Total bilirubin assay differences may cause inconsistent treatment decisions in neonatal hyperbilirubinaemia

OBJECTIVES

To assess interlaboratory variability of total serum bilirubin (TSB) results in newborns. Initiated following a clinical incident in which a neonate was transferred to a tertiary hospital for treatment of severe hyperbilirubinemia but on arrival was reclassified into a lower risk category due to a 20% difference in TSB between laboratories.

METHODS

Fresh residual plasma samples from hospital-born infants were pooled to obtain 11 samples across a range of total bilirubin concentrations. Aliquots were light-protected and measured on 7 commercial platforms at 4 accredited medical laboratories. Data from The Royal College of Pathologists of Australasia Quality Assurance Programs' (RCPAQAP) Neonatal Bilirubin program was analysed.

RESULTS

Twenty-four to 30% difference in results for individual samples, largely due to calibration differences between assays. When interpreted according to guidelines, results from different platforms would have led to different clinical interventions in some cases. RCPAQAP results showed significant within-method bias but were not shown to be commutable with patient samples.

CONCLUSIONS

There are clinically significant method-dependent differences in TSB results from neonatal samples, consistent with our clinical incident. The differences are largely due to lack of standardisation of calibrator values. This has implications for healthcare resource use and possibly for the neurodevelopment of infants. Intervention is needed at a number of levels, including clinical reporting of incidents arising from discordant results, commitment by manufacturers to ensure metrological traceability of methods with sufficiently low uncertainty in the final measurements, and availability of commutable quality assurance material to monitor assay performance, especially at the clinical decision points for neonatal jaundice.

Treatment of a Patient with b Cell Lymphoma by 1-131 Lym-1 Monoclonal Antibodies

A patient with Richter's syndrome, a malignant lymphomatous transformation of chronic lymphocytic leukemia, had become moribund with rapidly enlarging masses, granulocytopenia and thrombocytopenia despite the use of conventional chemotherapy and radiotherapy. Greater than ten percent of a test dose of I-131 Lym-1, a murine monoclonal antibody produced against Burkitt's African B cell lymphoma, was accumulated by her tumor. The patient was subsequently treated with a series of injections of I-131 Lym-1 with dramatic clinical response, reduction of tumor volume by x-ray computerized tomography and progression of circulating cellular elements toward normality. Her course over the next ten months was not like that to be expected for Richter's syndrome, which has an average survival of four months. This mode of treatment appears promising.

Radioimmunotherapy for Breast Cancer: Treatment of a Patient with I-131 L6 Chimeric Monoclonal Antibody

We report the first treatment of metastatic breast cancer by systemic radioimmunotherapy. The serial therapy doses were chosen based on quantitative imaging data in a treatment planning approach. A terminally ill patient with aggressive, locally advanced breast cancer who had failed radiation treatment and chemotherapy was injected intravenously with radiolabeled I-131 chimeric L6, a human-mouse chimeric IgG1 monoclonal antibody to adenocarcinoma. Initially, an imaging 10 mCi dose of 1-131 chimeric L6 (dose 1) deposited 8.8% of the injected dose in her chest wall tumor at 48 hours. Ten days later the patient was given a 150 mCi I-131 chimeric L6 dose (dose 2) followed three weeks later by a 100 mCi dose (dose 3). Tumor uptake and retention were comparable for doses 1 and 2, and decreased for dose 3. Following dose 3 the patient developed a manageable thrombocytopenia and transient Grade IV granulocytopenia. The tumor was observed to decrease in size with peak tumor regression occurring two weeks after dose 3. This partial response (PR) was achieved by radioimmunotherapy at a time when conventional therapy had been unable to impact the growth of the patient's massive and aggressive tumor.

Annual influenza vaccination

Despite national and international recommendations, annual influenza vaccination uptake among health care providers (HCPs) remains sub-optimal. This study investigated the uptake, enablers, and barriers to annual influenza vaccination in medicine, nursing, and physiotherapy students at the University of Notre Dame Australia, Fremantle, using an online survey and semi-structured interviews. In 2013, uptake rate of influenza vaccination was 36.3% (95% CI = 31.8-40.8%). Employment as a HCP (OR 1.6, 95% CI 1.1-2.5), being a medical student (OR 2.5, 95% CI 1.2-5.1) and eligibility for government-funded vaccine (OR 7.1, 95% CI 2.7-18.6) were independently associated with increased uptake. Awareness, cost, and convenience were identified as key barriers to vaccination with interview data suggesting that raising awareness of the benefits of influenza vaccination, along with improving student HCPs' access to affordable, convenient vaccination are likely to improve uptake. Responsibility to increase uptake should be shared between universities and student HCPs.

An observation of venous gas emboli in divers and susceptibility to decompression sickness

INTRODUCTION

Decompression sickness (DCS) results from the formation of bubbles within the tissues and blood in response to a reduction in environmental pressure. Venous gas emboli (VGE) are common after diving and are usually only present in small numbers. Greater VGE numbers are an indication of decompression stress, and can be reliably detected using ultrasound imaging.

AIM

To examine the relationship between production of VGE following a routine dive and the risk of DCS.

METHODS

A matched population of divers with and without a history of DCS were monitored for the production of VGE at 15-minute intervals using ultrasound, following a 405 kPa air dive in a hyperbaric chamber using the DCIEM air decompression table. VGE production was graded using a validated grading system and the data analysed to compare maximum VGE grade and duration of VGE formation.

RESULTS

Eleven divers with a history of DCS were compared with 13 divers with no history of DCS. Divers with a history of DCS demonstrated both a higher maximum grade (P=0.04) and longer duration (P=0.002) of VGE production compared to divers without a history of DCS.

CONCLUSION

Higher maximum VGE grades and longer durations of VGE following decompression were associated with a history of DCS and, in particular, musculoskeletal DCS. Although the exact mechanism of DCS remains poorly understood, our data suggest some individuals are inherently more prone to develop VGE, increasing the probability of DCS. Modification of diving practices in those with high VGE grades could potentially decrease DCS risk in these individuals.

Tooth use and wear in three iron-biomineralizing mollusc species

Chitons and limpets harden their teeth with biominerals in order to scrape algae from hard rock surfaces. To elucidate relationships between tooth structure and function, light and electron microscopy were used to examine naturally worn teeth in three species of mollusc with iron-mineralized teeth and to analyze the grazing marks left by members of these species feeding on wax. For the two chiton species, teeth wore down progressively from the medial to the lateral edge of the cusp, while for the limpet, wear was more evenly distributed across the edges of each cusp. In chitons, this pattern of wear matched the medially biased morphology of the cusps in their protracted position and relates to what is known about the mineral composition and substructure of the teeth. The patterns of progressive tooth wear for each of these species, together with the distinct grazing marks left by each species on the wax substrate, indicate that the teeth are designed to remain functionally effective for as long as possible, and have proved to be a valuable means of rationalizing the internal architecture of the teeth at a range of spatial scales. This information is critical for ongoing studies aimed at understanding the interactions between the organic matrix and mineral components of these teeth.

