Technical note: Quantifying radionuclide residues in hospital wastewater: A case study on [131I]I and [177mLu]Lu/[177Lu]Lu.

BACKGROUND: Historically, [131I]I has been a common isotope in radionuclide therapy, with [177Lu]Lu-labelled radiopharmaceuticals now seeing a surge in use. These can include no-carrier-added or carrier-added [177Lu]Lu with slight impurities of [177mLu]Lu with a significantly longer half-life than [131I]I. Wastewater from therapy wards can contain a mixture of these radioisotopes. In some countries, national regulations require wastewater to be stored in dedicated systems before it is discharged into the public sewage system. To fulfill legal requirements, the nuclide specific activity concentration must be verified. PURPOSE: We evaluate a method for determining the activity concentration of [177mLu]Lu /[177Lu]Lu at equilibrium and [131I]I in pure and mixed samples in order to prove that the determined values are reliably below the limits for release. METHODS: We analysed the emitted energy spectrum of 1 L samples with a wastewater counter using an energy window-based approach by evaluating measurements from two different time points. Based on the law of decay and the time and energy-dependent measured values, equation systems were set up to calculate the count rates for [131I]I and [177mLu]Lu, which were converted into activity concentration using calibration factors. RESULTS: There is strong linear correlation between the nominal and determined activity concentrations (correlation coefficients R = 0.99; coefficient of determinations R2 = 0.99). We underestimate the actual activity concentration by a median of -1.4% for [177mLu]Lu and overestimate the activity concentration for [131I]I by a median of 7.1%. CONCLUSION: We show that an undercut of the clearance levels for material release is measurable. We analyse and determine activity concentrations of mixed samples consisting of [131I]I and [177mLu]Lu/[177Lu]Lu in equilibrium. The method is simple to implement using a conventional wastewater counter, however with a slightly increased effort, as two samples and measurements are required. The methodology can be adapted for the analysis of other nuclide mixtures.

Technical note: Assessment of radiation measurement devices for the detection of [177 Lu]Lu-labeled radiopharmaceuticals containing [177m Lu]Lu-impurities.

BACKGROUND: Nuclear medicine therapies using [177 Lu]Lu-labeled radiopharmaceuticals have increased significantly in recent years. Some of these radiopharmaceuticals contain long-lived impurities of [177m Lu]Lu. Identification of this specific contamination and its quantification is important in different scenarios. PURPOSE: In this study, standard measurement hardware used for handling radioisotopes was evaluated for the measurement of [177m Lu]Lu and [177 Lu]Lu at equilibrium. Device-specific detection limits (LODs) for [177m Lu]Lu were determined according to international standards and then validated. METHODS: The LODs were determined according to the international standard ISO 11929-1 for [177m Lu]Lu for five identical portable contamination monitors (PCMs), a wastewater counter (WWC), and a release counter system (RCS) at different measuring times. Subsequent activity measurements of the defined samples were used to validate the linearity of the measurement instruments down to the LOD for each system. RESULTS: The average LOD across all PCMs was 0.249 ± 0.009 and 0.129 ± 0.005 Bq/cm2 for 10 and 30 s measurements, respectively. The LODs of WWC varied between 3.3 and 4.7 Bq/L for measurement times of 300 s and 0.8-1.3 Bq/L for 3600 s depending on the energy window studied. The LOD of the RCS depended on the container volume and was 0.08 Bq/g for the 50 L container at 60 s measurement. The measurements for all examined devices were linear down to the LOD (correlation coefficient R ≥ 0.96; coefficient of determination R2  ≥ 0.92). CONCLUSIONS: All investigated measuring instruments (PCM, WWC, RCS) were suitable for the determination of [177m Lu]Lu at equilibrium, and their specific LODs were determined. Based on the measurements performed, activity is overestimated; however, this is tolerable because assumptions and measurements in the context of radiation protection should be conservative.

Anatomical MRI and [18F]FDG PET/CT imaging of Schistosoma mansoni in a NMRI mouse model.

