in the Years to Come. Eur Urol 2022;82:578-80. Eur Urol 2023; 83:e133-e134. [PMID: 36781337 DOI: 10.1016/j.eururo.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/13/2023]
Affiliation(s)
- Melline G M Schilham
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands; Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Mark Rijpkema
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tom Scheenen
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rick Hermsen
- Department of Nuclear Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jelle O Barentsz
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Diederik M Somford
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
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16
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Jansen TJP, Brom M, Boss M, Buitinga M, Tack CJ, van Meijel LA, de Galan BE, Gotthardt M. Importance of beta cell mass for glycaemic control in people with type 1 diabetes. Diabetologia 2023; 66:367-375. [PMID: 36394644 PMCID: PMC9669532 DOI: 10.1007/s00125-022-05830-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022]
Abstract
AIMS/HYPOTHESIS The role of beta cell mass in the balance of glucose control and hypoglycaemic burden in people with type 1 diabetes is unclear. We applied positron emission tomography (PET) imaging with radiolabelled exendin to compare beta cell mass among people with type 1 diabetes and either low glucose variability (LGV) or high glucose variability (HGV). METHODS All participants with either LGV (n=9) or HGV (n=7) underwent a mixed-meal tolerance test to determine beta cell function and wore a blinded continuous glucose monitor for a week. After an i.v. injection with [68Ga]Ga-NODAGA-exendin-4, PET images were acquired for the quantification of pancreatic uptake of radiolabelled exendin. The mean standardised uptake value (SUVmean) of the pancreas was used to determine the amount of beta cell mass. RESULTS Participants with LGV had lower HbA1c (46.0 mmol/mol [44.5-52.5] [6.4% (6.3-7)] vs 80 mmol/mol [69.0-110] [9.5% (8.5-12.2)], p=0.001) and higher time in range (TIR) (75.6% [73.5-90.3] vs 38.7% [25.1-48.5], p=0.002) than those with HGV. The SUVmean of the pancreas was higher for the LGV than for the HGV group (5.1 [3.6-5.6] vs 2.9 [2.1-3.4], p=0.008). The AUCC-peptide:AUCglucose ratio was numerically, but not statistically, higher in the LGV compared with the HGV group (2.7×10-2 [6.2×10-4-5.3×10-2] vs 9.3×10-4 [4.7×10-4-5.2×10-3], p=0.21). SUVmean correlated with the AUCC-peptide:AUCglucose ratio (Pearson r=0.64, p=0.01), as well as with the TIR (r=0.64, p=0.01) and the SD of interstitial glucose levels (r=-0.66, p=0.007). CONCLUSION/INTERPRETATION Our data show higher beta cell mass in people with type 1 diabetes and LGV than in those with HGV, independent of beta cell function.
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Affiliation(s)
- Theodorus J P Jansen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maarten Brom
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marti Boss
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Mijke Buitinga
- Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands
- Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - Cees J Tack
- Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lian A van Meijel
- Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Internal Medicine, Maxima Medical Center, Veldhoven, the Netherlands
| | - Bastiaan E de Galan
- Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Internal Medicine, Maastricht UMC+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, the Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
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Peters SMB, Mink MCT, Privé BM, de Bakker M, de Lange F, Muselaers CHJ, Mehra N, Witjes JA, Gotthardt M, Nagarajah J, Konijnenberg MW. Optimization of the radiation dosimetry protocol in Lutetium-177-PSMA therapy: toward clinical implementation. EJNMMI Res 2023; 13:6. [PMID: 36692682 PMCID: PMC9873880 DOI: 10.1186/s13550-023-00952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Dosimetry in [177Lu]Lu-PSMA therapy is a valuable tool to assess treatment efficacy and toxicity. This study aims to develop a clinically implementable protocol to determine the absorbed dose in organs and tumor lesions after [177Lu]Lu-PSMA-617 therapy, by reducing the imaging time points and utilizing population-based kinetics with a single scan, with evaluation of its influence on the uncertainty in absorbed dose. METHODS Ten patients with metastatic hormone-sensitive prostate cancer received two cycles of [177Lu]Lu-PSMA-617. Post-treatment imaging was performed at 1 h, 24 h, 48 h, 72 h and 168 h, consisting of three-bed positions SPECT/CT and a whole-body planar scan. Five-time point SPECT dosimetry was performed for lesions and organs with physiological uptake (kidneys, liver and salivary glands) and used as the reference standard. Absorbed dose values for various simplified protocols were compared to the reference standard. RESULTS Accurate lesion dosimetry is possible using one-time point SPECT imaging at 168 h, with an increase in uncertainty (20% vs. 14% for the reference standard). By including a second time point, uncertainty was comparable to the reference standard (13%). Organ dosimetry can be performed using a single SPECT at 24 h or 48 h. Dosimetry based on planar scans did not provide accurate dose estimations. CONCLUSION Accurate lesion dosimetry in [177Lu]Lu-PSMA therapy can be performed using a one- or two-time point protocol, making dosimetry assessments more suitable for routine clinical implementation, although dosimetry based om multiple time points is more accurate. Clinical trial registration This study was approved by the Medical Review Ethics Committee Region Arnhem-Nijmegen on January 23, 2018 and was registered on clinicaltrials.gov (NCT03828838).
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Affiliation(s)
- Steffie M B Peters
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Maaike C T Mink
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Physics and Astronomy, Radboud University, Nijmegen, The Netherlands
| | - Bastiaan M Privé
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Maarten de Bakker
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Frank de Lange
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - James Nagarajah
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mark W Konijnenberg
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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18
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Collado Camps E, van Lith SAM, Kip A, Frielink C, Joosten L, Brock R, Gotthardt M. Conjugation to a cell-penetrating peptide drives the tumour accumulation of the GLP1R antagonist exendin(9-39). Eur J Nucl Med Mol Imaging 2023; 50:996-1004. [PMID: 36446951 PMCID: PMC9931918 DOI: 10.1007/s00259-022-06041-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/13/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Exendin, an analogue of the glucagon-like peptide 1 (GLP1), is an excellent tracer for molecular imaging of pancreatic beta cells and beta cell-derived tumours. The commonly used form, exendin-4, activates the GLP1 receptor and causes internalisation of the peptide-receptor complex. As a consequence, injection of exendin-4 can lead to adverse effects such as nausea, vomiting and hypoglycaemia and thus requires close monitoring during application. By comparison, the antagonist exendin(9-39) does not activate the receptor, but its lack of internalisation has precluded its use as a tracer. Improving the cellular uptake of exendin(9-39) could turn it into a useful alternative tracer with less side-effects than exendin-4. METHODS We conjugated exendin-4 and exendin(9-39) to the well-known cell-penetrating peptide (CPP) penetratin. We evaluated cell binding and internalisation of the radiolabelled peptides in vitro and their biodistribution in vivo. RESULTS Exendin-4 showed internalisation irrespective of the presence of the CPP, whereas for exendin(9-39) only the penetratin conjugate internalised. Conjugation to the CPP also enhanced the in vivo tumour uptake and retention of exendin(9-39). CONCLUSION We demonstrate that penetratin robustly improves internalisation and tumour retention of exendin(9-39), opening new avenues for antagonist-based in vivo imaging of GLP1R.
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Affiliation(s)
- Estel Collado Camps
- Department of Medical Imaging, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands ,Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands ,Present Address: Department of Tumour Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, 278 Tumor Immunology, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sanne A. M. van Lith
- Department of Medical Imaging, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Annemarie Kip
- Department of Medical Imaging, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Cathelijne Frielink
- Department of Medical Imaging, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Lieke Joosten
- Department of Medical Imaging, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Roland Brock
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands ,Department of Medical Biochemistry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Martin Gotthardt
- Department of Medical Imaging, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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19
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Banda A, Privé BM, Allach Y, Uijen MJM, Peters SMB, Loeff CC, Gotthardt M, Muselaers CHJ, Witjes JA, van Oort IM, Sedelaar JPM, Westdorp H, Mehra N, Khreish F, Ezziddin S, Sabet A, Kreissl MC, Winkens T, Seifert P, Janssen MJR, van Gemert WAM, Nagarajah J. PSMA-RLT in Patients with Metastatic Hormone-Sensitive Prostate Cancer: A Retrospective Study. Cancers (Basel) 2022; 15:cancers15010297. [PMID: 36612293 PMCID: PMC9818570 DOI: 10.3390/cancers15010297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/09/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT) is a novel treatment for patients with castration-resistant prostate cancer (CRPC). Given the mode of action, patients in an earlier disease stage, such as hormone-sensitive prostate cancer (HSPC), are also likely to benefit from [177Lu]Lu-PSMA- (177Lu-PSMA) or [225Ac]Ac-PSMA-radioligand treatment (225Ac-PSMA). In this retrospective study, we analyzed the safety and efficacy of PSMA-RLT in early-stage and hormone-sensitive metastatic prostate cancer patients. METHODS A retrospective study was performed in patients who received 177Lu-PSMA and/or 225Ac-PSMA with early-stage metastatic prostate cancer. The primary outcome parameter evaluated in this study was the progression-free survival (PFS) after PSMA-RLT and toxicity according to the Common Terminology Criteria for Adverse Events. Secondary outcome parameters were prostate-specific antigen (PSA) response and the date of onset of CRPC state. RESULTS In total, 20 patients were included of which 18 patients received 177Lu-PSMA radioligand and two patients received tandem treatment with both 177Lu-PSMA and 225Ac-PSMA radioligands. Patients received a median of 2 treatment cycles (range 1-6) and a median activity of 6.2 GBq 177Lu-PSMA per cycle (interquartile range (IQR) 5.2-7.4 GBq). PSMA-RLT was overall well-tolerated. The most common grade 1-2 side effects were xerostomia (n = 6) and fatigue (n = 8), which were only temporarily reported. One patient that received 225Ac-PSMA developed grade 3-4 bone marrow toxicity. The median PFS was 12 months (95% confidence interval (CI), 4.09-19.9 months). Seventeen (85%) patients had a ≥50% PSA response following PSMA-RLT. One patient developed CRPC 9 months following PSMA-RLT. CONCLUSIONS In this small cohort study, PSMA-RLT appeared safe and showed encouraging efficacy for (metastasized) early-stage and hormone-sensitive prostate cancer patients. Prospective studies are awaited and should include long-term follow-up.