Ultrastructure of the epithelial cells associated with tooth biomineralization in the chiton Acanthopleura hirtosa

The cusp epithelium is a specialized branch of the superior epithelium that surrounds the developing teeth of chitons and is responsible for delivering the elements required for the formation of biominerals within the major lateral teeth. These biominerals are deposited within specific regions of the tooth in sequence, making it possible to conduct a row by row examination of cell development in the cusp epithelium as the teeth progress from the unmineralized to the mineralized state. Cusp epithelium from the chiton Acanthopleura hirtosa was prepared using conventional chemical and microwave assisted tissue processing, for observation by light microscopy, conventional transmission electron microscopy (TEM) and energy filtered TEM. The onset of iron mineralization within the teeth, initiated at row 13, is associated with a number of dramatic changes in the ultrastructure of the apical cusp cell epithelium. Specifically, the presence of ferritin containing siderosomes, the position and number of mitochondria, and the structure of the cell microvilli are each linked to aspects of the mineralization process. These changes in tissue development are discussed in context with their influence over the physiological conditions within both the cells and extracellular compartment of the tooth at the onset of iron mineralization.

Imaging organic and mineral phases in a biomineral using novel contrast techniques

Chitons are marine molluscs that mineralize their teeth by the process of matrix-mediated biomineralization. The teeth develop in a continuous manner forming hard minerals, including magnetite, making analysis of the matrix within these mineralized regions difficult. This article describes the use of charge contrast imaging techniques, rarely applied to biological samples, to simultaneously image the organic and mineral phases within the teeth of these animals. Resulting evidence demonstrates the power of this technique in delivering architectural information concerning both the matrix and mineral phases, without the need for removal of the hard mineralized material.

Fine structure of the mineralized teeth of the chitonAcanthopleura echinata (Mollusca: Polyplacophora)

The major lateral teeth of the chiton Acanthopleura echinata are composite structures composed of three distinct mineral zones: a posterior layer of magnetite; a thin band of lepidocrocite just anterior to this; and apatite throughout the core and anterior regions of the cusp. Biomineralization in these teeth is a matrix-mediated process, in which the minerals are deposited around fibers, with the different biominerals described as occupying architecturally discrete compartments. In this study, a range of scanning electron microscopes was utilized to undertake a detailed in situ investigation of the fine structure of the major lateral teeth. The arrangement of the organic and biomineral components of the tooth is similar throughout the three zones, having no discrete borders between them, and with crystallites of each mineral phase extending into the adjacent mineral zone. Along the posterior surface of the tooth, the organic fibers are arranged in a series of fine parallel lines, but just within the periphery their appearance takes on a "fish scale"-like pattern, reflective of the cross section of a series of units that are overlaid, and offset from each other, in adjacent rows. The units are approximately 2 microm wide and 0.6 microm thick and comprise biomineral plates separated by organic fibers. Two types of subunits make up each "fish scale": one is elongate and curved and forms a trough, in which the other, rod-like unit, is nestled. Adjacent rod and trough units are aligned into large sheets that define the fracture plane of the tooth. The alignment of the plates of rod-trough units is complex and exhibits extreme spatial variation within the tooth cusp. Close to the posterior surface the plates are essentially horizontal and lie in a lateromedial plane, while anteriorly they are almost vertical and lie in the posteroanterior plane. An understanding of the fine structure of the mineralized teeth of chitons, and of the relationship between the organic and mineral components, provides a new insight into biomineralization mechanisms and controls.

Quantitative imaging of holmium-166 with an Anger camera

The objective of this study was to develop a quantitative Anger camera imaging approach for 166Ho in the skeletal system of patients. A dual energy window method was designed to subtract the interference from septal penetration and bremsstrahlung events in Anger camera images acquired with the 80 keV x-rays emitted by 166Ho. The validity of this scatter subtraction method for 166Ho images was demonstrated as improvements of the line spread function and modulation transfer function. Camera sensitivity was found to be nearly independent of source-to-collimator distance only for images acquired with a high-energy collimator. Studies in an Alderson abdominal water phantom demonstrated scatter subtraction can provide quantitative Anger camera images of 166Ho with a scatter multiplier of k = 1.0 and a correction for attenuation. Attenuation correction factors derived from a transmission image were measured for the phantom and verified with water-equivalent blocks of known thickness. Whole-body scan images of 166Ho localized in the skeletal system of patients were significantly improved with this simple scatter subtraction method, and when used to estimate the activity distribution within separate bone regions of the skeleton.

Contribution of Raman spectroscopy to identification of biominerals present in teeth of Acanthopleura rehderi, Acanthopleura curtisiana, and Onithochiton quercinus

Raman spectroscopic investigations of the major lateral teeth of the chitons Acanthopleura rehderi and Acanthopleura curtisiana indicate that, in addition to the magnetite of the cutting surface and a carbonated hydroxyapatite in the central tooth core, these species deposit limonite in place of the lepidocrocite reported for other members of the genus Acanthopleura. A comparison of the spectra from these species with those of Onithochiton quercinus, which also deposits limonite, indicates that the current assignment of these species to Acanthopleura may not be appropriate. Biomineralization of the major lateral teeth may be a useful parameter to include in the taxonomic classification of chiton species.

A new biomineral identified in the cores of teeth from the chiton Plaxiphora albida

The hydrated iron(III) oxide limonite is reported for the first time as a biomineral. In situ laser Raman spectra of the tooth cores from major lateral teeth of the chiton Plaxiphora albida are compared with those of synthetic and mineral iron phosphates and iron oxides. Raman spectra measured on iron phosphate and iron oxide standard materials are shown to be easily distinguishable from one another. The central tooth cores of mature P. albida teeth do not show any evidence for the presence of a separate iron phosphate mineral. Rather, in each tooth a narrow band of the hydrated iron(III) oxide limonite is shown to separate the magnetite of the tooth surface from a central core region comprising both lepidocrocite and limonite. The high concentration of phosphorus in P. albida tooth cores, previously observed by energy dispersive spectroscopy, is not associated with a separate iron phosphate mineral, indicating that this element may be adsorbed onto the surface of the iron oxide minerals present. The failure to detect a separate iron(III) phosphate is discussed with reference to other chiton species that display high levels of iron and phosphorus in the cores of their mature major lateral teeth.

Intraperitoneal radioimmunochemotherapy of ovarian cancer: a phase I study

A phase I trial was designed to examine the feasibility of combining interferon and Taxol with intraperitoneal radioimmunotherapy (177Lu-CC49). Patients with recurrent or persistent ovarian cancer confined to the abdominal cavity after first line therapy, Karnofsky performance status > 60, adequate liver, renal and hematologic function, and tumor that reacted with CC49 antibody were enrolled. Human recombinant alpha interferon (IFN) was administered as 4 subcutaneous injections of 3 x 10(6) U on alternate days beginning 5 days before RIT to increase the expression of the tumor-associated antigen, TAG-72. The addition of IFN increased hematologic toxicity such that the maximum tolerated dose (MTD) of the combination was 40 mCi/m2 compared to 177Lu-CC49 alone (45 mCi/m2). Taxol, which has radiosensitizing effects as well as antitumor activity against ovarian cancer, was given intraperitoneally (i.p.) 48 hrs before RIT. It was initiated at 25 mg/m2 and escalated at 25 mg/m2 increments to 100 mg/m2. Subsequent groups of patients were treated with IFN + 100 mg/m2 Taxol + escalating doses of 177Lu-CC49. Three or more patients were treated in each dose group and 34 patients were treated with the 3-agent combination. Therapy was well tolerated with the expected reversible hematologic toxicity. The MTD for 177Lu-CC49 was 40 mCi/m2 when given with IFN + 100 mg/m2 Taxol. Interferon increased the effective whole body half-time of radioactivity and the whole body radiation dose. Taxol did not have a significant effect on pharmacokinetic or dosimetry parameters. Four of 17 patients with CT measurable disease had a partial response (PR) and 4 of 27 patients with non-measurable disease have progression-free intervals of 18+, 21+, 21+, and 37+ months. The combination of intraperitoneal Taxol chemotherapy (100 mg/m2) with RIT using 177Lu-CC49 and interferon was well tolerated, with bone marrow suppression as the dose-limiting toxicity.