Schistosomiasis represents one of the most devastating worm parasitosis in the world. Current diagnostic methods are insufficient to determine the infection grade and the disease related organ damage. We herein investigated whether discrimination of infection grade and its correlation to liver damage could be accurately performed by multimodal imaging in a mouse model of Schistosoma mansoni infection. Therefore, groups of uninfected and infected mice underwent MRI and [18F]FDG PET/CT imaging. Anatomical MRI images were used for liver volumetry and for quantification of hepatic granulomas. For PET/CT images a volume of interest based analyses were employed to calculate the [18F]FDG uptake in liver, portal vein, spleen and abdomen. Herein, we demonstrate that the combined use of [18F]FDG-PET/CT and MRI represents an appropriate diagnostic tool for Schistosoma mansoni infection, but fails to discriminate the infection grade and the linked organ damage. Only the splenic [18F]FDG uptake in the 25 cercariae group (5.68 ± 0.90%ID/cc) and 50 cercariae group (4.98 ± 1.43%ID/cc) was significantly higher compared to the control group (2.13 ± 0.69%ID/cc). Nevertheless, future multimodal imaging studies with new radiopharmaceuticals could build a highly sensitive and specific basis for the diagnosis and evaluation of organ damage of schistosomiasis.

Antifibrogenic effects of vitamin D derivatives on mouse pancreatic stellate cells.

AIM: To study the molecular effects of three different D-vitamins, vitamin D2, vitamin D3 and calcipotriol, in pancreatic stellate cells (PSCs). METHODS: Quiescent PSCs were isolated from mouse pancreas and activated in vitro by seeding on plastic surfaces. The cells were exposed to D-vitamins as primary cultures (early-activated PSCs) and upon re-culturing (fully-activated cells). Exhibition of vitamin A-containing lipid droplets was visualized by oil-red staining. Expression of α-smooth muscle actin (α-SMA), a marker of PSC activation, was monitored by immunofluorescence and immunoblot analysis. The rate of DNA synthesis was quantified by 5-bromo-2'-deoxyuridine (BrdU) incorporation assays. Real-time PCR was employed to monitor gene expression, and protein levels of interleukin-6 (IL-6) were measured by ELISA. Uptake of proline was determined using 18F-proline. RESULTS: Sustained culture of originally quiescent PSCs induced cell proliferation, loss of lipid droplets and exhibition of stress fibers, indicating cell activation. When added to PSCs in primary culture, all three D-vitamins diminished expression of α-SMA (to 32%-39% of the level of control cells; P < 0.05) and increased the storage of lipids (scores from 1.97-2.15 on a scale from 0-3; controls: 1.49; P < 0.05). No such effects were observed when Dvitamins were added to fully-activated cells, while incorporation of BrdU remained unaffected under both experimental conditions. Treatment of re-cultured PSCs with Dvitamins was associated with lower expression of IL-6 (-42% to -49%; P < 0.05; also confirmed at the protein level) and increased expression of the vitamin D receptor gene (209%-321% vs controls; P < 0.05). There was no effect of Dvitamins on the expression of transforming growth factor-ß1 and collagen type 1 (chain α1). The lowest uptake of proline, a main component of collagen, was observed in calcipotriol-treated PSCs. CONCLUSION: The three D-vitamins inhibit, with similar efficiencies, activation of PSCs in vitro, but cannot reverse the phenotype once the cells are fully activated.

[68Ga]pentixafor for CXCR4 imaging in a PC-3 prostate cancer xenograft model - comparison with [18F]FDG PET/CT, MRI and ex vivo receptor expression.

PURPOSE: The aim was to characterize the properties of [68Ga]Pentixafor as tracer for prostate cancer imaging in a PC-3 prostate cancer xenograft mouse model and to investigate its correlation with [18F]FDG PET/CT, magnetic resonance imaging (MRI) and ex vivo analyses. METHODS: Static [68Ga]Pentixafor and [18F]FDG PET as well as morphological/ diffusion weighted MRI and 1H MR spectroscopy was performed. Imaging data were correlated with ex vivo biodistribution and CXCR4 expression in PC-3 tumors (immunohistochemistry (IHC), mRNA analysis). Flow cytometry was performed for evaluation of localization of CXCR4 receptors (in vitro PC-3 cell experiments). RESULTS: Tumor uptake of [68Ga]Pentixafor was significantly lower compared to [18F]FDG. Ex vivo CXCR4 mRNA expression of tumors was shown by PCR. Only faint tumor CXCR4 expression was shown by IHC (immuno reactive score of 3). Accordingly, flow cytometry of PC-3 cells revealed only a faint signal, cell membrane permeabilisation showed a slight signal increase. There was no significant correlation of [68Ga]Pentixafor tumor uptake and ex vivo receptor expression. Spectroscopy showed typical spectra of prostate cancer. CONCLUSION: PC-3 tumor uptake of [68Ga]Pentixafor was existent but lower compared to [18F]FDG. No significant correlation of ex vivo tumor CXCR4 receptor expression and [68Ga]Pentixafor tumor uptake was shown. CXCR4 receptor expression on the surface of PC-3 cells was existent but rather low possibly explaining the limited [68Ga]Pentixafor tumor uptake; receptor localization in the interior of PC-3 cells is presumable as shown by cell membrane permeabilisation. Further studies are necessary to define the role of [68Ga]Pentixafor in prostate cancer imaging.