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Affiliation(s)
- Amina Banda
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands
- Correspondence: (A.B.); (B.M.P.); Tel.: +31-24-3690031 (A.B. & B.M.P.)
| | - Bastiaan M. Privé
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands
- Correspondence: (A.B.); (B.M.P.); Tel.: +31-24-3690031 (A.B. & B.M.P.)
| | - Youssra Allach
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands
| | - Maike J. M. Uijen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands
| | - Steffie M. B. Peters
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands
| | - Cato C. Loeff
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands
| | - Constantijn H. J. Muselaers
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands
| | - J. Alfred Witjes
- Department of Medical Oncology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Inge M. van Oort
- Department of Medical Oncology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - J. P. Michiel Sedelaar
- Department of Medical Oncology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Harm Westdorp
- Department of Urology and Oncology, Radboud Universiteit Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Niven Mehra
- Department of Urology and Oncology, Radboud Universiteit Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Fadi Khreish
- Department of Nuclear Medicine, University of Saarland, D-66421 Homburg, Germany
| | - Samer Ezziddin
- Department of Nuclear Medicine, University of Saarland, D-66421 Homburg, Germany
| | - Amir Sabet
- University Hospital, Department of Nuclear Medicine, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Michael C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital, 39120 Magdeburg, Germany
| | - Thomas Winkens
- Clinic for Nuclear Medicine, University Hospital of Jena, 07743 Jena, Germany
| | - Philipp Seifert
- Clinic for Nuclear Medicine, University Hospital of Jena, 07743 Jena, Germany
| | - Marcel J. R. Janssen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands
| | - Willemijn A. M. van Gemert
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands
| | - James Nagarajah
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6525 GA Nijmegen, The Netherlands
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Tokgöz S, Boss M, Prasad S, Shah P, Laverman P, van Riel M, Gotthardt M. Protocol for Clinical GLP-1 Receptor PET/CT Imaging with [ 68Ga]Ga-NODAGA-Exendin-4. Methods Mol Biol 2022; 2592:143-153. [PMID: 36507990 DOI: 10.1007/978-1-0716-2807-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Imaging with radiolabeled exendin enables detection and characterization of glucagon-like peptide 1 receptors (GLP-1Rs) in vivo with high specificity. The novel radiotracer [68Ga]Ga-NODAGA-exendin-4 forms a stable complex after a simple and fast labeling procedure. Beta-cell mass in the islets of Langerhans can be visualized using [68Ga]Ga-NODAGA-exendin-4, which is promising for research into diabetes mellitus (DM) pathophysiology. Furthermore, this radiotracer enables very sensitive detection of insulinomas, resulting from vast overexpression of GLP-1Rs, and seems promising for the detection of focal lesions in congenital hyperinsulinism (CHI). Here, we describe the procedures involved in [68Ga]Ga-NODAGA-exendin-4 positron emission tomography (PET)/computed tomography (CT) imaging including the radiolabeling of the NODAGA-exendin conjugate with 68Ga, quality controls, and PET/CT.
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Affiliation(s)
- S Tokgöz
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Boss
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Prasad
- Department of Nuclear Medicine, Radiopharmacy, Berlin Experimental Radionuclide Imaging Center (BERIC), Berlin, Germany
| | - P Shah
- Department of Pediatric Endocrinology, Barts Health NHS Trust (The Royal London Childrens Hospital), London, UK
| | - P Laverman
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M van Riel
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Gotthardt
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
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21
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Zamecnik P, Israel B, Feuerstein J, Nagarajah J, Gotthardt M, Barentsz JO, Hambrock T. Ferumoxtran-10-enhanced 3-T Magnetic Resonance Angiography of Pelvic Arteries: Initial Experience. Eur Urol Focus 2022; 8:1802-1808. [PMID: 35337778 DOI: 10.1016/j.euf.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/12/2022] [Accepted: 03/03/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with renal impairment cannot undergo angiography because iodine and gadolinium contrast agents are contraindicated. Iron-containing ultrasmall superparamagnetic iron oxide particles, such as ferumoxtran-10, are not contraindicated in these patients. Thus, patients with renal failure can still undergo angiography with ferumoxtran-10. OBJECTIVE To evaluate the visibility of pelvic vessels with magnetic resonance angiography (MRA) using ferumoxtran-10 as contrast agent. DESIGN, SETTING, AND PARTICIPANTS Three hundred and eighty-one patients diagnosed with primary or recurrent prostate cancer underwent pelvic ferumoxtran-10 MRA. Eleven anatomical pelvic-vessel segments per patient were evaluated using qualitative and quantitative criteria for image quality (IQ), vessel visibility (VV), and the contrast-to-noise ratio (CNR). INTERVENTION Ferumoxtran-10-enhaced MRA. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS IQ, VV, and CNR were assessed on a 5-point scale for each data set/vessel segment (very poor, poor, moderate, good, and excellent). RESULTS AND LIMITATIONS IQ was good to excellent for 98.2% of the data sets and VV was good to excellent for 97.7% of all vessel segments. The mean CNR for all segments was 88.13 (standard deviation 4.22). Contrast bolus imaging cannot be performed with this technique, so it is impossible to visualize the arterial or venous phase separately. The timing of contrast administration is also a limitation, with MRA performed 1 d after contrast infusion. CONCLUSIONS Ferumoxtran-10 MRA showed excellent image quality and visibility for pelvic vessels. In addition, the homogeneity of the intraluminal contrast was superior. Patients with preterminal or terminal renal function can benefit from ferumoxtran-10 MRA if visualization of their pelvic vessels is required. PATIENT SUMMARY Magnetic resonance imaging of blood vessels using a contrast agent called ferumoxtran-10 is a promising technique for patients with impaired kidney function, as it provides high-quality visualization of blood vessels in the pelvis.
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Affiliation(s)
- Patrik Zamecnik
- Department of Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Bas Israel
- Department of Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - James Nagarajah
- Department of Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle O Barentsz
- Department of Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas Hambrock
- Department of Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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22
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Schilham MGM, Rijpkema M, Scheenen T, Hermsen R, Barentsz JO, Michiel Sedelaar JP, Kusters-Vandevelde H, Kerkmeijer LGW, Somford DM, Gotthardt M. How Advanced Imaging Will Guide Therapeutic Strategies for Patients with Newly Diagnosed Prostate Cancer in the Years to Come. Eur Urol 2022; 82:578-580. [PMID: 36167598 DOI: 10.1016/j.eururo.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
In recent years, clinical use of novel advanced imaging modalities in prostate cancer detection, staging, and therapy has intensified and is currently reforming clinical guidelines. In the future, advanced imaging technologies will continue to develop and become even more accurate, which will offer new opportunities for improving patient selection, surgical treatment, and radiotherapy, with the potential to guide prostate cancer therapy.
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Affiliation(s)
- Melline G M Schilham
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands; Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Mark Rijpkema
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tom Scheenen
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rick Hermsen
- Department of Nuclear Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jelle O Barentsz
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Diederik M Somford
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
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23
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Chaman Baz AH, van de Wiel E, Groenewoud H, Arntz M, Gotthardt M, Deinum J, Langenhuijsen J. CXCR4-directed [ 68Ga]Ga-PentixaFor PET/CT versus adrenal vein sampling performance: a study protocol for a randomised two-step controlled diagnoStic Trial Ultimately comparing hypertenSion outcome in primary aldosteronism (CASTUS). BMJ Open 2022; 12:e060779. [PMID: 35998969 PMCID: PMC9403157 DOI: 10.1136/bmjopen-2022-060779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Primary aldosteronism (PA) is the most common form of secondary hypertension. It is caused by overproduction of aldosterone by either a unilateral aldosterone-producing adenoma (APA) or by bilateral adrenal hyperplasia (BAH). Distinction is crucial, because PA is cured by adrenalectomy in APA and is treated by mineralocorticoid receptor antagonists in BAH. The distinction is currently made by adrenal vein sampling (AVS). AVS is a costly, invasive and complex technical procedure with limited availability and is not superior in terms of outcomes to CT scan-based diagnosis. Thus, there is a need for a cheaper, non-invasive and readily available diagnostic tool in PA. We propose a new diagnostic imaging modality employing the positron emission tomography (PET) tracer [68Ga]Ga-PentixaFor. This tracer has high focal uptake in APAs, whereas low uptake was shown in patients with normal adrenals. Thus, [68Ga]Ga-PentixaFor PET/CT is an imaging modality with the potential to improve subtyping of PA. It is readily available, safe and, as an out-patient procedure, much cheaper diagnostic method than AVS. METHODS AND ANALYSIS We present a two-step randomised controlled trial (RCT) protocol in which we assess the accuracy of [68Ga]Ga-PentixaFor PET/CT in the first step and compare [68Ga]Ga-PentixaFor PET/CT to AVS in the second step. In the first step, the concordance will be determined between [68Ga]Ga-PentixaFor PET/CT and AVS and a concordance probability is calculated with a Bayesian prediction model. In the second step, we will compare [68Ga]Ga-PentixaFor PET/CT and AVS for clinical outcome and intensity of hypertensive drug use defined as daily defined doses in a RCT. ETHICS AND DISSEMINATION Ethics approval was acquired from the medical ethical committee East-Netherlands (METC Oost-Nederland). Results will be disseminated through peer-reviewed articles. TRIAL REGISTRATION NUMBER NL9625.
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Affiliation(s)
| | | | - Hans Groenewoud
- Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark Arntz
- Radiology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Martin Gotthardt
- Nuclear Medicine, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Jaap Deinum
- Internal Medicine, Radboudumc, Nijmegen, Gelderland, The Netherlands
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24
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Ulijn E, Den Broeder A, Boers N, Gotthardt M, Bouman C, Landewé RBM, Den Broeder N, Van Herwaarden N. POS0125 EXTRA-ARTICULAR FINDINGS WITH FDG-PET/CT IN RHEUMATOID ARTHRITIS PATIENTS: MORE HARM THAN BENEFIT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundWhole-body Positron Emission Tomography with CT-scanning using fluorine-18 fluorodeoxyglucose (18F-FDG) is occasionally used in Rheumatoid Arthritis (RA) patients. Reasons to use FDG-PET/CT-scans are to diagnose arthritis or guide decisions on systemic therapy, as FDG uptake in affected joints may reflect disease activity [1]. FDG-PET/CT might also detect malignancies, but the frequency of incidental findings and the proportion of relevant malignant disease that could be missed are currently unknown.ObjectivesTo study the malignancy screening performance of whole-body FDG-PET/CT in longstanding RA patients with low disease activity.MethodsFDG-PET/CT-scanning was done in the intervention arm of the Dose REduction Strategy of Subcutaneous TNF-inhibitors (DRESS) study, a randomized controlled trial on dose-tapering of biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs) [3]. Baseline and if applicable follow up whole-body FDG-PET/CT-scans were performed in consenting patients in the tapering arm to assess predictive value of subclinical PET-arthritis for risk of flaring [4]. The scans were also read by experienced nuclear medicine specialists immediately after they were performed for any unexpected extra-articular finding, conform routine clinical care.The reference standard was clinical diagnosis of malignancy during the 3 year follow-up. Prevalence of extra-articular abnormalities, follow-up, and received treatments were summarized post-hoc.Results121 scans were made in 79 patients. Extra-articular abnormalities were found in 59/121 (48.8%) scans (Table 1) in 45/79 (57%) patients.Table 1.Abnormalities found on FDG-PET/CT scans# abnormal results found on scans (%)No PET/CT result obtained3 (2.5)No abnormalities found on any scan59 (48.8)One or more abnormalities found per scan*59 (48.8)Total number of scans121 Inflammatory7 (5.7) Suspected malignancies9 (7.4) Cardiovascular2 (1.6) Pulmonary7 (5.8) Gastrointestinal10 (8.3) Muscles/tendons3 (2.5) Bone-related3 (2.5) Hypermetabolic lymph nodes (non-specific)16 (13.2) Thyroid4 (3.3)* Fifteen of these abnormalities were found on the second PET/CT, the rest was found on the first scan. 11 abnormalities on the second PET/CT were the same as the one seen on the first scan, and 7 abnormalities resolved after the first scan. One scan can show multiple abnormalities, from different categories.Follow-up action occurred in 21 (26.6%) patients, consisting of referral to a specialist or reassessing and/or scheduling diagnostics directly by the treating rheumatologist. In 5 (6.3%) patients, the rheumatologist followed-up. In 17 (21.5%) patients a consultation with a different specialist was scheduled. In five patients surgical/invasive intervention took place. In one patient a hemi-thyroidectomy was performed revealing a follicular adenoma. This resection was complicated by persistent recurrent laryngeal nerve paresis and hoarseness. In a second, an intra-uterine myomectomy took place. In a third, a colonoscopy was performe revealing two low-grade adenomas. In a fourth a benign cyst in the neck was extracted. A fifth patient underwent spinal marginal myotomy which turned out to be a benign schwannoma.Nine patients (7.4%) were suspected of malignancy, none turned out to be malignant. Six clinical malignancies (bladder, penile, lymphoma, 2x melanoma and prostate) that developed during follow-up were all negative on baseline FDG-PET/CT. The malignancies were diagnosed after an interval of between 5 and 34 months (mean 13 months).ConclusionWhole-body FDG-PET/CT-scanning for arthritis imaging in RA patients results in frequent incidental extra-articular findings, while some who apparently had normal scans developed malignancies.References[1]Mandl P. et al. RMD open 2019;5:e000950.[2]Van Herwaarden N. et al. BMJ 2015;350:1–8. doi:10.1136/bmj.h1389[3]Bouman C.A.M et al. Rheumatology 2021.Disclosure of InterestsNone declared
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25
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Schilham MG, Küsters-Vandevelde H, Somford DM, Rijpkema M, Gotthardt M. How Image-Guided Pathology Can Improve the Detection of Lymph Node Metastases in Prostate Cancer. Clin Nucl Med 2022; 47:559-561. [PMID: 35439175 PMCID: PMC9071021 DOI: 10.1097/rlu.0000000000004158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/20/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Detection of lymph node (LN) metastases in prostate cancer (PCa) is pivotal for accurate staging and determining treatment options. To date, the reference standard for nodal staging is histopathological examination of all harvested surgical specimens from extended pelvic LN dissections. However, this is a labor-intensive process, and small metastatic foci can be missed due to sampling effects. With current research expanding toward using radiolabeled prostate-specific membrane antigen ligands for image-guided surgery, new opportunities arise for image-guided pathological assessment of surgical specimens. Here, we illustrate how molecular imaging can complement histopathology and improve accurate detection of LN metastases.