Both GABA(B) receptor agonist and antagonists decreased brain stimulation reward in the rat

The present experiments were designed to determine the role of GABA(B) receptor function on brain stimulation reward. Using a discrete-trial current-intensity threshold procedure, dose-effect functions were generated for the GABA(B) receptor agonist CGP 44532 (0-1.0 mg/kg, s.c.) and the GABA(B) receptor antagonists CGP 56433A (0-10.0 mg/kg, s.c.) and CGP 51176 (0-300.0 mg/kg, s.c.) on brain reward thresholds in rats. The GABA(B) receptor antagonists CGP 56433A and CGP 51176 were used also to examine interaction effects with the GABA(B) receptor agonist CGP 44532 on reward thresholds. Administration of the highest doses of both the GABA(B) receptor agonist and antagonists elevated reward thresholds. Thus, both the agonist and antagonists used induced a reward decrement when administered separately. In addition, the co-administration of either of the two receptor antagonists with the agonist induced an additive effect on thresholds, rather than blocking the agonist-induced threshold elevations. These results suggest that activation of GABA(B) receptors modulates intracranial self-stimulation behavior in a complex fashion, possibly through differential effects of GABA(B) agonists and antagonists on pre- and post-synaptic GABA(B) receptors.

Real-time monitoring and verification of in vivo high dose rate brachytherapy using a pinhole camera

We investigated a pinhole imaging system for independent in vivo monitoring and verification of high dose rate (HDR) brachytherapy treatment. The system consists of a high-resolution pinhole collimator, an x-ray fluoroscope, and a standard radiographic screen-film combination. Autofluoroscopy provides real-time images of the in vivo Ir-192 HDR source for monitoring the source location and movement, whereas autoradiography generates a permanent record of source positions on film. Dual-pinhole autoradiographs render stereo-shifted source images that can be used to reconstruct the source dwell positions in three dimensions. The dynamic range and spatial resolution of the system were studied with a polystyrene phantom using a range of source strengths and dwell times. For the range of source activity used in HDR brachytherapy, a 0.5 mm diameter pinhole produced sharp fluoroscopic images of the source within the dynamic range of the fluoroscope. With a source-to-film distance of 35 cm and a 400 speed screen-film combination, the same pinhole yielded well recognizable images of a 281.2 GBq (7.60 Ci) Ir-192 source for dwell times in the typical clinical range of 2 to 400 s. This 0.5 mm diameter pinhole could clearly resolve source positions separated by lateral displacements as small as 1 mm. Using a simple reconstruction algorithm, dwell positions in a phantom were derived from stereo-shifted dual-pinhole images and compared to the known positions. The agreement was better than 1 mm. A preliminary study of a patient undergoing HDR treatment for cervical cancer suggests that the imaging method is clinically feasible. Based on these studies we believe that the pinhole imaging method is capable of providing independent and reliable real-time monitoring and verification for HDR brachytherapy.

Current Chemistry: Biomineralization-Controlled Microarchitecture in the Radula Teeth of Chitons and Limpets

Manuscript received: 17 October 2001. Final version: 20 December 2001.

The new iron age

In the last four years there has been a major change in the approach to diagnosis of the iron overload disorder hereditary haemochromatosis (HH) following the discovery of the gene that is mutated in HH called HFE. In the first part of this review we will give a concise overview of the disease. Also the current literature on the role of HFE in iron absorption and transport at a molecular level and how mutations in HFE may lead to the break down in the regulation of iron homeostasis is reviewed. The second part of the review focuses on the molecular aspects of iron storage. Different chemical forms of storage iron deposits such as ferrihydrite and geotite are present in the iron storage proteins ferritin and haemosiderin. The type of iron storage deposits is thought to be an important factor in determining the degree of iron toxicity and tissue damage in patients with iron overload. Variations in the form of iron deposits in different types of iron overload disease e.g. HH or beta-thalessemia, the site of iron deposition and the clinical treatment used will be discussed.

Apatite mineralization in teeth of the chiton Acanthopleura echinata

Raman spectroscopy has been used to demonstrate, for the first time, that calcium mineralization in the core of the major lateral teeth of the chiton Acanthopleura echinata takes place as an ordered process, with crystalline carbonated apatite being the first mineral deposited. Deposition begins at the top of the tooth core, under the so-called tab region, progresses down the interior surface of the tab and lepidocrocite layer, and then extends outwards to the anterior surface. Mineralization is not initiated until the lepidocrocite layer has isolated the core of the tooth from the magnetite cap. The last region to be infiltrated is the anterior basal region of the tooth cusp, immediately above the junction zone. The junction zone is also a region of high ion density, as determined by energy dispersive spectroscopy (EDS) analysis, but we show here for the first time that it is free of mineral deposits, acting instead as a transfer and storage region.

CRF and urocortin decreased brain stimulation reward in the rat: reversal by a CRF receptor antagonist

The present studies were designed to investigate the effects of corticotropin-releasing factor (CRF) receptor activation and antagonism on intracranial self-stimulation (ICSS) reward using a discrete-trial current-intensity threshold procedure. Bipolar electrodes were implanted in the lateral hypothalamus, and cannula guides were implanted above the lateral ventricle of male Wistar rats. Dose-effect functions were established for the effects on ICSS of the competitive CRF receptor agonist h/rCRF (0-5.0 microg, i.c.v. ), the CRF receptor agonist urocortin (0-5.0 microg, i.c.v.), and the CRF receptor antagonist [D-Phe(12), Nle(21,38), C(alpha) MeLeu(37)] h/rCRF(12-41) (0-5.0 microg, i.c.v.). Administration of h/rCRF or urocortin dose-dependently elevated ICSS thresholds without altering performance measures (latencies to respond to stimulation, extra and time-out responses). CRF was more potent than urocortin in terms of threshold dose-effects on ICSS thresholds compared to vehicle. Despite these apparent potency differences, percent effect sizes on ICSS thresholds were comparable at the highest doses of both peptides. In contrast to the significant threshold elevation effects of CRF and urocortin, the competitive CRF antagonist D-Phe CRF(12-41) had no effect on ICSS thresholds or performance measures. To determine the neuropharmacological specificity of the effect of CRF on brain stimulation reward, D-Phe CRF(12-41) was used to antagonize CRF-induced threshold elevations. Pretreatment with either the 5.0- or 10.0-microg doses of D-Phe CRF(12-41) effectively blocked CRF-induced reward threshold elevations (3.0 microg) without affecting other ICSS performance measures. These results indicate that CRF neurotransmission can modulate ICSS reward processes.