Application of in vivo imaging techniques to monitor therapeutic efficiency of PLX4720 in an experimental model of microsatellite instable colorectal cancer.

OBJECTIVES: Patient-derived tumor cell lines are a powerful tool to analyze the sensitivity of individual tumors to specific therapies in mice. An essential prerequisite for such an approach are reliable quantitative techniques to monitor tumor progression in vivo. METHODS: We have employed HROC24 cells, grown heterotopically in NMRI Foxn1nu mice, as a model of microsatellite instable colorectal cancer to investigate the therapeutic efficiencies of 5'-fluorouracil (5'-FU) and the mutant BRAF inhibitor PLX4720, a vemurafenib analogue, by three independent methods: external measurement by caliper, magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG). RESULTS: Repeated measure ANOVA by a general linear model revealed that time-dependent changes of anatomic tumor volumes measured by MRI differed significantly from those of anatomic volumes assessed by caliper and metabolic volumes determined by PET/CT. Over the investigation period of three weeks, neither 5'-FU, PLX4720 nor a combination of both drugs affected the tumor volumes. Also, there was no drug effect on the apparent diffusion constant (ADC) value as detected by MRI. Interestingly, however, PET/CT imaging showed that PLX4720-containing therapies transiently reduced the standardized uptake value (SUV), indicating a temporary response to treatment. CONCLUSIONS: 5'-FU and PLX4720 were largely ineffective with respect to HROC24 tumor growth. Tumoral uptake of 18F-FDG, as expressed by the SUV, proved as a sensitive indicator of small therapeutic effects. Metabolic imaging by 18F-FDG PET/CT is a suitable approach to detect effects of tumor-directed therapies early and even in the absence of morphological changes.

A unique matched quadruplet of terbium radioisotopes for PET and SPECT and for α- and ß- radionuclide therapy: an in vivo proof-of-concept study with a new receptor-targeted folate derivative.

UNLABELLED: Terbium offers 4 clinically interesting radioisotopes with complementary physical decay characteristics: (149)Tb, (152)Tb, (155)Tb, and (161)Tb. The identical chemical characteristics of these radioisotopes allow the preparation of radiopharmaceuticals with identical pharmacokinetics useful for PET ((152)Tb) and SPECT diagnosis ((155)Tb) and for α- ((149)Tb) and ß(-)-particle ((161)Tb) therapy. The goal of this proof-of-concept study was to produce all 4 terbium radioisotopes and assess their diagnostic and therapeutic features in vivo when labeled with a folate-based targeting agent. METHODS: (161)Tb was produced by irradiation of (160)Gd targets with neutrons at Paul Scherrer Institute or Institut Laue-Langevin. After neutron capture, the short-lived (161)Gd decays to (161)Tb. (149)Tb, (152)Tb, and (155)Tb were produced by proton-induced spallation of tantalum targets, followed by an online isotope separation process at ISOLDE/CERN. The isotopes were purified by means of cation exchange chromatography. For the in vivo studies, we used the DOTA-folate conjugate cm09, which binds to folate receptor (FR)-positive KB tumor cells. Therapy experiments with (149)Tb-cm09 and (161)Tb-cm09 were performed in KB tumor-bearing nude mice. Diagnostic PET/CT ((152)Tb-cm09) and SPECT/CT ((155)Tb-cm09 and (161)Tb-cm09) studies were performed in the same tumor mouse model. RESULTS: Carrier-free terbium radioisotopes were obtained after purification, with activities ranging from approximately 6 MBq (for (149)Tb) to approximately 15 MBq (for (161)Tb). The radiolabeling of cm09 was achieved in a greater than 96% radiochemical yield for all terbium radioisotopes. Biodistribution studies showed high and specific uptake in FR-positive tumor xenografts (23.8% ± 2.5% at 4 h after injection, 22.0% ± 4.4% at 24 h after injection, and 18.4% ± 1.8% at 48 h after injection). Excellent tumor-to-background ratios at 24 h after injection (tumor to blood, ≈ 15; tumor to liver, ≈ 5.9; and tumor to kidney, ≈ 0.8) allowed the visualization of tumors in mice using PET ((152)Tb-cm09) and SPECT ((155)Tb-cm09 and (161)Tb-cm09). Compared with no therapy, α- ((149)Tb-cm09) and ß(-)-particle therapy ((161)Tb-cm09) resulted in a marked delay in tumor growth or even complete remission (33% for (149)Tb-cm09 and 80% for (161)Tb-cm09) and a significantly increased survival. CONCLUSION: For the first time, to our knowledge, 4 terbium radionuclides have been tested in parallel with tumor-bearing mice using an FR targeting agent. Along with excellent tumor visualization enabled by (152)Tb PET and (155)Tb SPECT, we demonstrated the therapeutic efficacy of the α-emitter (149)Tb and ß(-)-emitter (161)Tb.