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Affiliation(s)
- Melline G.M. Schilham
- From the Department of Medical Imaging, Nuclear Medicine
- Department of Urology, Radboud University Medical Centre
- Prosper Prostate Cancer Clinics, Nijmegen, the Netherlands
| | | | - Diederik M. Somford
- Urology, Canisius Wilhelmina Hospital
- Prosper Prostate Cancer Clinics, Nijmegen, the Netherlands
| | - M. Rijpkema
- From the Department of Medical Imaging, Nuclear Medicine
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26
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Hagemans IM, Wierstra PJ, Steuten K, Molkenboer-Kuenen JDM, van Dalen D, Ter Beest M, van der Schoot JMS, Ilina O, Gotthardt M, Figdor CG, Scheeren FA, Heskamp S, Verdoes M. Correction to: Multiscale imaging of therapeutic anti-PD-L1 antibody localization using molecularly defined imaging agents Iris. J Nanobiotechnology 2022; 20:229. [PMID: 35568872 PMCID: PMC9107661 DOI: 10.1186/s12951-022-01306-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Iris M Hagemans
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Institute for Chemical Immunology, Nijmegen, The Netherlands
| | - Peter J Wierstra
- Department of Medical Imaging, Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kas Steuten
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Institute for Chemical Immunology, Nijmegen, The Netherlands
| | - Janneke D M Molkenboer-Kuenen
- Department of Medical Imaging, Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Duco van Dalen
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Institute for Chemical Immunology, Nijmegen, The Netherlands
| | - Martin Ter Beest
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johan M S van der Schoot
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga Ilina
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Institute for Chemical Immunology, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carl G Figdor
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Institute for Chemical Immunology, Nijmegen, The Netherlands.,Division of Immunotherapy, Oncode Institute, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ferenc A Scheeren
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sandra Heskamp
- Department of Medical Imaging, Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Martijn Verdoes
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. .,Institute for Chemical Immunology, Nijmegen, The Netherlands.
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Allach Y, Banda A, van Gemert W, de Groot M, Derks Y, Schilham M, Hoepping A, Perk L, Gotthardt M, Janssen M, Nagarajah J, Privé BM. An Explorative Study of the Incidental High Renal Excretion of [ 18F]PSMA-1007 for Prostate Cancer PET/CT Imaging. Cancers (Basel) 2022; 14:cancers14092076. [PMID: 35565204 PMCID: PMC9100267 DOI: 10.3390/cancers14092076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023] Open
Abstract
Positron emission tomography (PET) of prostate-specific membrane antigen (PSMA) allows for accurate diagnosis and staging of prostate cancer (PCa). Compared to other PSMA PET tracers available, [18F]PSMA-1007 is predominantly excreted via the hepatobiliary tract resulting in low renal excretion which improves evaluation of the pelvic area. However, some patients do show high urinary uptake of [18F]PSMA-1007. The present study aimed to investigate this sudden high urinary uptake of [18F]PSMA-1007 by evaluating [18F]PSMA-1007 PET scans from PCa patients. In this single-center retrospective study, patients that underwent [18F]PSMA-1007 PET imaging between July 2018 and January 2021 were included. Data regarding the individual patient characteristics, scan acquisition and batch production were analyzed. To determine the urinary excretion of [18F]PSMA-1007, a region of interest was drawn in the bladder, and standardized uptake values (SUVs) were calculated and compared to SUVs in the prostate. An SUVmax of >10 was considered high urinary excretion, an SUVmax 7.5−10 intermediate and an SUVmax < 7.5 low urinary excretion. A total of 344 patients underwent [18F]PSMA-1007 PET/CT imaging, with 37 patients receiving three or more [18F]PSMA-1007 PET/CT scans. The mean SUVmean and SUVmax of the bladder were 3.9 (SD 2.9) and 5.9 (SD 4.2), respectively. Fourteen percent of patients showed high urinary uptake of [18F]PSMA-1007. Twelve of the thirty-seven patients (32.4%) that had multiple scans showed a varying urinary uptake of [18F]PSMA-1007 per PSMA PET/CT scan. In terms of patient characteristics, risk factors, medication and blood laboratory results, no significant influencing variables were found. Nor was there a difference observed in the batch size and the mean radiochemical purity of PSMA-1007 for high- and low-excreting patients. However, the bladder volume affected the mean SUVmax in the bladder significantly, with higher SUVs in lower bladder volumes. In this study, we observed that a higher SUV in the urinary tract seemed to occur in patients with low bladder volume. A prospective study is needed to corroborate this hypothesis.
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Affiliation(s)
- Youssra Allach
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (Y.A.); (A.B.); (W.v.G.); (M.d.G.); (Y.D.); (M.S.); (L.P.); (M.G.); (M.J.); (J.N.)
- Department of Cardiology, Erasmus MC, 3015 CE Rotterdam, The Netherlands
| | - Amina Banda
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (Y.A.); (A.B.); (W.v.G.); (M.d.G.); (Y.D.); (M.S.); (L.P.); (M.G.); (M.J.); (J.N.)
| | - Willemijn van Gemert
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (Y.A.); (A.B.); (W.v.G.); (M.d.G.); (Y.D.); (M.S.); (L.P.); (M.G.); (M.J.); (J.N.)
| | - Michel de Groot
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (Y.A.); (A.B.); (W.v.G.); (M.d.G.); (Y.D.); (M.S.); (L.P.); (M.G.); (M.J.); (J.N.)
| | - Yvonne Derks
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (Y.A.); (A.B.); (W.v.G.); (M.d.G.); (Y.D.); (M.S.); (L.P.); (M.G.); (M.J.); (J.N.)
| | - Melline Schilham
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (Y.A.); (A.B.); (W.v.G.); (M.d.G.); (Y.D.); (M.S.); (L.P.); (M.G.); (M.J.); (J.N.)
| | - Alexander Hoepping
- Department of Medicinal Chemistry, ABX Advanced Biochemical Compounds GmbH, 1454 Radeberg, Germany;
| | - Lars Perk
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (Y.A.); (A.B.); (W.v.G.); (M.d.G.); (Y.D.); (M.S.); (L.P.); (M.G.); (M.J.); (J.N.)
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (Y.A.); (A.B.); (W.v.G.); (M.d.G.); (Y.D.); (M.S.); (L.P.); (M.G.); (M.J.); (J.N.)
| | - Marcel Janssen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (Y.A.); (A.B.); (W.v.G.); (M.d.G.); (Y.D.); (M.S.); (L.P.); (M.G.); (M.J.); (J.N.)
| | - James Nagarajah
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (Y.A.); (A.B.); (W.v.G.); (M.d.G.); (Y.D.); (M.S.); (L.P.); (M.G.); (M.J.); (J.N.)
| | - Bastiaan M. Privé
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (Y.A.); (A.B.); (W.v.G.); (M.d.G.); (Y.D.); (M.S.); (L.P.); (M.G.); (M.J.); (J.N.)
- Correspondence: ; Tel.: +31-24-3690031
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Prasad V, Boss M, Rottenburger C, Brenner W, Blankenstein O, Prasad S, Buitinga M, Shah P, Gotthardt M. Reply: 68Ga NODAGA-Exendin-4 PET Scanning for Focal Congenital Hyperinsulinism: Need for Replication. J Nucl Med 2022; 63:493-494. [PMID: 35232881 DOI: 10.2967/jnumed.121.263167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Martin Gotthardt
- Radboud University Medical Centre Nijmegen, The Netherlands E-mail:
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Baas DJH, Schilham M, Hermsen R, de Baaij JMS, Vrijhof HJEJ, Hoekstra RJ, Sedelaar JPM, Küsters-Vandevelde HVN, Gotthardt M, Wijers CHW, van Basten JP, Somford DM. Preoperative PSMA-PET/CT as a predictor of biochemical persistence and early recurrence following radical prostatectomy with lymph node dissection. Prostate Cancer Prostatic Dis 2022; 25:65-70. [PMID: 34471231 DOI: 10.1038/s41391-021-00452-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aims to evaluate the predictive value of lymph nodes (LN) suspicious for metastases on preoperative prostate-specific membrane antigen (PSMA) PET/CT for biochemical persistence (BCP) and early biochemical recurrence (BCR) following robotic-assisted radical prostatectomy (RARP) with extended pelvic LN dissection (ePLND). METHODS We evaluated 213 patients with intermediate and high-risk prostate cancer (PCa) who underwent clinical staging with preoperative 68Ga- or 18F-PSMA-PET/CT scan and subsequent RARP with ePLND. Patients were grouped as PSMA- or PSMA+ depending on their LN status on PSMA-PET/CT and subdivided according to histological LN status in pN0 or pN1. Diagnostic accuracy of PSMA-PET/CT for the detection of pN1 was evaluated. BCP was defined as a first postoperative serum PSA level ≥0.1 ng/mL 6-12 weeks following RP. Early BCR was defined as detectable PSA > 0.2 ng/mL within 12 months of follow-up. Univariable logistic regression analyses were used to evaluate the effect of PSMA+ on BCP and BCR. RESULTS Forty patients (19%) were PSMA+. The overall incidence of pN1 was 23%. Sensitivity, specificity, PPV and NPV on a per patient level for the detection of pN1 was 29%, 84%, 35%, and 80% respectively. BCP was observed in 26 of 211 patients (12%) and early BCR in 23 of 110 patients (21%). The presence of PSMA+ was a significant predictor for BCP (OR 7.1, 2.9-17.1 95% CI) and BCR (OR 8.1, 2.9-22.6 95% CI). CONCLUSION Preoperative PSMA-PET/CT may be a valuable tool for patient counseling for RARP and ePLND as it is a significant predictor for the risk of postoperative BCP and early BCR. We conclude that an ePLND should not be avoided in men with intermediate or high-risk PCa and preoperative negative PSMA-PET/CT, as 20% have microscopic LN metastasis.