Phase II study of interferon-enhanced 131I-labeled high affinity CC49 monoclonal antibody therapy in patients with metastatic prostate cancer

Adjuvant Interferon (IFN) was given to increase tumor antigen expression and enhance localization with 131I-labeled CC49 radioimmunotherapy in a Phase II trial for hormone resistant metastatic prostate cancer. Patients received four doses of alpha-IFN (3 x 10(6) IU) s.c. on alternate days, from day -5 to day +1 of 75 mCi/m2 131I-CC49 treatment. Toxicity was well tolerated, with the majority of patients experiencing transient grade 3 or 4 neutropenia and/or thrombocytopenia (maximal at 4-6 weeks). The absorbed dose was >25 Gy in four of eight tumors visualized, which represents an increase of >20 fold over whole body radiation dose. Two patients had radiographic minor responses by 6 weeks post-therapy, whereas five of six patients experiencing pain had symptom relief without radiographic changes. The protocol provided modest antitumor effects (pain relief in five of six patients and two minor radiographic responses). This study suggests that the addition of IFN enhanced tumor uptake and antitumor effects as compared to a prior Phase II trial of 131I-CC49 alone.

A strategy to reduce red marrow dose for intraperitoneal radioimmunotherapy

The aim of this study was to determine whether shorter-lived radionuclides can reduce red marrow (RM) toxicity for i.p. radioimmunotherapy (RIT). The potential radionuclides, which included Lu-177, I-131, Y-90, Re-186, Re-188, and Ho-166, were attached to antibody CC49. Each radiopharmaceutical was assumed to have identical in vivo pharmacokinetics. Blood and whole body retention data acquired from 26 patients who received i.p. RIT with Lu-177 CC49 were used as input. The average biological half-time of Lu-177 CC49 in the whole body was 280 h, and the average Lu-177 concentration in plasma increased to a maximum at 2 days postinfusion, followed by steady clearance. The residence time and RM doses were calculated for each radionuclide. In the current model, Re-188 was found to deliver the lowest RM dose, primarily because it had the shortest half-life, whereas Y-90 delivers the highest dose. Re-188 delivers 60% of the RM dose as compared with Lu-177 and can increase the dose to metastatic sites in the i.p. space by a similar factor. Based on limiting the RM dose to 200 cGy, the maximum administered activity of each radionuclide is as follows: (a) 106 mCi, Lu-177; (b) 58 mCi, I-131; (c) 34 mCi, Y-90; (d) 70 mCi, Re-186; (e) 169 mCi, Re-188; and (f) 110 mCi, Ho-166. Because of the delayed steady leakage of radiopharmaceuticals from the i.p. cavity to the plasma, short-lived radionuclides may offer special advantages for i.p. RIT.

Planar gamma camera quantitation of 123I, 99mTc or 111In in the liver and spleen of an abdominal phantom

Three planar, gamma camera methods for quantitating radiopharmaceuticals, such as radiolabeled antibodies, were investigated. Iodine-123 (123I), technetium-99m (99mTc) or indium-111 (111In) in the liver and spleen of an abdominal phantom were assessed in this study. In the first approach, the number of counts detected in a "single image" of the liver or spleen was used to measure radionuclide content using an attenuation correction factor (ACF) calculated from data obtained without radionuclide in the background volume of the phantom. In the other two methods, radionuclide content was derived from either the geometric mean (GM) of counts in conjugate, opposed images ("global conjugate") or in individual, opposed pixels of the conjugate, opposed images ("pixel conjugate") of the liver and spleen. Both of the conjugate image methods were corrected for attenuation with a first order ACF derived from a transmission image. The influence of background radionuclide on the accuracy of quantitation was studied by filling the background volume of the phantom with water containing 7 or 14 percent of the concentration of the radioactive water placed in the liver and spleen. The best estimates of radionuclide content were obtained by quantitation from the GM of counts in conjugate images of the liver and spleen. Radionuclide content of the liver and spleen could be determined from a single image if correction for attenuation was available. In all instances, measurements were less accurate for the spleen and for either organ when 111In was used. These results further validate and extend observations reported by others and provide a basis for radiation dosimetry for these and similar radionuclides and organs in patients.

Factors affecting 131I-Lym-1 pharmacokinetics and radiation dosimetry in patients with non-Hodgkin's lymphoma and chronic lymphocytic leukemia

Lym-1, a monoclonal antibody that preferentially targets malignant lymphocytes, has induced therapeutic responses in patients with non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL) when labeled with 131I. Responders had statistically significant prolongation of survival compared with nonresponders. The nonmyeloablative, maximum tolerated dose for each of two doses of 131I-Lym-1 was 3.7 GBq/m2 (total 7.4 GBq/m2 [100 mCi/m2, total 200 mCi/m2]) of body surface area. The purpose of this study was to determine the pharmacokinetics and radiation dosimetry for the initial 131I-Lym-1 therapy dose in patients with NHL and CLL and to compare tumor dosimetry with 131I-Lym-1 dosing and other patient parameters.

METHODS

Fifty-one patients with stage 3 or 4 lymphoma were treated with 131I-Lym-1 (0.74-8.04 GBq [20-217 mCi]) in either a maximum tolerated dose (MTD) or low-dose (LD) trial. Total Lym-1 given to each patient was sufficient in all instances to exceed the threshold required for stable pharmacokinetics. Quantitative imaging and physical examination, including caliper and CT measurement of tumor size and analysis of blood, urine and feces, were performed for a period of 7 to 10 d after infusion to assess pharmacokinetics and radiation dosimetry. Clinical records were reviewed to obtain data required for comparative assessments.

RESULTS

The concentration (%ID/g) and biologic half-time of 131-Lym-1 in tumor were about twice those in normal tissues, although tumor half-time was similar to that of the thyroid. Pharmacokinetics were similar for patients in the MTD and LD trials, and for NHL and CLL patients in the LD trial, except that the latter group had less tumor concentration of 131I. Mean tumor radiation dose per unit of administered 131I was 1.0 Gy/GBq (3.7 rad/mCi) for patients with NHL whether in MTD or LD trials, about nine times greater than that for body or marrow. Tumor radiation dose was less and liver radiation dose was more in patients with CLL. Otherwise, radiation dosimetry was, on average, remarkably similar among groups of patients and among individual patients. Pharmacokinetics and dosimetry did not appear to be influenced by the amount of 131I or Lym-1 within the ranges administered. Tumor concentration of 131I and radiation dose per gigabecquerel were inversely related to tumor size but did not seem to be related to histologic grade or type, tumor burden or therapeutic response.

CONCLUSION

The therapeutic index of 131I-Lym-1 was favorable, although the index for patients with CLL was less than that for patients with NHL. Pharmacokinetics and radiation dosimetry were, on average, remarkably similar among patients and groups of patients in different trials.