Radioiodinated folic acid conjugates: evaluation of a valuable concept to improve tumor-to-background contrast.

Folic acid radioconjugates can be used for targeting folate receptor positive (FR(+)) tumors. However, the high renal uptake of radiofolates is a drawback of this strategy, particularly with respect to a therapeutic application due to the risk of damage to the kidneys by particle radiation. The goal of this study was to develop and evaluate radioiodinated folate conjugates as a novel class of folate-based radiopharmaceuticals potentially suitable for therapeutic application. Two different folic acid conjugates, tyrosine-folate (1) and tyrosine-click-folate (3), were synthesized and radioiodinated using the Iodogen method resulting in [(125)I]-2 and [(125/131)I]-4. Both radiofolates were highly stable in mouse and human plasma. Determination of FR binding affinities using (3)H-folic acid and FR(+) KB tumor cells revealed affinities in the nanomolar range for 2 and 4. The cell uptake of [(125)I]-2 and [(125/131)I]-4 proved to be FR specific as it was blocked by the coincubation of folic acid. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) in vitro assays were employed for the determination of tumor cell viability upon exposure to [(131)I]-4. Compared to untreated control cells, significantly reduced cell viability was observed for FR(+) cancer cells (KB, IGROV-1, SKOV-3), while FR(-) cells (PC-3) were not affected. Biodistribution studies performed in tumor bearing nude mice showed the specific accumulation of both radiofolates in KB tumor xenografts ([(125)I]-2: 3.43 ± 0.28% ID/g; [(125)I]-4: 2.28 ± 0.46% ID/g, 4 h p.i.) and increasing tumor-to-kidney ratios over time. The further improvement of the tumor-to-background contrast was achieved by preinjection of the mice with pemetrexed allowing excellent imaging via single-photon emission computed tomography (SPECT/CT). These findings confirmed the hypothesis that the application of radioiodinated folate conjugates may be a valuable concept to improve tumor-to-background contrast. The inhibitory effect of [(131)I]-4 on FR(+) cancer cells in vitro indicates the potential of this class of radiofolates for therapeutic application.

L1-CAM-targeted antibody therapy and (177)Lu-radioimmunotherapy of disseminated ovarian cancer.

The L1-cell adhesion molecule (L1-CAM) is highly expressed in various cancer types including ovarian carcinoma but is absent from most normal tissue. A chimeric monoclonal antibody, chCE7, specifically binds to human L1-CAM and exhibits anti-proliferative effects on L1-CAM-expressing tumor cells. The goal of this study was to evaluate the efficacy of a novel (177)Lu-chCE7 radioimmunotherapeutic agent and to compare it to a treatment protocol with unlabeled, growth-inhibiting chCE7 in a mouse xenograft model of disseminated ovarian cancer. chCE7agl, an aglycosylated IgG1 variant with improved pharmacokinetics, was conjugated with 1,4,7,10-tetraazacyclododecane-N-N'-N'-N‴-tetraacetic acid (DOTA) and labeled with the low-energy ß-emitter (177)Lu. Tumor growth and survival were assessed after a single i.v. dose of 8 MBq (60 µg) radioimmunoconjugate in nude mice bearing either subcutaneous or intraperitoneal SKOV3.ip1 human ovarian cancer tumors. Therapeutic efficacy was compared with three times weekly i.p. administration of 10 mg/kg unconjugated chCE7. In vivo analysis of (177)Lu-chCE7agl biodistribution demonstrated high and specific accumulation of radioactivity at the tumor site with maximal tumor uptake of up to 48.0 ± 8.1% ID/g at 168 h postinjection. A single treatment with (177)Lu-DOTA-chCE7agl caused significant retardation of tumor growth and prolonged median survival from 33 to 71 days, while administration of a nontargeted (177)Lu-immunoconjugate had no beneficial effect. Three times weekly i.p. application of unlabeled chCE7 10 mg/kg similarly increased survival from 44 to 72 days. We conclude that a single dose of (177)Lu-DOTA-chCE7agl is as effective as repeated administration of nonradioactive chCE7 for treatment of small intraperitoneal tumors expressing L1-CAM.