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Affiliation(s)
- D J H Baas
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. .,Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands.
| | - M Schilham
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands.,Department of Medical Imaging, Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - R Hermsen
- Department of Nuclear Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J M S de Baaij
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
| | - H J E J Vrijhof
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands.,Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - R J Hoekstra
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands.,Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - J P M Sedelaar
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands.,Department of Urology, Radboudumc, Nijmegen, The Netherlands
| | | | - M Gotthardt
- Department of Medical Imaging, Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - C H W Wijers
- CWZ Academy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J P van Basten
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
| | - D M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
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Ulijn E, den Broeder AA, Boers N, Gotthardt M, Bouman CAM, Landewé R, den Broeder N, van Herwaarden N. Extra-articular findings with FDG-PET/CT in rheumatoid arthritis patients: more harm than benefit. Rheumatol Adv Pract 2022; 6:rkac014. [PMID: 35311064 PMCID: PMC8924972 DOI: 10.1093/rap/rkac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/15/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Objective
Whole-body Positron Emission Tomography with CT-scanning using fluorine-18 fluorodeoxyglucose (18F-FDG) is occasionally used in rheumatoid arthritis (RA) patients to detect arthritis. FDG-PET/CT might also detect malignancies, but the amount of incidental findings and the number of relevant malignant disease that could be missed are currently unknown. We aimed to study the malignancy screening performance of whole-body FDG-PET/CT in longstanding RA patients with low disease activity.
Methods
FDG-PET/CT-scanning was done in the intervention arm of the Dose REduction Strategy of Subcutaneous TNF-inhibitors (DRESS) study, a randomized controlled trial on dose-tapering of biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs). The reference standard was clinical diagnosis of malignancy during the 3 year follow-up of the study. Prevalence of extra-articular abnormalities, follow-up, and treatments were summarized post-hoc.
Results
121 scans were made in 79 patients. Extra-articular abnormalities were found in 59/121 (49%) scans, resulting in additional diagnostic procedures in 21/79 (26.6%) patients. Nine patients (7.4%) were suspected of malignancy, none turned out to be malignant. Six clinical malignancies that developed during follow-up were all negative on baseline FDG-PET/CT.
Conclusion
Whole-body FDG-PET/CT-scanning used in RA patients for imaging of arthritis results in frequent incidental extra-articular findings, while some who apparently had normal scans also developed malignancies.
Trial registration
Netherlands Trial Register, www.trialregister.nl, NL6771
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Affiliation(s)
- Evy Ulijn
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Alfons A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nadine Boers
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Martin Gotthardt
- Radiology Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Chantal A M Bouman
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert Landewé
- Department of Rheumatology and Clinical immunology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Nathan den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Noortje van Herwaarden
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
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Hagemans IM, Wierstra PJ, Steuten K, Molkenboer-Kuenen JDM, van Dalen D, Ter Beest M, van der Schoot JMS, Ilina O, Gotthardt M, Figdor CG, Scheeren FA, Heskamp S, Verdoes M. Multiscale imaging of therapeutic anti-PD-L1 antibody localization using molecularly defined imaging agents. J Nanobiotechnology 2022; 20:64. [PMID: 35109860 PMCID: PMC8811974 DOI: 10.1186/s12951-022-01272-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/17/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND While immune checkpoint inhibitors such as anti-PD-L1 antibodies have revolutionized cancer treatment, only subgroups of patients show durable responses. Insight in the relation between clinical response, PD-L1 expression and intratumoral localization of PD-L1 therapeutics could improve patient stratification. Therefore, we present the modular synthesis of multimodal antibody-based imaging tools for multiscale imaging of PD-L1 to study intratumoral distribution of PD-L1 therapeutics. RESULTS To introduce imaging modalities, a peptide containing a near-infrared dye (sulfo-Cy5), a chelator (DTPA), an azide, and a sortase-recognition motif was synthesized. This peptide and a non-fluorescent intermediate were used for site-specific functionalization of c-terminally sortaggable mouse IgG1 (mIgG1) and Fab anti-PD-L1. To increase the half-life of the Fab fragment, a 20 kDa PEG chain was attached via strain-promoted azide-alkyne cycloaddition (SPAAC). Biodistribution and imaging studies were performed with 111In-labeled constructs in 4T1 tumor-bearing mice. Comparing our site-specific antibody-conjugates with randomly conjugated antibodies, we found that antibody clone, isotype and method of DTPA conjugation did not change tumor uptake. Furthermore, addition of sulfo-Cy5 did not affect the biodistribution. PEGylated Fab fragment displayed a significantly longer half-life compared to unPEGylated Fab and demonstrated the highest overall tumor uptake of all constructs. PD-L1 in tumors was clearly visualized by SPECT/CT, as well as whole body fluorescence imaging. Immunohistochemistry staining of tumor sections demonstrated that PD-L1 co-localized with the fluorescent and autoradiographic signal. Intratumoral localization of the imaging agent could be determined with cellular resolution using fluorescent microscopy. CONCLUSIONS A set of molecularly defined multimodal antibody-based PD-L1 imaging agents were synthesized and validated for multiscale monitoring of PD-L1 expression and localization. Our modular approach for site-specific functionalization could easily be adapted to other targets.
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Affiliation(s)
- Iris M Hagemans
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute for Chemical Immunology, Nijmegen, The Netherlands
| | - Peter J Wierstra
- Department of Medical Imaging, Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kas Steuten
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute for Chemical Immunology, Nijmegen, The Netherlands
| | - Janneke D M Molkenboer-Kuenen
- Department of Medical Imaging, Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Duco van Dalen
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute for Chemical Immunology, Nijmegen, The Netherlands
| | - Martin Ter Beest
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johan M S van der Schoot
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga Ilina
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute for Chemical Immunology, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carl G Figdor
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute for Chemical Immunology, Nijmegen, The Netherlands
- Division of Immunotherapy, Oncode Institute, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ferenc A Scheeren
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sandra Heskamp
- Department of Medical Imaging, Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Martijn Verdoes
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
- Institute for Chemical Immunology, Nijmegen, The Netherlands.
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Westdorp H, Verhoeff SR, Gotthardt M, van Herpen CM, van den Heuvel MM, Heskamp S, Aarntzen EH. Towards a better understanding of immune checkpoint inhibitor radiolabeled PET imaging studies. J Nucl Med 2022; 63:359-361. [DOI: 10.2967/jnumed.121.262622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/27/2021] [Indexed: 11/16/2022] Open
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van Lith SAM, Huizing FJ, Franssen GM, Hoeben BAW, Lok J, Doulkeridou S, Boerman OC, Gotthardt M, van Bergen En Henegouwen PMP, Bussink J, Heskamp S. Novel VHH-Based Tracers with Variable Plasma Half-Lives for Imaging of CAIX-Expressing Hypoxic Tumor Cells. Mol Pharm 2022; 19:3511-3520. [PMID: 35044182 PMCID: PMC9533306 DOI: 10.1021/acs.molpharmaceut.1c00841] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
![]()
Hypoxic areas are
present in the majority of solid tumors, and
hypoxia is associated with resistance to therapies and poor outcomes.
A transmembrane protein that is upregulated by tumor cells that have
adapted to hypoxic conditions is carbonic anhydrase IX (CAIX). Therefore,
noninvasive imaging of CAIX could be of prognostic value, and it could
steer treatment strategies. The aim of this study was to compare variants
of CAIX-binding VHH B9, with and without a C-terminal albumin-binding
domain with varying affinity (ABDlow and ABDhigh), for SPECT imaging of CAIX expression. The binding affinity and
internalization of the various B9-variants were analyzed using SK-RC-52
cells. Biodistribution studies were performed in mice with subcutaneous
SCCNij153 human head and neck cancer xenografts. Tracer uptake was
determined by ex vivo radioactivity counting and
visualized by SPECT/CT imaging. Furthermore, autoradiography images
of tumor sections were spatially correlated with CAIX immunohistochemistry.
B9-variants demonstrated a similar moderate affinity for CAIX in vitro. Maximal tumor uptake and acceptable tumor-to-blood
ratios were found in the SCCNij153 model at 4 h post injection for
[111In]In-DTPA-B9 (0.51 ± 0.08%ID/g and 8.1 ±
0.85, respectively), 24 h post injection for [111In]In-DTPA-B9-ABDlow (2.39 ± 0.44%ID/g and 3.66 ± 0.81, respectively)
and at 72 h post injection for [111In]In-DTPA-B9-ABDhigh (8.7 ± 1.34%ID/g and 2.43 ± 0.15, respectively). An excess of unlabeled monoclonal anti-CAIX antibody efficiently
inhibited tumor uptake of [111In]In-DTPA-B9, while only
a partial reduction of [111In]In-DTPA-B9-ABDlow and [111In]In-DTPA-B9-ABDhigh uptake was found.
Immunohistochemistry and autoradiography images showed colocalization
of all B9-variants with CAIX expression; however, [111In]In-DTPA-B9-ABDlow and [111In]In-DTPA-B9-ABDhigh also
accumulated in non-CAIX expressing regions. Tumor uptake of [111In]In-DTPA-B9-ABDlow and [111In]In-DTPA-B9-ABDhigh, but not of [111In]In-DTPA-B9, could be visualized
with SPECT/CT imaging. In conclusion, [111In]In-DTPA-B9
has a high affinity to CAIX and shows specific targeting to CAIX in
head and neck cancer xenografts. The addition of ABD prolonged plasma
half-life, increased tumor uptake, and enabled SPECT/CT imaging. This
uptake was, however, partly CAIX- independent, precluding the ABD-tracers
for use in hypoxia quantification in this tumor type.
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Affiliation(s)
- Sanne A M van Lith
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands
| | - Fokko J Huizing
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands.,Department of Radiation Oncology, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands
| | - Gerben M Franssen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands
| | - Bianca A W Hoeben
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| | - Jasper Lok
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands
| | - Sofia Doulkeridou
- Department of Cell Biology, University of Utrecht, Utrecht, 3584 GE, The Netherlands
| | - Otto C Boerman
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands
| | | | - Johan Bussink
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands
| | - Sandra Heskamp
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands
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Migliari S, Sammartano A, Boss M, Gotthardt M, Scarlattei M, Baldari G, Silva C, Bonadonna RC, Ruffini L. Development and Validation of an Analytical HPLC Method to Assess Chemical and Radiochemical Purity of [ 68Ga]Ga-NODAGA-Exendin-4 Produced by a Fully Automated Method. Molecules 2022; 27:543. [PMID: 35056858 PMCID: PMC8778103 DOI: 10.3390/molecules27020543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Glucagon-like peptide 1 receptor (GLP-1R) is preferentially expressed in pancreatic islets, especially in β-cells, and highly expressed in human insulinomas and gastrinomas. In recent years several GLP-1R-avid radioligands have been developed to image insulin-secreting tumors or to provide a tentative quantitative in vivo biomarker of pancreatic β-cell mass. Exendin-4, a 39-amino acid peptide with high binding affinity to GLP-1R, has been labeled with Ga-68 for imaging with positron emission tomography (PET). Preparation conditions may influence the quality and in vivo behavior of tracers. Starting from a published synthesis and quality controls (QCs) procedure, we have developed and validated a new rapid and simple UV-Radio-HPLC method to test the chemical and radiochemical purity of [68Ga]Ga-NODAGA-exendin-4, to be used in the clinical routine. Methods: Ga-68 was obtained from a 68Ge/68Ga Generator (GalliaPharma®) and purified using a cationic-exchange cartridge on an automated synthesis module (Scintomics GRP®). NODAGA-exendin-4 contained in the reactor (10 µg) was reconstituted with HEPES and ascorbic acid. The reaction mixture was incubated at 100 °C. The product was purified through HLB cartridge, diluted, and sterilized. To validate the proposed UV-Radio-HPLC method, a stepwise approach was used, as defined in the guidance document released by the International Conference on Harmonization of Technical Requirements of Pharmaceuticals for Human Use (ICH), adopted by the European Medicines Agency (CMP/ICH/381/95 2014). The assessed parameters are specificity, linearity, precision (repeatability), accuracy, and limit of quantification. Therefore, a range of concentrations of Ga-NODAGA-exendin-4, NODAGA-exendin-4 (5, 4, 3.125, 1.25, 1, and 0.75 μg/mL) and [68Ga]Ga-NODAGA-exendin-4 were analyzed. To validate the entire production process, three consecutive batches of [68Ga]Ga-NODAGA-exendin-4 were tested. Results: Excellent linearity was found between 5-0.75 μg/mL for both the analytes (NODAGA-exendin-4 and 68Ga-NODAGA-exendin-4), with a correlation coefficient (R2) for calibration curves equal to 0.999, average coefficients of variation (CV%) < 2% (0.45% and 0.39%) and average per cent deviation value of bias from 100%, of 0.06% and 0.04%, respectively. The calibration curve for the determination of [68Ga]Ga-NODAGA-exendin-4 was linear with a R2 of 0.993 and CV% < 2% (1.97%), in accordance to acceptance criteria. The intra-day and inter-day precision of our method was statistically confirmed using 10 μg of peptide. The mean radiochemical yield was 45 ± 2.4% in all the three validation batches of [68Ga]Ga-NODAGA-exendin-4. The radiochemical purity of [68Ga]Ga-NODAGA-exendin-4 was >95% (97.05%, 95.75% and 96.15%) in all the three batches. Conclusions: The developed UV-Radio-HPLC method to assess the radiochemical and chemical purity of [68Ga]Ga-NODAGA-exendin-4 is rapid, accurate and reproducible like its fully automated production. It allows the routine use of this PET tracer as a diagnostic tool for PET imaging of GLP-1R expression in vivo, ensuring patient safety.