The effect of prolonged iron loading on the chemical form of iron oxide deposits in rat liver and spleen

Female Porton rats were loaded with iron either by supplementing the diet with 2.5% carbonyl iron for up to 22 months (18 rats) or by regularly injecting rat blood cells intraperitoneally for up to 10 months (eight rats). 57Fe Mössbauer spectroscopy of freeze-dried samples of liver and spleen was used to analyse the chemical forms of iron deposited in these tissues over the period of iron loading. A sextet signal in the Mössbauer spectra was identified as being due to a form of haemosiderin based on the structure of the mineral goethite. The spectral parameters of the sextet signal in the rat tissues indicate that the goethite-like haemosiderin particles are less crystalline than those found in iron-loaded human tissues. For the dietary-iron-loaded rat livers, the fraction (Fs) of the Mössbauer signal in the form of this sextet was found to increase significantly (from approx 0.04 to 0.09) with the age of the rats (r=0.77, P<0.0005). This indicates that the fraction of liver iron in the form of the goethite-like haemosiderin increases with age of the rat and hence with the duration of iron loading. In addition, Fs for these livers was found to increase significantly with the fraction of iron in non-parenchymal cells as measured by computer-assisted morphometric analysis of histological sections (r=0.71, P<0.005).

Effects of prolonged iron loading in the rat using both parenteral and dietary routes

Female Porton rats have been treated with either parenteral iron (intraperitoneal red cells) or dietary iron (carbonyl iron) for up to 12 months or 22 months respectively. In the parenteral iron loaded animals, the liver iron concentration rose from approximately 2 mg g-1 dry wt at 2 months to 21 mg g-1 dry wt at 12 months, while for the dietary iron loaded animals, this value rose from 14 to 48 mg g-1 dry wt at 12 months to over 60 mg g-1 dry wt after 22 months. In contrast, splenic iron concentrations rose more in the parenterally loaded animals (up to 66 mg g-1 dry wt after 12 months) than in the dietary loaded animals (approx. 34 mg g-1 dry wt after 24 months). This study yielded hepatic iron concentrations comparable to those seen in human thalassaemia patients with comparative low hepatotoxicity. Splenic iron concentrations in the parenteral iron loaded group generally exceeded those reported in thalassaemia. Iron concentrations derived from computer assisted morphometry of liver iron deposits correlated well (r = 0.88, p < 0.001) with chemical analysis data. The fraction of iron in the non-parenchymal cells correlated positively with the duration of iron loading (r = 0.86, p < 0.001).

Dissociation of consummatory and vocal components of feeding in squirrel monkeys treated with benzodiazepines and alcohol

The primary aim of the current experiments was to develop methods that engender vocalizations associated with positive social situations comprising affiliative behavior and feeding that could be quantified under controlled laboratory conditions and were sensitive to anxiolytic drugs. Classical conditioning procedures were used to elicit vocalizations during presentation of stimulus lights (i.e., CS condition) previously paired with either preferred foods (e.g., grapes, peanuts, bananas) or standard foods (e.g., monkey chow) as well as during presentation of both food types (i.e., UCS condition). When compared to the period before stimulus light presentation (i.e., Pre-CS condition), the rate, duration and number of elemental units of food-related "twitter" vocalizations were increased during the CS conditions regardless of food type. Monkeys spent significantly more time oriented toward the food box during the light stimulus that preceded preferred food than for the light stimulus that preceded standard food. However, twitter vocalizations were higher for standard food regardless of the stimulus conditions (i.e., Pre-CS, CS and UCS). Administration of the benzodiazepine full agonist chlordiazepoxide (CDP, 1-10 mg/kg), the partial agonist bretazenil (BRZ, 1-10 mg/kg), the antagonist flumazenil (FLZ, 1-10 mg/kg) and ethyl alcohol (EtOH, 0.1-1.0 g/kg) differentially altered vocalizations. Although CDP and BRZ increased feeding of standard food, twitters were reduced across stimulus conditions. CDP and BRZ did not alter other social contact calls (i.e., "peeps"). FLZ also reduced twitters without altering peeps, but did not increase feeding. In contrast, EtOH did not increase feeding or peeps, but did increase food-related twitters. These results indicate that there is a dissociation between food-related behaviors, such as food consumption and orientation towards the food source, and vocal behaviors associated with group communication during feeding.

Low-dose, fractionated radioimmunotherapy for B-cell malignancies using 131I-Lym-1 antibody

PURPOSE

This trial was conducted to assess the toxicity and efficacy of 131I-Lym-1 in patients with either malignant B-cell non-Hodgkin's lymphoma (NHL) or chronic lymphocytic leukemia (CLL) using low-dose, fractionated radioimmunotherapy (RIT).

MATERIALS AND METHODS

Thirty adult patients who had advanced B-cell malignancies (25 NHL and 5 CLL) had progressed despite standard therapy; 12 patients entered the trial with Karnofsky performance status (KPS) of equal to or greater than 60. Patients were treated with a series of intravenous doses of 131I-Lym-1 with a goal of reaching a cumulative dose in each patient of at least 300 mCi. All patients were Lym-1 reactive. Clinical responses and immediate toxicity were evaluable in all 30 patients and delayed toxicity in 26.

RESULTS

Toxicity to Lym-1 antibody occurred with 28% of the 176 doses and was transient. Human antimouse antibodies (HAMA) were generated in 30% after a mean of 4 doses, but interrupted therapy in only 10% of the patients. Thrombocytopenia was dose-limiting; there were no deaths due to toxicity. Tumor regression occurred in 25 (83%) of the patients and was great enough, and durable enough, in 17 (57%) to qualify them as responders; 13 NHL patients and 4 CLL patients. Advanced disease often interrupted therapy prematurely. However, 18 patients received at least 180 mCi of 131I-Lym-1; 17 (94%) of these responded to the therapy.

CONCLUSION

Although advanced disease often interrupted therapy prematurely, the results from 131I-Lym-1 therapy are clearly promising and warrant additional trials.

Oxygen consumption, carbon dioxide excretion and respiratory quotient of larval lampreys (Mordacia mordax) in air

The standard rates of O2 consumption of larval Mordacia mordax (weight range 1.3-2.3 g), after these ammocetes had been in humidified air for 18 hr, were 26.8, 46.3 and 71.2 microL x g(-1) x hr(-1) at 10, 15 and 20 degrees C, respectively. The corresponding rates of CO2 excretion were 20.7, 35.6 and 54.1 microL x g(-1) x hr(-1). The RQs at the three temperatures were essentially identical (0.76 or 0.77) and similar to that of adults of the lamprey Geotria australis in air at 15 degrees C. The above RQs for ammocoetes, which are probably similar to those that would be recorded in water, are consistent with the view that the aerobic respiration of these animals relies predominantly on lipid as an energy source, but that some energy is derived from carbohydrate and/or protein. The RQs for larval and adult lampreys in air lie well within the range recorded for amphibious fishes in air.