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Affiliation(s)
- Silvia Migliari
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy; (A.S.); (M.S.); (G.B.); (L.R.)
| | - Antonino Sammartano
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy; (A.S.); (M.S.); (G.B.); (L.R.)
| | - Marti Boss
- Department of Medical Imaging, Radboudumc, 6500 HB Nijmegen, The Netherlands; (M.B.); (M.G.)
| | - Martin Gotthardt
- Department of Medical Imaging, Radboudumc, 6500 HB Nijmegen, The Netherlands; (M.B.); (M.G.)
| | - Maura Scarlattei
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy; (A.S.); (M.S.); (G.B.); (L.R.)
| | - Giorgio Baldari
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy; (A.S.); (M.S.); (G.B.); (L.R.)
| | - Claudia Silva
- Food and Drug Sciences Department, University of Parma, Parco Area delle Scienze 27/A, 43126 Parma, Italy;
| | - Riccardo C. Bonadonna
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy
| | - Livia Ruffini
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy; (A.S.); (M.S.); (G.B.); (L.R.)
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35
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Privé BM, Derks YHW, Rosar F, Franssen GM, Peters SMB, Khreish F, Bartholomä M, Maus S, Gotthardt M, Laverman P, Konijnenberg MW, Ezziddin S, Nagarajah J, Heskamp S. 89Zr-labeled PSMA ligands for pharmacokinetic PET imaging and dosimetry of PSMA-617 and PSMA-I&T: a preclinical evaluation and first in man. Eur J Nucl Med Mol Imaging 2021; 49:2064-2076. [PMID: 34932154 DOI: 10.1007/s00259-021-05661-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/12/2021] [Indexed: 01/04/2023]
Abstract
RATIONALE Prolonged in vivo evaluation of PSMA tracers could improve tumor imaging and patient selection for 177Lu-PSMA-617 and 177Lu-PSMA-I&T. In this study, we present the radiolabeling method of PSMA-617 and PSMA-I&T with the long-lived positron emitter 89Zr to enable PET imaging up to 7 days post-injection. We compared the biodistribution of 89Zr-PSMA-617 and 89Zr-PSMA-I&T to those of 177Lu-PSMA-617 and 177Lu-PSMA-I&T, respectively, in a PSMA+ xenograft model. Moreover, we provide the first human 89Zr-PSMA-617 images. MATERIALS AND METHODS PSMA ligands were labeled with 50-55 MBq [89Zr]ZrCl4 using a two-step labeling protocol. For biodistribution, BALB/c nude mice bearing PSMA+ and PSMA- xenografts received 0.6 µg (0.6-1 MBq) of 89Zr-PSMA-617, 89Zr-PSMA-I&T, 177Lu-PSMA-617, or 177Lu-PSMA-I&T intravenously. Ex vivo biodistribution and PET/SPECT imaging were performed up to 168 h post-injection. Dosimetry was performed from the biodistribution data. The patient received 90.5 MBq 89Zr-PSMA-617 followed by PET/CT imaging. RESULTS 89Zr-labeled PSMA ligands showed a comparable ex vivo biodistribution to its respective 177Lu-labeled counterparts with high tumor accumulation in the PSMA+ xenografts. However, using a dose estimation model for 177Lu, absorbed radiation dose in bone and kidneys differed among the 177Lu-PSMA and 89Zr-PSMA tracers. 89Zr-PSMA-617 PET in the first human patient showed high contrast of PSMA expressing tissues up to 48 h post-injection. CONCLUSION PSMA-617 and PSMA-I&T were successfully labeled with 89Zr and demonstrated high uptake in PSMA+ xenografts, which enabled PET up to 168 h post-injection. The biodistribution of 89Zr-PSMA-I&T and 89Zr-PSMA-617 resembled that of 177Lu-PSMA-I&T and 177Lu-PSMA-617, respectively. The first patient 89Zr-PSMA-617 PET images were of high quality warranting further clinical investigation.
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Affiliation(s)
- Bastiaan M Privé
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Yvonne H W Derks
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Florian Rosar
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Gerben M Franssen
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Steffie M B Peters
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Fadi Khreish
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Mark Bartholomä
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Stephan Maus
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Martin Gotthardt
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Peter Laverman
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mark W Konijnenberg
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - James Nagarajah
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sandra Heskamp
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Deden LN, Booij J, Grandjean J, Homberg JR, Hazebroek EJ, Gotthardt M, Boss M. Brain Imaging of the GLP-1 Receptor in Obesity Using 68Ga-NODAGA-Exendin-4 PET. Brain Sci 2021; 11:brainsci11121647. [PMID: 34942949 PMCID: PMC8699257 DOI: 10.3390/brainsci11121647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/28/2022] Open
Abstract
Stimulation of glucagon-like peptide-1 (GLP-1) receptors increases the insulin release in the pancreas during high glucose levels, and also stimulates a feeling of satiety. Likewise, synthetic GLP-1 receptor agonists derived from exendin are used successfully in the treatment of type-2 diabetes mellitus and obesity. Interestingly, preclinical and clinical studies further suggest that GLP-1 receptor agonists may decrease motor, behavioral, and cognitive symptoms in (animal models) Parkinson’s disease and Alzheimer’s disease and may slow down neurodegeneration. These observations suggest stimulation of GLP-1 receptors in the brain. The GLP-1 positron emission tomography (PET) tracer 68Ga-NODAGA-exendin-4 has been developed and successfully used for imaging in humans. In an ongoing study on the effects of bariatric surgery on GLP-1 receptor expression, we performed 68Ga-NODAGA-exendin-4 PET in obese subjects. Here we evaluated whether GLP-1 receptor binding could be visualized in the central nervous system in 10 obese subjects (seven woman; body mass index: mean ± SD: 39 ± 4.4 kg/m2) before bariatric surgery. Although we observed clear uptake in the pituitary area (mean SUVmax 4.3 ± 2.3), we found no significant uptake in other parts of the brain. We conclude that 68Ga-NODAGA-exendin-4 PET cannot be used to analyze GLP-1 receptors in the brain of obese subjects.
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Affiliation(s)
- Laura N. Deden
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (L.N.D.); (J.B.); (J.G.); (M.B.)
- Department of Surgery, Vitalys Clinic, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands;
| | - Jan Booij
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (L.N.D.); (J.B.); (J.G.); (M.B.)
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands
| | - Joanes Grandjean
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (L.N.D.); (J.B.); (J.G.); (M.B.)
- Center for Medical Neuroscience, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 EN Nijmegen, The Netherlands;
| | - Judith R. Homberg
- Center for Medical Neuroscience, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 EN Nijmegen, The Netherlands;
| | - Eric J. Hazebroek
- Department of Surgery, Vitalys Clinic, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands;
- Division of Human Nutrition and Health, Wageningen University, 6708 PB Wageningen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (L.N.D.); (J.B.); (J.G.); (M.B.)
- Correspondence:
| | - Marti Boss
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (L.N.D.); (J.B.); (J.G.); (M.B.)
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Bouman CAM, van Herwaarden N, Blanken AB, Van der Laken CJ, Gotthardt M, Oyen WJG, den Broeder AA, van der Maas A, van den Ende CH. 18F-FDG PET-CT scanning in rheumatoid arthritis patients tapering TNFi: reliability, validity and predictive value. Rheumatology (Oxford) 2021; 61:SI6-SI13. [PMID: 34791068 DOI: 10.1093/rheumatology/keab842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/03/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To investigate the reliability and validity of 18F-FDG PET-CT scanning (FDG-PET) in rheumatoid arthritis (RA) patients with low disease activity tapering tumor necrosis factor inhibitors (TNFi) and its' predictive value for successful tapering or discontinuation. METHODS Patients in the tapering arm of the DRESS study, a randomized controlled trial on TNFi tapering in RA, underwent FDG-PET before tapering (baseline) and after maximal tapering. 48 joints per scan were scored: 1) visually (FDG-avid joint (FAJ) y/n), 2) quantitatively (maximal and mean standardized uptake values (SUVmax and SUVmean)). Interobserver agreement was calculated in 10 patients at baseline. Quantitative and visual FDG-PET scores were investigated for: 1) (multilevel) association with clinical parameters both on joint and patient level and 2) predictive value at baseline and change between baseline and maximal tapering (delta) for successful tapering and discontinuation at 18 months. RESULTS 79 patients underwent FDG-PET. For performance of identification of FAJs on PET, Cohen's kappa was 0.49 (0.35-0.63). For SUVmax and SUVmean, ICCs were 0.80 (0.77-0.83) and 0.96 (0.9-1.0), respectively. On joint level, swelling was significantly associated with SUVmax and SUVmean (B coefficients with 95%CI 1.0 (0.73-1.35) and 0.2 (0.08-0.32) respectively). On patient level only correlation with acute phase reactants was found. FDG-PET scores were not predictive for successful tapering or discontinuation. CONCLUSIONS Quantitative FDG-PET arthritis scoring in RA patients with low disease activity is reliable and has some construct validity. However, no predictive values were found for FDG-PET parameters for successful tapering and/or discontinuation of TNFi.
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Affiliation(s)
- Chantal A M Bouman
- Department of Rheumatology, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noortje van Herwaarden
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Farmacology-Toxicology, Radboudumc, Nijmegen, The Netherlands
| | - Annelies B Blanken
- Department of Rheumatology, AmsterdamUMC-location VU Medical Center, Amsterdam, The Netherlands.,Department of Rheumatology, Reade, Amsterdam, The Netherlands
| | - Conny J Van der Laken
- Department of Rheumatology, AmsterdamUMC-location VU Medical Center, Amsterdam, The Netherlands
| | - Martin Gotthardt
- Department of Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Wim J G Oyen
- Department of Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands.,Department of Nuclear Medicin, Humanitas University and Clinical and Research Center, Milan, Italy.,Department of Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Alfons A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rheumatology, Radboudumc, Nijmegen, The Netherlands
| | - Aatke van der Maas
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Cornelia H van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rheumatology, Radboudumc, Nijmegen, The Netherlands
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Privé BM, Janssen MJR, van Oort IM, Muselaers CHJ, Jonker MA, van Gemert WA, de Groot M, Westdorp H, Mehra N, Verzijlbergen JF, Scheenen TWJ, Zámecnik P, Barentsz JO, Gotthardt M, Noordzij W, Vogel WV, Bergman AM, van der Poel HG, Vis AN, Oprea-Lager DE, Gerritsen WR, Witjes JA, Nagarajah J. Update to a randomized controlled trial of lutetium-177-PSMA in Oligo-metastatic hormone-sensitive prostate cancer: the BULLSEYE trial. Trials 2021; 22:768. [PMID: 34736509 PMCID: PMC8566967 DOI: 10.1186/s13063-021-05733-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND The BULLSEYE trial is a multicenter, open-label, randomized controlled trial to test the hypothesis if 177Lu-PSMA is an effective treatment in oligometastatic hormone-sensitive prostate cancer (oHSPC) to prolong the progression-free survival (PFS) and postpone the need for androgen deprivation therapy (ADT). The original study protocol was published in 2020. Here, we report amendments that have been made to the study protocol since the commencement of the trial. CHANGES IN METHODS AND MATERIALS Two important changes were made to the original protocol: (1) the study will now use 177Lu-PSMA-617 instead of 177Lu-PSMA-I&T and (2) responding patients with residual disease on 18F-PSMA PET after the first two cycles are eligible to receive additional two cycles of 7.4 GBq 177Lu-PSMA in weeks 12 and 18, summing up to a maximum of 4 cycles if indicated. Therefore, patients receiving 177Lu-PSMA-617 will also receive an interim 18F-PSMA PET scan in week 4 after cycle 2. The title of this study was modified to; "Lutetium-177-PSMA in Oligo-metastatic Hormone Sensitive Prostate Cancer" and is now partly supported by Advanced Accelerator Applications, a Novartis Company. CONCLUSIONS We present an update of the original study protocol prior to the completion of the study. Treatment arm patients that were included and received 177Lu-PSMA-I&T under the previous protocol will be replaced. TRIAL REGISTRATION ClinicalTrials.gov NCT04443062 . First posted: June 23, 2020.
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Affiliation(s)
- Bastiaan M Privé
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Marcel J R Janssen
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Inge M van Oort
- Department of Urology, Radboudumc, Nijmegen, The Netherlands
| | | | - Marianne A Jonker
- Department of Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | - Willemijn A van Gemert
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Michel de Groot
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Harm Westdorp
- Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands
| | - J Fred Verzijlbergen
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Tom W J Scheenen
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Patrik Zámecnik
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Walter Noordzij
- Department of Radiology and Nuclear Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wouter V Vogel
- Department of Radiology and Nuclear Medicine, NKI Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Radiation Oncology, NKI Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Andries M Bergman
- Department of Medical Oncology, NKI Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, NKI Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - André N Vis
- Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - J Alfred Witjes
- Department of Urology, Radboudumc, Nijmegen, The Netherlands
| | - James Nagarajah
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.
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Vad OB, Angeli E, Liss M, Ahlberg G, Andreasen L, Christophersen IE, Tveit A, Haunsoe S, Svendsen JH, Lundegaard PR, Gotthardt M, Olesen MS. Integration of Scandinavian genetic data with UK biobank data implicates the RBM20 gene with atrial fibrillation pathogenesis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
Atrial fibrillation (AF) is the most common sustained arrhythmia. It carries a large healthcare burden and is associated with serious complications. The arrhythmia has a substantial genetic component and is associated with several structural genes, including the gene TTN. A recent large genome-wide association study on AF found an association to RBM20. The RBM20 gene is a splicing factor targeting TTN, RYR2 and CAMK2D among other cardiac genes. Using Next-Generation Sequencing and data derived from the UK Biobank, we aimed to reveal the role of RBM20 in AF.
Methods and results
We examined the burden of rare (Minor allele frequency (MAF)<0.01%) RBM20 loss-of-function (LOF) variants in whole-exome sequencing data from the UK Biobank (n=175,280). AF was defined by ICD9/10, while individuals without AF were used as controls. Association tests aggregating rare variants in RBM20 using the Efficient Variant-Set Mixed Model Association Test (SMMAT) were performed to assess the effect of LOF RBM20 variants, adjusted for age, sex and principal components. We identified 33 LOF variants in RBM20, which were significantly enriched in AF (P=0.0087).
To examine the effect of rare missense RBM20 variants in the splicing of TTN, we screened an in-house cohort of 531 Scandinavian early-onset AF patients using targeted sequencing. We filtered for rare (MAF<0.1%) and deleterious (defined as combined annotation dependent depletion score >20) variants and identified nine missense variants and three novel LOF variants in RBM20. To evaluate the effect of these RBM20 variants, we constructed a series of human RBM20 single nucleotide base exchange mutants. The splicing activity of the variants was measured with RT-qPCR on HEK293 cells transfected with a TTN241–3 splicing reporter. Four of these variants resulted in a significantly altered splicing activity in TTN, with the largest effect observed for LOF variants.
In order to examine the biological effect of RBM20 variants on structural changes in atrial tissue, we used a Norwegian Brown rat animal model with loss of RBM20. In this model, Transmission Electron Microscopy revealed altered sarcomere and mitochondrial structure in its atrial cardiomyocytes. Furthermore, nanopore RNA sequencing of atrial tissue from the aforementioned animal model indicated altered expression in several key cardiac genes, including TTN and PITX2.
Conclusion
Rare RBM20 LOF variants are significantly enriched in AF cases, seen in a large population of 175,000 individuals. We demonstrated that the effect of LOF RBM20 on alternative TTN splicing can be detected on an individual level in patients with AF. Studies using an animal model indicates that LOF in RBM20 may affect atrial function through altered expression of several genes in the atria, and may cause structural changes in the atrial cardiomyocytes. This suggests that RBM20 may be involved in AF pathogenesis mediated through an atrial cardiomyopathy.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation Pre-Graduate Scholarships (NNF18OC0053094)The Hallas Møller Emerging Investigator grant (Novo Nordisk Foundation (NNF17OC0031204))
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Affiliation(s)
- O B Vad
- University of Copenhagen, Department of Biomedical Science, Copenhagen, Denmark
| | - E Angeli
- University of Copenhagen, Department of Biomedical Science, Copenhagen, Denmark
| | - M Liss
- Max Delbruck Center for Molecular Medicine, Neuromuscular and Cardiovascular Cell Biology, Berlin, Germany
| | - G Ahlberg
- University of Copenhagen, Department of Biomedical Science, Copenhagen, Denmark
| | - L Andreasen
- University of Copenhagen, Department of Biomedical Science, Copenhagen, Denmark
| | | | - A Tveit
- University of Oslo, Insititute of Clinical Medicine, Department of Cardiology, Oslo, Norway
| | - S Haunsoe
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - P R Lundegaard
- University of Copenhagen, Department of Biomedical Science, Copenhagen, Denmark
| | - M Gotthardt
- Max Delbruck Center for Molecular Medicine, Neuromuscular and Cardiovascular Cell Biology, Berlin, Germany
| | - M S Olesen
- University of Copenhagen, Department of Biomedical Science, Copenhagen, Denmark
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Schilham MGM, Zamecnik P, Privé BM, Israël B, Rijpkema M, Scheenen T, Barentsz JO, Nagarajah J, Gotthardt M. Head-to-Head Comparison of 68Ga-Prostate-Specific Membrane Antigen PET/CT and Ferumoxtran-10-Enhanced MRI for the Diagnosis of Lymph Node Metastases in Prostate Cancer Patients. J Nucl Med 2021; 62:1258-1263. [PMID: 33517328 PMCID: PMC8882902 DOI: 10.2967/jnumed.120.258541] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/03/2021] [Indexed: 12/31/2022] Open
Abstract
Accurate assessment of lymph node (LN) metastases in prostate cancer (PCa) patients is critical for prognosis and patient management. Both prostate-specific membrane antigen (PSMA) PET/CT and ferumoxtran-10 nanoparticle–enhanced MRI (nano-MRI) are imaging modalities with high potential to identify LN metastases in PCa patients. The aim of this study was to compare the results of these imaging technologies in terms of characteristics and anatomic localization of suspicious LNs in order to assess the feasibility of their complementary use for imaging in PCa patients. Methods: In total, 45 patients with either primary PCa (n = 8) or recurrence (n = 36) were included in this retrospective study. All patients underwent both 68Ga-PSMA PET/CT and nano-MRI between October 2015 and July 2017 within 3 wk. Both scans were performed at the same institution according to local clinical protocols. All scans were analyzed independently by experienced nuclear medicine physicians and radiologists. The size, anatomic location, and level of suspicion were determined for all visible LNs. Subsequently, the findings from 68Ga-PSMA PET/CT and nano-MRI were compared without respect to a reference standard. Results: In total, 179 suspicious LNs were identified. Significantly more suspicious LNs per patient were detected by nano-MRI (P < 0.001): 160 were identified in 33 patients by nano-MRI, versus 71 in 25 patients by 68Ga-PSMA PET/CT. Of all suspicious LNs, 108 were identified only by nano-MRI (60%), 19 (11%) only by 68Ga-PSMA PET/CT, and 52 (29%) by both methods. The mean size of the suspicious LNs as identified by nano-MRI was significantly smaller (5.3 mm) than that by 68Ga-PSMA PET/CT (6.0 mm; P = 0.006). The median level of suspicion did not differ significantly. Both modalities identified suspicious LNs in all anatomic regions of the pelvis. Conclusion: Both modalities identified suspicious LNs that were missed by the other. Both modalities identified suspicious LNs in all anatomic regions of the pelvis; however, nano-MRI appeared to be superior in detecting smaller suspicious LNs. These findings suggest that nano-MRI has a potential role as a complement to PSMA PET/CT. However, since the clinical implications of the different results are not well established yet, further investigation of this complementary use is encouraged.
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Affiliation(s)
- Melline G M Schilham
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; and
| | - Patrik Zamecnik
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; and
| | - Bastiaan M Privé
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; and
| | - Bas Israël
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; and
| | - Mark Rijpkema
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; and
| | - Tom Scheenen
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; and
| | - Jelle O Barentsz
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; and
| | - James Nagarajah
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; and.,Department of Nuclear Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Martin Gotthardt
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; and
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Dorst DN, Rijpkema M, Buitinga M, Walgreen B, Helsen MMA, Brennan E, Klein C, Laverman P, Ramming A, Schmidkonz C, Kuwert T, Schett G, van der Kraan PM, Gotthardt M, Koenders MI. Targeting of fibroblast activation protein in rheumatoid arthritis patients: imaging and ex vivo photodynamic therapy. Rheumatology (Oxford) 2021; 61:2999-3009. [PMID: 34450633 PMCID: PMC9258553 DOI: 10.1093/rheumatology/keab664] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/20/2021] [Indexed: 12/21/2022] Open
Abstract
Objective Activated synovial fibroblasts are key effector cells in RA. Selectively depleting these based upon their expression of fibroblast activation protein (FAP) is an attractive therapeutic approach. Here we introduce FAP imaging of inflamed joints using 68Ga-FAPI-04 in a RA patient, and aim to assess feasibility of anti-FAP targeted photodynamic therapy (FAP-tPDT) ex vivo using 28H1-IRDye700DX on RA synovial explants. Methods Remnant synovial tissue from RA patients was processed into 6 mm biopsies and, from several patients, into primary fibroblast cell cultures. Both were treated using FAP-tPDT. Cell viability was measured in fibroblast cultures and biopsies were evaluated for histological markers of cell damage. Selectivity of the effect of FAP-tPDT was assessed using flow cytometry on primary fibroblasts and co-cultured macrophages. Additionally, one RA patient intravenously received 68Ga-FAPI-04 and was scanned using PET/CT imaging. Results In the RA patient, FAPI-04 PET imaging showed high accumulation of the tracer in arthritic joints with very low background signal. In vitro, FAP-tPDT induced cell death in primary RA synovial fibroblasts in a light dose-dependent manner. An upregulation of cell damage markers was observed in the synovial biopsies after FAP-tPDT. No significant effects of FAP-tPDT were noted on macrophages after FAP-tPDT of neighbouring fibroblasts. Conclusion In this study the feasibility of selective FAP-tPDT in synovium of rheumatoid arthritis patients ex vivo is demonstrated. Furthermore, this study provides the first indication that FAP-targeted PET/CT can be used to image arthritic joints, an important step towards application of FAP-tPDT as a targeted locoregional therapy for RA.