Effect of recombinant alpha-interferon on pharmacokinetics, biodistribution, toxicity, and efficacy of 131I-labeled monoclonal antibody CC49 in breast cancer: a phase II trial

Preclinical studies have demonstrated that recombinant IFN-alpha (rIFN-alpha) can enhance the tumor associated glycoprotein 72 (TAG-72) on tumors. To determine whether rIFN-alpha could enhance TAG-72 expression in vivo in patients, 15 women with breast cancer were randomized to receive daily injections of rIFN-alpha (3 x 10(6) units/m2 for 14 days) beginning on day 1 (group 1 = 7 patients) or on day 6 (group 2 = 8 patients). On day 3, all patients received a 10-20-mCi tracer dose of 131I-CC49, a high-affinity murine monoclonal antibody reactive against TAG-72, followed by a therapy dose of 60-75 mCi/m2 of 131I-CC49 on day 6. Whole body and single-photon emission computed tomography scans along with whole blood pharmacokinetics were performed following tracer and treatment phases. Hematological toxicity was considerable; reversible grade 3-4 neutropenia and thrombocytopenia was observed in 12 of 15 patients. Twelve of 14 patients tested developed human antimouse antibodies 3-6 weeks after treatment. For group 1 patients, whole blood residence time increased significantly between that predicted from the tracer doses and therapy doses (42.6 +/- 4.7 versus 51.5 +/- 4.8 h, respectively; P < 0.01). The calculated radiation absorbed dose to red marrow from therapy compared to tracer activity was also significantly higher for this group (1.25 +/- 0.35 versus 1. 07 +/- 0.26 cGy/mCi; P < 0.05). Treatment with rIFN-alpha was found to enhance TAG-72 expression in tumors from patients receiving rIFN-alpha (group 1) by 46 +/- 19% (P < 0.05) compared to only 1.3 +/- 0.95% in patients not initially receiving IFN (group 2). The uptake of CC49 in tumors was also significantly increased in rIFN-alpha-treated patients. One partial and two minor tumor responses were seen. In summary, rIFN-alpha treatment altered the pharmacokinetics and tumor uptake of 131I-CC49 in patients at the expense of increased toxicity.

Practical determination of organ S values for individual patients for therapy

Radiation dose calculations using S values of a reference man can introduce substantial errors for individuals patients. We found that all non target sources can be included in the remainder of the body estimate for therapeutic radionuclides. A practical method to derive organ S values based on MIRD data and the mass of the organ and total body of individual patients is proposed.

The effect of histological processing on the form of iron in iron-loaded human tissues

Iron-loaded human spleen tissue was immersed in neutral buffered formalin over a period of 200 days. Over the first 60 days, iron leached steadily from the tissue until 3% had been lost. Thereafter, no further iron leaching was detected. Comparisons of Mossbauer spectra of freeze-dried tissue and tissue freeze-dried after immersion in formalin for 200 days showed no evidence of chemical transformation of the iron remaining in the tissue. The spectra indicated a difference in the heme-iron to non-heme iron ratio between the two samples probably reflecting inhomogeneity of the ratio throughout the spleen as measured on the centimetre scale. Mossbauer spectra of freeze-dried samples of iron-loaded human liver and pancreas tissue were compared with those for samples from the same patient that had been processed by routine hospital procedures for histology and archival. These spectra showed no evidence for chemical transformation of the iron present in the tissues. These results demonstrate that it is feasible to use archived fixed and embedded human tissue samples for studies aimed at gauging the relative fraction of goethite-like hemosiderin present in the tissue.

Prediction of radiation doses from therapy using tracer studies with iodine-131-labeled antibodies

Tracer pharmacokinetic studies are often used in treatment planning for radionuclide therapy including radioimmunotherapy. This study evaluates the validity of using tracer studies to predict radiation doses from therapy with the same radiolabeled antibody.

METHODS

Quantitative imaging and blood radioactivity were used to obtain the pharmacokinetics and radiation doses that were delivered to the total body, blood, marrow, lungs, liver, kidneys, thyroid, spleen and tumors. Tracer and therapy data for eight patients with lymphoma and one patient with breast cancer were compared using linear regression statistics. Doses of 131I-labeled antibody for the tracer studies ranged from 0.1 to 0.4 GBq (2 to 10 mCi), and therapy doses ranged from 0.7 to 5.6 GBq (20 to 150 mCi).

RESULTS

Radiation doses to tissues and, in particular, the bone marrow and tumors were reliably predicted from tracer studies. In this group of patients, median dose to marrow from marrow targeting, total body and blood was 9.2 cGy/GBq for tracer studies and 7.6 cGy/GBq for therapy studies with a median difference of 0.5 cGy/GBq. Median dose to tumors was 81.1 cGy/GBq for tracer studies and 70.3 cGy/GBq for therapy studies with a median difference of 5.9 cGy/GBq.

CONCLUSION

In these patients, tracer studies were predictive of the radiation doses from therapy for total body, major organs and tumors. The radiation doses to marrow and tumors, which are the usual determinants of the therapeutic index, correlated well between tracer and therapy studies (r > or = 0.95).

Oxygen consumption by ammocoetes of the lamprey Geotria australis in air

When covered by moistened lint-free gauze, the larvae (ammocoetes) of the lamprey Geotria australis survived, without apparent discomfort, for 4 days in water-saturated air at 10, 15 and 20 degrees C. In air, the mean standard rates of O2 consumption of medium to large ammocoetes of G. australis (mean = 0.52 g) at 10, 15 and 20 degrees C were 14.5, 35.7 and 52.1 microliters.g-1.h-1, respectively. At 15 degrees C, the slope of the relationship between log O2 consumption (microliter O2.h-1) and log body weight for ammocoetes over a wide range in body weight was 0.987. The Q10s for rate of O2 consumption between 10 and 15 degrees C, 15 and 20 degrees C and 10 and 20 degrees C were 4.9, 2.9 and 3.6, respectively. Our results and observations of the ammocoetes suggest that, when out of water, larval G. australis derives most of its O2 requirements from cutaneous respiration, particularly at lower temperatures. This would be facilitated by the small size and elongate shape (and thus a relatively high surface-to-volume ratio), low metabolic rate, thin dermis, extensive subdermal capillary network and high haemoglobin concentration of larval G. australis.

A radioimmunoimaging and MIRD dosimetry treatment planning program for radioimmunotherapy

A treatment planning program for radioimmunotherapy employing quantitative Anger camera imaging and the MIRD formalism has been designed and implemented on a clinical nuclear medicine computer. Radionuclide residence times are calculated from linear, mono- and bi-exponential, and cubic spline fits to regional activity versus time curves, and radiation-absorbed dose estimates for all target organs for 131I, 67Cu, and 58 other radionuclides can be calculated. This software has been successfully applied to radioimmunotherapy of B-cell malignancies and breast adenocarcinomas.

Time-dependent quantifiable withdrawal from ethanol in the rat: effect of method of dependence induction

The importance of temporal factors on the presence and severity of ethanol withdrawal signs in the rat was quantified using rating scale, tremor, and acoustic startle paradigms. Ethanol dependence was induced in naive male Wistar rats by liquid diet administration (n = 21) or vapor inhalation (n = 13). Subjects were analyzed for intensity and duration of physiological ethanol dependence in repeated-measures trials conducted over 72 h post-ethanol withdrawal. Indices of dependence included CNS hyperexcitability manifested as observable withdrawal signs increased acoustic startle reactivity, and tremor activity. Data analysis revealed that withdrawal signs, observed and elicited, generally reached peak intensities between 12 and 24 h postwithdrawal and were more readily observed following vapor inhalation than liquid diet administration, probably because of the higher BALs attained with the inhalation procedure. Results suggest a difference in time course observed with the different behavioral paradigms. In particular, a possible sensitization to startle stimuli was exhibited independent of both startle intensity and dependence induction method. The neural substrates governing these behavioral time course differences remain to be determined.