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Affiliation(s)
- Daphne N Dorst
- Department of medical imaging: Nuclear medicine, Radboudumc, Nijmegen, The Netherlands.,Department of Experimental Rheumatology, Radboudumc, Nijmegen, The Netherlands
| | - Mark Rijpkema
- Department of medical imaging: Nuclear medicine, Radboudumc, Nijmegen, The Netherlands
| | - Mijke Buitinga
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Birgitte Walgreen
- Department of Experimental Rheumatology, Radboudumc, Nijmegen, The Netherlands
| | - Monique M A Helsen
- Department of Experimental Rheumatology, Radboudumc, Nijmegen, The Netherlands
| | - Evan Brennan
- Department of Experimental Rheumatology, Radboudumc, Nijmegen, The Netherlands
| | - Christian Klein
- Roche Pharmaceutical Research and Early Development, Innovation Center Zurich, Schlieren, Switzerland
| | - Peter Laverman
- Department of medical imaging: Nuclear medicine, Radboudumc, Nijmegen, The Netherlands
| | - Andreas Ramming
- Department of medicine 3, Friedrich Alexander University Erlangen-Nürnberg and Universtitätsklinikum Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Erlangen, Germany
| | | | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of medicine 3, Friedrich Alexander University Erlangen-Nürnberg and Universtitätsklinikum Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Erlangen, Germany
| | | | - Martin Gotthardt
- Department of medical imaging: Nuclear medicine, Radboudumc, Nijmegen, The Netherlands
| | - Marije I Koenders
- Department of Experimental Rheumatology, Radboudumc, Nijmegen, The Netherlands
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42
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Peters SMB, Meyer Viol SL, van der Werf NR, de Jong N, van Velden FHP, Meeuwis A, Konijnenberg MW, Gotthardt M, de Jong HWAM, Segbers M. Correction to: Variability in lutetium-177 SPECT quantification between different state-of-the-art SPECT/CT systems. EJNMMI Phys 2021; 8:59. [PMID: 34406512 PMCID: PMC8374010 DOI: 10.1186/s40658-021-00399-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Steffie M B Peters
- Department of Radiology and Nuclear Medicine, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Sebastiaan L Meyer Viol
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niels R van der Werf
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Nick de Jong
- Department of Radiology, Section of Medical Technology, Leiden University Medical Center, Leiden, The Netherlands
| | - Floris H P van Velden
- Department of Radiology, Section of Medical Technology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antoi Meeuwis
- Department of Radiology and Nuclear Medicine, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Mark W Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel Segbers
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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Peters SMB, Privé BM, de Bakker M, de Lange F, Jentzen W, Eek A, Muselaers CHJ, Mehra N, Witjes JA, Gotthardt M, Nagarajah J, Konijnenberg MW. Intra-therapeutic dosimetry of [ 177Lu]Lu-PSMA-617 in low-volume hormone-sensitive metastatic prostate cancer patients and correlation with treatment outcome. Eur J Nucl Med Mol Imaging 2021; 49:460-469. [PMID: 34218300 PMCID: PMC8803803 DOI: 10.1007/s00259-021-05471-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/18/2021] [Indexed: 12/09/2022]
Abstract
Introduction While [177Lu]Lu-PSMA radioligand therapy is currently only applied in end-stage metastatic castrate-resistant prostate cancer (mCRPC) patients, also low-volume hormone-sensitive metastatic prostate cancer (mHSPC) patients can benefit from it. However, there are toxicity concerns related to the sink effect in low-volume disease. This prospective study aims to determine the kinetics of [177Lu]Lu-PSMA in mHSPC patients, analyzing the doses to organs at risk (salivary glands, kidneys, liver, and bone marrow) and tumor lesions < 1 cm diameter. Methods Ten mHSPC patients underwent two cycles of [177Lu]Lu-PSMA therapy. Three-bed position SPECT/CT was performed at 5 time points after each therapy. Organ dosimetry and lesion dosimetry were performed using commercial software and a manual approach, respectively. Correlation between absorbed index lesion dose and treatment response (PSA drop of > 50% at the end of the study) was calculated and given as Spearman’s r and p-values. Results Kinetics of [177Lu]Lu-PSMA in mHSPC patients are comparable to those in mCRPC patients. Lesion absorbed dose was high (3.25 ± 3.19 Gy/GBq) compared to organ absorbed dose (salivary glands: 0.39 ± 0.17 Gy/GBq, kidneys: 0.49 ± 0.11 Gy/GBq, liver: 0.09 ± 0.01 Gy/GBq, bone marrow: 0.017 ± 0.008 Gy/GBq). A statistically significant correlation was found between treatment response and absorbed index lesion dose (p = 0.047). Conclusions We successfully performed small lesion dosimetry and showed that the tumor sink effect in mHSPC patients is of less concern than was expected. Tumor-to-organ ratio of absorbed dose was high and tumor uptake correlates with PSA response. Additional treatment cycles are legitimate in terms of organ toxicity and could lead to better tumor response. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05471-4.
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Affiliation(s)
- Steffie M B Peters
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Bastiaan M Privé
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Maarten de Bakker
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Frank de Lange
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Walter Jentzen
- Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany
| | - Annemarie Eek
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - James Nagarajah
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mark W Konijnenberg
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Boss M, Rottenburger C, Brenner W, Blankenstein O, Prasad V, Prasad S, de Coppi P, Kühnen P, Buitinga M, Nuutila P, Otonkoski T, Hussain K, Brom M, Eek A, Bomanji JB, Shah P, Gotthardt M. 68Ga-NODAGA-exendin-4 PET improves the detection of focal congenital hyperinsulinism. J Nucl Med 2021; 63:310-315. [PMID: 34215672 PMCID: PMC8805776 DOI: 10.2967/jnumed.121.262327] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/05/2021] [Indexed: 11/18/2022] Open
Abstract
Surgery with curative intent can be offered to congenital hyperinsulinism (CHI) patients, provided that the lesion is focal. Radiolabeled exendin-4 specifically binds the glucagonlike peptide 1 receptor on pancreatic β-cells. In this study, we compared the performance of 18F-DOPA PET/CT, the current standard imaging method for CHI, and PET/CT with the new tracer 68Ga-NODAGA-exendin-4 in the preoperative detection of focal CHI. Methods: Nineteen CHI patients underwent both 18F-DOPA PET/CT and 68Ga-NODAGA-exendin-4 PET/CT before surgery. The images were evaluated in 3 settings: a standard clinical reading, a masked expert reading, and a joint reading. The target (lesion)-to-nontarget (normal pancreas) ratio was determined using SUVmax. Image quality was rated by pediatric surgeons in a questionnaire. Results: Fourteen of 19 patients having focal lesions underwent surgery. On the basis of clinical readings, the sensitivity of 68Ga-NODAGA-exendin-4 PET/CT (100%; 95% CI, 77%–100%) was higher than that of 18F-DOPA PET/CT (71%; 95% CI, 42%–92%). Interobserver agreement between readings was higher for 68Ga-NODAGA-exendin-4 than for 18F-DOPA PET/CT (Fleiss κ = 0.91 vs. 0.56). 68Ga-NODAGA-exendin-4 PET/CT provided significantly (P = 0.021) higher target-to-nontarget ratios (2.02 ± 0.65) than did 18F-DOPA PET/CT (1.40 ± 0.40). On a 5-point scale, pediatric surgeons rated 68Ga-NODAGA-exendin-4 PET/CT as superior to 18F-DOPA PET/CT. Conclusion: For the detection of focal CHI, 68Ga-NODAGA-exendin-4 PET/CT has higher clinical sensitivity and better interobserver correlation than 18F-DOPA PET/CT. Better contrast and image quality make 68Ga-NODAGA-exendin-4 PET/CT superior to 18F-DOPA PET/CT in surgeons’ intraoperative quest for lesion localization.
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Affiliation(s)
- Marti Boss
- Radboud University Medical Center, Netherlands
| | | | | | | | | | | | - Paolo de Coppi
- Great Ormond Street Hospital for Children NHS Foundation Trust, London
| | | | | | | | | | | | | | | | | | - Pratik Shah
- Great Ormond Street Hospital for Children NHS Foundation Trust
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45
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Collado Camps E, van Lith SAM, Frielink C, Lankhof J, Dijkgraaf I, Gotthardt M, Brock R. CPPs to the Test: Effects on Binding, Uptake and Biodistribution of a Tumor Targeting Nanobody. Pharmaceuticals (Basel) 2021; 14:ph14070602. [PMID: 34201507 PMCID: PMC8308549 DOI: 10.3390/ph14070602] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 01/22/2023] Open
Abstract
Nanobodies are well-established targeting ligands for molecular imaging and therapy. Their short circulation time enables early imaging and reduces systemic radiation exposure. However, shorter circulation time leads to lower tracer accumulation in the target tissue. Cell-penetrating peptides (CPPs) improve cellular uptake of various cargoes, including nanobodies. CPPs could enhance tissue retention without compromising rapid clearance. However, systematic investigations on how the functionalities of nanobody and CPP combine with each other at the level of 2D and 3D cell cultures and in vivo are lacking. Here, we demonstrate that conjugates of the epidermal growth factor receptor (EGFR)-binding nanobody 7D12 with different CPPs (nonaarginine, penetratin, Tat and hLF) differ with respect to cell binding and induction of endocytosis. For nonaarginine and penetratin we compared the competition of EGF binding and performance of L- and D-peptide stereoisomers, and tested the D-peptide conjugates in tumor cell spheroids and in vivo. The D-peptide conjugates showed better penetration into spheroids than the unconjugated 7D12. Both in vivo and in vitro, the behavior of the agent reflects the combination of both functionalities. Although CPPs cause promising increases in in vitro uptake and 3D penetration, the dominant effect of the CPP in the control of biodistribution warrants further investigation.
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Affiliation(s)
- Estel Collado Camps
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboudumc, 6525 GA Nijmegen, The Netherlands; (E.C.C.); (J.L.)