Enhanced TAG-72 expression and tumor uptake of radiolabeled monoclonal antibody CC49 in metastatic breast cancer patients following alpha-interferon treatment

The IFNs, alpha and gamma, have been shown to enhance the tumor-associated glycoprotein (TAG-72) on adenocarcinoma cells in vitro and in mice with human breast cancer xenografts, resulting in improved targeting of monoclonal antibody CC49. To determine the effect of IFN-alpha on biodistribution and tumor uptake of 131I-labeled CC49, patients with metastatic breast cancer were randomized to either receive or not receive IFN-alpha (3 million units daily for 14 days) by s.c. injection. Three days after beginning IFN-alpha, all patients received 10-20 mCi of 131I-CC49 (specific activity, 16.7 mCi/mg) i.v. Total-body Anger camera scans, along with total-body blood and plasma pharmacokinetics, were performed. Tumor biopsies were taken in all patients before and 48 h after IFN-alpha treatment. There were no significant differences in number of metastases imaged or whole-body, blood and plasma pharmacokinetics between IFN-alpha-treated and untreated patients. Quantitative immunohistochemistry on biopsy specimens from IFN-alpha-treated patients demonstrated a significant increase in mean +/- SEM TAG-72 expression (45.7 +/- 19.4%) compared to patients that were not given IFN-alpha (1.3 +/- 0.95%; P < 0.05). Although slight increases in the percent injected dose of 131I-CC49 in tumor occurred after IFN-alpha-treatment, the changes were not significant at the P < 0.05 level. These data suggest that IFN-alpha may be useful in enhancing TAG-72 antigen expression in vivo in humans, despite modest improvement in tumor uptake of CC49, possibly because of limited tumor access or other unknown factors.

Development of a SPECT-based three-dimensional treatment planning system for radioimmunotherapy

Two major obstacles in the development of improved methods for more accurate dose estimates for radioimmunotherapy have been the difficulty in obtaining an accurate patient-specific three-dimensional activity map in vivo and calculating the resulting absorbed dose. We propose a method for three-dimensional internal dosimetry that integrates the three-dimensional activity map from SPECT with a dose-point kernel convolution technique to provide the three-dimensional distribution of absorbed dose.

METHODS

Accurate activity quantitation was achieved with appropriate methods. The count density map from SPECT images was converted into an activity concentration map with a calibration phantom approach. This map was then convolved with an 131I dose-point kernel and three-dimensional fast Fourier transform to yield three-dimensional distribution of absorbed dose, which was then processed to provide the absorbed dose distribution in regions of interest.

RESULTS

The accuracy of quantitative SPECT was validated to be within 16%. The calculated penetrating radiation absorbed dose was verified with thermoluminescent dosimeter measurements to be within 8%. With standard organs and configuration, the method calculated absorbed dose in good agreement with the MIRD formalism (less than 14%).

CONCLUSION

This method overcomes the limitations of planar imaging techniques and the current routine implementation of the MIRD formalism. The results can be processed to provide the absorbed dose distribution in regions of interest and parameters for treatment optimization. Absorbed dose distribution from any plane can be graphically displayed in various ways.

Improved conjugate view quantitation of I-131 by subtraction of scatter and septal penetration events with a triple energy window method

The majority of radiation absorbed dose estimates for radioimmunotherapy (RIT) with I-131 labeled antibodies have been calculated based on in vivo quantitation of activity using the conjugate view approach with planar Anger camera images. Scatter and septal penetration events contributed by a small fraction of high-energy photons emitted by I-131 with an energy exceeding 600 KeV lead to a significant degradation of I-131 images acquired with an Anger camera, which blurs the images of uptake sites and complicates the definition of background regions. The objective of this study was to evaluate a triple energy window (TEW) subtraction method that has been used to remove these interfering events from I-131 images. In the method, a primary photopeak image for I-131 is obtained after sequential subtraction of septal penetration and scatter events by using scatter multipliers derived from a photopeak window and two adjacent scatter window images. Qualitative improvement in image contrast was demonstrated with this technique, together with more accurate and reproducible quantitation for I-131 in the organs of an abdominal phantom. This TEW scatter subtraction method can be used to provide more precise dosimetry estimates for radionuclide therapy and RIT with I-131.

Radiation dose distribution within the bone marrow of patients receiving holmium-166-labeled-phosphonate for marrow ablation

The primary objective of this work was to estimate the absorbed dose distribution to the bone marrow of six multiple myeloma patients who received holmium-166 (166Ho) DOTMP (1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylene-phosphonic acid) for the purpose of bone marrow ablation. A methodology based on gamma camera images was developed to estimate the regional absorbed dose distributions delivered to the bone marrow, and this was compared with values calculated from the MIRD technique and bone marrow biopsies. The activity concentration in various skeletal regions was calculated from the activity in the region of interest (ROI) drawn on whole body gamma camera images, and the mass of bone in each ROI was derived from a dual x-ray absorptiometry image. The radiation absorbed dose to the bone marrow was calculated from this activity concentration using an adaptation of Bragg-Gray cavity theory. The radiation absorbed dose delivered to the bone marrow in the six patients calculated from the MIRD "S" factors ranged from 15.0 to 46.3 Gy. The gamma camera measured activity concentration in skeletal regions predominantly composed of trabecular bone was approximately five to six times higher than that in cortical regions. The skeletal activity concentration in each patient ranged from highs in such regions as the ribs to lows in such regions as the shin and foot by a factor of nearly 20, producing a heterogeneous distribution of absorbed dose within the marrow. Dose volume histograms calculated for these patients indicated that 15%-20% of the marrow received an absorbed dose significantly larger than the average value, while 5%-10% of the marrow received a substantially lower dose. Weighted mean dose estimates from the regional technique were typically 30% greater than the average dose estimates calculated with the MIRD "S" factors. Finally, absorbed dose estimates for the marrow calculated from the regional technique correlated more closely with the clinical response of blood cells and abnormal proteins measured in bone marrow aspirates and peripheral blood samples than estimates from the MIRD "S" factors.

Pharmacokinetics, dosimetry and toxicity of holmium-166-DOTMP for bone marrow ablation in multiple myeloma

In this Phase I clinical trial, six multiple myeloma patients who had not responded to conventional therapy and were scheduled for bone marrow transplantation received a bone-seeking radiopharmaceutical for bone marrow ablation. The pharmacokinetics, dosimetry, and toxicity of this radiopharmaceutical were studied.

METHODS

Patients received from 519 mCi to 2.1 Ci (19.2 GBq to 77.7 GBq) of holmium-166 (166Ho) complexed with a bone-seeking agent, DOTMP (1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylene-phosphonic acid). The reproducibility of pharmacokinetics from multiple injections of 166Ho-DOTMP administered to these myeloma patients was demonstrated from blood (r2 = 0.926) and whole-body retention (r2 = 0.983), which allowed therapeutic parameters to be determined from a diagnostic study.

RESULTS

Over 50% of the 166Ho-DOTMP injected dose was excreted within 2-3 hr postinjection, increasing to 75%-85% over a 24-hr period. Rapid blood clearance minimized radiation dose to nontarget tissue: less than 10% of the injected activity was retained in the blood pool at 1 hr postinjection, and less than 2% remained after 5 hr. The total radiation absorbed dose delivered to the bone marrow for the six patients ranged from 7.9 Gy to 41.4 Gy.