- Department of Medical Imaging, Nuclear Medicine, Radboudumc, 6525 GA Nijmegen, The Netherlands; (S.A.M.v.L.); (C.F.); (M.G.)
| | - Sanne A. M. van Lith
- Department of Medical Imaging, Nuclear Medicine, Radboudumc, 6525 GA Nijmegen, The Netherlands; (S.A.M.v.L.); (C.F.); (M.G.)
| | - Cathelijne Frielink
- Department of Medical Imaging, Nuclear Medicine, Radboudumc, 6525 GA Nijmegen, The Netherlands; (S.A.M.v.L.); (C.F.); (M.G.)
| | - Jordi Lankhof
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboudumc, 6525 GA Nijmegen, The Netherlands; (E.C.C.); (J.L.)
| | - Ingrid Dijkgraaf
- Department of Biochemistry, Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Martin Gotthardt
- Department of Medical Imaging, Nuclear Medicine, Radboudumc, 6525 GA Nijmegen, The Netherlands; (S.A.M.v.L.); (C.F.); (M.G.)
| | - Roland Brock
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboudumc, 6525 GA Nijmegen, The Netherlands; (E.C.C.); (J.L.)
- Department of Medical Biochemistry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 293, Bahrain
- Correspondence: ; Tel.: +31-2436-66213
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46
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Schilham M, Hermsen R, Küsters-Vandevelde H, Scheenen T, Gotthardt M, Somford D, Sedelaar J, Rijpkema M. Radio-guided lymph node dissection in primary oligometastatic prostate cancer patients. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01298-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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47
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Gotthardt M, Joosten L, Jansen TJP, Brom M, Boss M, Willekens SMA. From Mice to Humans: The Exocrine Pancreas Does Not Matter in Human GLP-1 Receptor Imaging. J Nucl Med 2021; 62:745. [PMID: 33608428 DOI: 10.2967/jnumed.120.259184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martin Gotthardt
- Radboud University Medical Center Nijmegen, The Netherlands E-mail:
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48
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Privé BM, Peters SMB, Muselaers CHJ, van Oort IM, Janssen MJR, Sedelaar JPM, Konijnenberg MW, Zámecnik P, Uijen MJM, Schilham MGM, Eek A, Scheenen TWJ, Verzijlbergen JF, Gerritsen WR, Mehra N, Kerkmeijer LGW, Smeenk RJ, Somford DM, van Basten JPA, Heskamp S, Barentsz JO, Gotthardt M, Witjes JA, Nagarajah J. Lutetium-177-PSMA-617 in Low-Volume Hormone-Sensitive Metastatic Prostate Cancer: A Prospective Pilot Study. Clin Cancer Res 2021; 27:3595-3601. [PMID: 33883176 DOI: 10.1158/1078-0432.ccr-20-4298] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/25/2021] [Accepted: 04/16/2021] [Indexed: 12/09/2022]
Abstract
PURPOSE [177Lu]Lu-PSMA-617 radioligand therapy (177Lu-PSMA) is a novel treatment for metastatic castration-resistant prostate cancer (mCRPC), which could also be applied to patients with metastatic hormone-sensitive prostate cancer (mHSPC) with PSMA expression. In this prospective study (NCT03828838), we analyzed toxicity, radiation doses, and treatment effect of 177Lu-PSMA in pateints with low-volume mHSPC. PATIENTS AND METHODS Ten progressive patients with mHSPC following local treatment, with a maximum of ten metastatic lesions on [68Ga]Ga-PSMA-11 PET/diagnostic-CT imaging (PSMA-PET) and serum PSA doubling time <6 months received two cycles of 177Lu-PSMA. Whole-body single-photon emission CT/CT (SPECT/CT) and blood dosimetry was performed to calculate doses to the tumors and organs at risk (OAR). Adverse events (AE), laboratory values (monitoring response and toxicity), and quality of life were monitored until week 24 after cycle 2, the end of study (EOS). All patients underwent PSMA-PET at screening, 8 weeks after cycle 1, 12 weeks after cycle 2, and at EOS. RESULTS All patients received two cycles of 177Lu-PSMA without complications. No treatment-related grade III-IV adverse events were observed. According to dosimetry, none of the OAR reached threshold doses for radiation-related toxicity. Moreover, all target lesions received a higher radiation dose than the OAR. All 10 patients showed altered PSA kinetics, postponed androgen deprivation therapy, and maintained good quality of life. Half of the patients showed a PSA response of more than 50%. One patient had a complete response on PSMA-PET imaging until EOS and two others had only minimal residual disease. CONCLUSIONS 177Lu-PSMA appeared to be a feasible and safe treatment modality in patients with low-volume mHSPC.
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Affiliation(s)
- Bastiaan M Privé
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Steffie M B Peters
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | | | - Inge M van Oort
- Department of Urology, Radboudumc, Nijmegen, the Netherlands
| | - Marcel J R Janssen
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | | | - Mark W Konijnenberg
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Patrik Zámecnik
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Maike J M Uijen
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Melline G M Schilham
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Annemarie Eek
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Tom W J Scheenen
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | - J Fred Verzijlbergen
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | | | - Niven Mehra
- Department of Medical Oncology, Radboudumc, Nijmegen, the Netherlands
| | | | - Robert J Smeenk
- Department of Radiation Oncology, Radboudumc, Nijmegen, the Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | - Sandra Heskamp
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboudumc, Nijmegen, the Netherlands
| | - James Nagarajah
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, the Netherlands. .,Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, München, Germany
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49
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Dorst DN, Rijpkema M, Boss M, Walgreen B, Helsen MMA, Bos DL, Brom M, Klein C, Laverman P, van der Kraan PM, Gotthardt M, Koenders MI, Buitinga M. Targeted photodynamic therapy selectively kills activated fibroblasts in experimental arthritis. Rheumatology (Oxford) 2021; 59:3952-3960. [PMID: 32734285 PMCID: PMC7733717 DOI: 10.1093/rheumatology/keaa295] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/30/2020] [Indexed: 12/11/2022] Open
Abstract
Objective In RA, synovial fibroblasts become activated. These cells express fibroblast activation protein (FAP) and contribute to the pathogenesis by producing cytokines, chemokines and proteases. Selective depletion in inflamed joints could therefore constitute a viable treatment option. To this end, we developed and tested a new therapeutic strategy based on the selective destruction of FAP-positive cells by targeted photodynamic therapy (tPDT) using the anti-FAP antibody 28H1 coupled to the photosensitizer IRDye700DX. Methods After conjugation of IRDye700DX to 28H1, the immunoreactive binding and specificity of the conjugate were determined. Subsequently, tPDT efficiency was established in vitro using a 3T3 cell line stably transfected with FAP. The biodistribution of [111In]In-DTPA-28H1 with and without IRDye700DX was assessed in healthy C57BL/6N mice and in C57BL/6N mice with antigen-induced arthritis. The potential of FAP-tPDT to induce targeted damage was determined ex vivo by treating knee joints from C57BL/6N mice with antigen-induced arthritis 24 h after injection of the conjugate. Finally, the effect of FAP-tPDT on arthritis development was determined in mice with collagen-induced arthritis. Results 28H1-700DX was able to efficiently induce FAP-specific cell death in vitro. Accumulation of the anti-FAP antibody in arthritic knee joints was not affected by conjugation with the photosensitizer. Arthritis development was moderately delayed in mice with collagen-induced arthritis after FAP-tPDT. Conclusion Here we demonstrate the feasibility of tPDT to selectively target and kill FAP-positive fibroblasts in vitro and modulate arthritis in vivo using a mouse model of RA. This approach may have therapeutic potential in (refractory) arthritis.
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Affiliation(s)
- Daphne N Dorst
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark Rijpkema
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marti Boss
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Birgitte Walgreen
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique M A Helsen
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Desirée L Bos
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maarten Brom
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christian Klein
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Zurich, Schlieren, Switzerland
| | - Peter Laverman
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter M van der Kraan
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marije I Koenders
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mijke Buitinga
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
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50
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Renard E, Collado Camps E, Canovas C, Kip A, Gotthardt M, Rijpkema M, Denat F, Goncalves V, van Lith SAM. Site-Specific Dual-Labeling of a VHH with a Chelator and a Photosensitizer for Nuclear Imaging and Targeted Photodynamic Therapy of EGFR-Positive Tumors. Cancers (Basel) 2021; 13:428. [PMID: 33498707 PMCID: PMC7865570 DOI: 10.3390/cancers13030428] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Variable domains of heavy chain only antibodies (VHHs) are valuable agents for application in tumor theranostics upon conjugation to both a diagnostic probe and a therapeutic compound. Here, we optimized site-specific conjugation of the chelator DTPA and the photosensitizer IRDye700DX to anti-epidermal growth factor receptor (EGFR) VHH 7D12, for applications in nuclear imaging and photodynamic therapy. 7D12 was site-specifically equipped with bimodal probe DTPA-tetrazine-IRDye700DX using the dichlorotetrazine conjugation platform. Binding, internalization and light-induced toxicity of DTPA-IRDye700DX-7D12 were determined using EGFR-overexpressing A431 cells. Finally, ex vivo biodistribution of DTPA-IRDye700DX-7D12 in A431 tumor-bearing mice was performed, and tumor homing was visualized with SPECT and fluorescence imaging. DTPA-IRDye700DX-7D12 was retrieved with a protein recovery of 43%, and a degree of labeling of 0.56. Spectral properties of the IRDye700DX were retained upon conjugation. 111In-labeled DTPA-IRDye700DX-7D12 bound specifically to A431 cells, and they were effectively killed upon illumination. DTPA-IRDye700DX-7D12 homed to A431 xenografts in vivo, and this could be visualized with both SPECT and fluorescence imaging. In conclusion, the dichlorotetrazine platform offers a feasible method for site-specific dual-labeling of VHH 7D12, retaining binding affinity and therapeutic efficacy. The flexibility of the described approach makes it easy to vary the nature of the probes for other combinations of diagnostic and therapeutic compounds.
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Affiliation(s)
- Emma Renard
- Institute de Chimie Moléculaire de l’Université de Bourgogne ICMUB UMR CNRS 6302, Université Bourgogne Franche-Comté, 21000 Dijon, France; (E.R.); (C.C.); (F.D.); (V.G.)
| | - Estel Collado Camps
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboudumc, 6525 GA Nijmegen, The Netherlands;
- Department of Medical Imaging, Nuclear Medicine, Radboudumc, 6525 GA Nijmegen, The Netherlands; (A.K.); (M.G.); (M.R.)
| | - Coline Canovas
- Institute de Chimie Moléculaire de l’Université de Bourgogne ICMUB UMR CNRS 6302, Université Bourgogne Franche-Comté, 21000 Dijon, France; (E.R.); (C.C.); (F.D.); (V.G.)
| | - Annemarie Kip
- Department of Medical Imaging, Nuclear Medicine, Radboudumc, 6525 GA Nijmegen, The Netherlands; (A.K.); (M.G.); (M.R.)
| | - Martin Gotthardt
- Department of Medical Imaging, Nuclear Medicine, Radboudumc, 6525 GA Nijmegen, The Netherlands; (A.K.); (M.G.); (M.R.)
| | - Mark Rijpkema
- Department of Medical Imaging, Nuclear Medicine, Radboudumc, 6525 GA Nijmegen, The Netherlands; (A.K.); (M.G.); (M.R.)
| | - Franck Denat
- Institute de Chimie Moléculaire de l’Université de Bourgogne ICMUB UMR CNRS 6302, Université Bourgogne Franche-Comté, 21000 Dijon, France; (E.R.); (C.C.); (F.D.); (V.G.)
| | - Victor Goncalves
- Institute de Chimie Moléculaire de l’Université de Bourgogne ICMUB UMR CNRS 6302, Université Bourgogne Franche-Comté, 21000 Dijon, France; (E.R.); (C.C.); (F.D.); (V.G.)
| | - Sanne A. M. van Lith
- Department of Medical Imaging, Nuclear Medicine, Radboudumc, 6525 GA Nijmegen, The Netherlands; (A.K.); (M.G.); (M.R.)
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