CONCLUSION

All patients demonstrated severe bone marrow toxicity with a white blood cell (WBC) count < 1,000 cells/microliters, two patients exhibited marrow ablation (WBC count < 100 cells/microliters), and no other toxicity > or = grade 2 was observed in any of the patients.

Validation of a dose-point kernel convolution technique for internal dosimetry

The objective of this study was to validate a dose-point kernel convolution technique that provides a three-dimensional (3D) distribution of absorbed dose from a 3D distribution of the radionuclide 131I. A dose-point kernel for the penetrating radiations was calculated by a Monte Carlo simulation and cast in a 3D rectangular matrix. This matrix was convolved with the 3D activity map furnished by quantitative single-photon-emission computed tomography (SPECT) to provide a 3D distribution of absorbed dose. The convolution calculation was performed using a 3D fast Fourier transform (FFT) technique, which takes less than 40 s for a 128 x 128 x 16 matrix on an Intel 486 DX2 (66 MHz) personal computer. The calculated photon absorbed dose was compared with values measured by thermoluminescent dosimeters (TLDS) inserted along the diameter of a 22 cm diameter annular source of 131I. The mean and standard deviation of the percentage difference between the measurements and the calculations were equal to -1% and 3.6%, respectively. This convolution method was also used to calculate the 3D dose distribution in an Alderson abdominal phantom containing a liver, a spleen, and a spherical tumour volume loaded with various concentrations of 131I. By averaging the dose calculated throughout the liver, spleen, and tumour the dose-point kernel approach was compared with values derived using the MIRD formalism, and found to agree to better than 15%.

Hepatic molecular conversion and detoxification of ferritin iron in adult lampreys (Geotria australis), following natural and induced iron loading

Weekly intramuscular injections of 3 mg of iron as horse spleen ferritin into adult Geotria australis over 10 weeks, resulted in a progressive increase in that form of iron in the serum. However, as with control animals, the ferritin in the liver of injected lampreys consisted of one subunit type, whose M(r) (20,300) differed from those of the two subunit types of horse spleen ferritin. Thus, lampreys had converted horse spleen ferritin iron into endogenous ferritin iron, presumably in their liver. Marked rises in hepatic non-haem iron during the first 2 weeks and between weeks 8 and 10 of iron injections were accompanied by pronounced increases in superoxide dismutase (SOD) activity. This rise, which parallels the rise in SOD activity that occurs as iron increases during the very protracted upstream migration of G. australis, is consistent with the view that SOD protects against iron-mediated damage by removing the superoxide radical, which facilitates the formation of the highly toxic hydroxyl radical. A levelling off of the iron concentration between weeks 2 and 8 was accompanied by a decline in SOD activity, even though nonhaem iron levels were well above those of control animals. Enhanced SOD activity may therefore only be required when there is an elevated flux of iron in the liver through low-molecular-mass intermediates. A small amount of ferritin iron was converted into the more inert haemosiderin iron.

Estimation of radiation absorbed doses to the red marrow in radioimmunotherapy

Myelotoxicity is the dose-limiting factor in radioimmunotherapy. Traditional methods most commonly used to estimate the radiation adsorbed dose to the bone marrow of patients consider contributions from radionuclide in the blood and/or total body. Targeted therapies, such as radioimmunotherapy, add a third potential source for radiation to the bone marrow because the radiolabeled targeting molecules can accumulate specifically on malignant target cells infiltrating the bone marrow. A non-invasive method for estimating the radiation absorbed dose to the red marrow of patients who have received radiolabeled monoclonal antibodies (MoAb) has been developed and explored. The method depends on determining the cumulated activity in three contributing sources: 1) marrow; 2) blood; and 3) total body. The novel aspect of this method for estimating marrow radiation dose is derivation of the radiation dose for the entire red marrow from radiation dose estimates obtained by detection of cumulated activity in three lumbar vertebrae using a gamma camera. Contributions to the marrow radiation dose from marrow, blood, and total body cumulated activity were determined for patients who received an I-131 labeled MoAb, Lym-1, that reacts with malignant B-lymphocytes of chronic lymphocytic leukemia and nonHodgkin's lymphoma. Six patients were selected for illustrative purposes because their vertebrae were readily visualized on lumbar images. The radiation doses to the marrow contributed by nonpenetrating emissions in the marrow blood and penetrating emissions in the total body were similar in these patients with a mean of 0.2 and 0.3 rads per administered mCi from the blood and total body, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Iron release from ferritin and its sensitivity to superoxide ions differs among vertebrates

The influence of the superoxide-generating system, xanthine oxidase, on the release of iron from various vertebrate ferritins was determined both in the presence and absence of superoxide dismutase. The initial rate of iron release in the presence of this system was higher for ferritins from human, trout and rat liver than for those from lamprey liver and horse spleen. The proportion of this iron release that was superoxide-dependent in the case of rat, human and trout ferritins was 92, 86 and 84% respectively, whereas no such superoxide-dependent iron release occurred from the ferritins of lamprey liver and horse spleen. On the other hand, the rate of superoxide-independent iron release was of comparable magnitude for all of the species examined. The rate of superoxide-dependent iron release was related neither to the iron: protein ratios nor to the subunit size of the ferritins. However, it is significant that the ferritins with a high rate of superoxide-dependent iron release came from tissues known to be susceptible to iron damage. It is thus proposed that the resistance of lamprey liver ferritin to the mobilization of iron by superoxide ions accounts in part for the tolerance of the lamprey liver to high iron loads.

Overview of radiation myelotoxicity secondary to radioimmunotherapy using 131I-Lym-1 as a model

The radiation dose-limiting toxicity from radioimmunotherapy has been myelotoxicity in the absence of bone marrow reconstitution (transplantation). Myelotoxicity can be assessed directly by biopsy examination of the bone marrow and indirectly by peripheral blood counts. In patients with B-cell malignancies, thrombocytopenia has been the initial and most severe manifestation of 131I-Lym-1 radiation toxicity from treatment. Manifestations of myelotoxicity varied greatly among the patients and from one treatment dose to another in the same patient, suggesting that additional factors were present. There was an increased likelihood of Grade 3-4 hematopoietic toxicity after 131I-Lym-1 treatment if the patient had peripheral blood cell abnormalities before undergoing 131I-Lym-1 treatment. Fractionation of the total 131I-Lym-1 dose was associated with less toxicity. In many patients, myelotoxicity could not be explained by marrow radiation dose (0.36 +/- 0.13 rads per administered mCi) from 131I-Lym-1 in the blood and body alone. Bone marrow examination and 131I-Lym-1 imaging usually provided evidence for additional marrow radiation from 131I-Lym-1-targeting of marrow malignancy and also for residual toxic effects from prior treatment in these patients. Immunohistologic and imaging examination of the bone marrow performed with the intended treatment antibody allowed assessment of extent of marrow malignancy and prediction of degree of myelotoxicity from subsequent treatment. Treatment programs (and protocols) for radioimmunotherapy should incorporate these methods into the decision process. Larger amounts of 131I-Lym-1 can be used in patients selected to have relatively normal peripheral blood cell counts and normocellular bone marrows uninvolved by the malignancy. These observations appear to be relevant to the maximum tolerated dose in radioimmunotherapy for other malignancies as well.