Divisão e expansão da crista do rebordo em duas etapas para instalação de implantes na região mandibular posterior / A two-step, split crest technique at posterior mandible for implant placement - case report

A reabilitação da região posterior da mandíbula atrófica com implantes osseointegráveis é um grande desafio. Os padrões de reabsorção pós-exodontia modificam significativamente a largura e a altura do rebordo ósseo residual. Diferentes técnicas já foram propostas para o tratamento de mandíbulas severamente reabsorvidas. A técnica de divisão e expansão da crista na mandíbula não é controlável devido a grande espessura das corticais ósseas, causando o desprendimento total do bloco ósseo. Uma abordagem técnica em duas etapas na mandíbula é indicada para evitar complicações, diminuindo-se assim à taxa de insucesso sem, no entanto, causar um atraso significante no tratamento.

Rehabilitation of atrophic, mandibular posterior regions with dental implants is a significant challenge. Post-extraction tooth resorption patterns can significantly modify the width and height of the residual bone. Several techniques have been proposed for the treatment of severely resorbed jaws. The technique of crest division and expansion cannot be predictable due to the large thickness of the cortical bone, causing total detachment of bone blocks. Thus, a two-step technical approach may be indicated to prevent complications, decreasing the morbidity rate without, however, causing a significant delaying on treatment time

The low-energy ß(-) and electron emitter (161)Tb as an alternative to (177)Lu for targeted radionuclide therapy.

INTRODUCTION: The low-energy ß(-) emitter (161)Tb is very similar to (177)Lu with respect to half-life, beta energy and chemical properties. However, (161)Tb also emits a significant amount of conversion and Auger electrons. Greater therapeutic effect can therefore be expected in comparison to (177)Lu. It also emits low-energy photons that are useful for gamma camera imaging. METHODS: The (160)Gd(n,γ)(161)Gd→(161)Tb production route was used to produce (161)Tb by neutron irradiation of massive (160)Gd targets (up to 40 mg) in nuclear reactors. A semiautomated procedure based on cation exchange chromatography was developed and applied to isolate no carrier added (n.c.a.) (161)Tb from the bulk of the (160)Gd target and from its stable decay product (161)Dy. (161)Tb was used for radiolabeling DOTA-Tyr3-octreotate; the radiolabeling profile was compared to the commercially available n.c.a. (177)Lu. A (161)Tb Derenzo phantom was imaged using a small-animal single-photon emission computed tomography camera. RESULTS: Up to 15 GBq of (161)Tb was produced by long-term irradiation of Gd targets. Using a cation exchange resin, we obtained 80%-90% of the available (161)Tb with high specific activity, radionuclide and chemical purity and in quantities sufficient for therapeutic applications. The (161)Tb obtained was of the quality required to prepare (161)Tb-DOTA-Tyr3-octreotate. CONCLUSIONS: We were able to produce (161)Tb in n.c.a. form by irradiating highly enriched (160)Gd targets; it can be obtained in the quantity and quality required for the preparation of (161)Tb-labeled therapeutic agents.

Radiolabeling of rituximab with (188)Re and (99m)Tc using the tricarbonyl technology.

INTRODUCTION: The most successful clinical studies of immunotherapy in patients with non-Hodgkin's lymphoma (NHL) use the antibody rituximab (RTX) targeting CD20(+) B-cell tumors. Rituximab radiolabeled with ß(-) emitters could potentiate the therapeutic efficacy of the antibody by virtue of the particle radiation. Here, we report on a direct radiolabeling approach of rituximab with the (99m)Tc- and (188)Re-tricarbonyl core (IsoLink technology). METHODS: The native format of the antibody (RTX(wt)) as well as a reduced form (RTX(red)) was labeled with (99m)Tc/(188)Re(CO)(3). The partial reduction of the disulfide bonds to produce free sulfhydryl groups (-SH) was achieved with 2-mercaptoethanol. Radiolabeling efficiency, in vitro human plasma stability as well as transchelation toward cysteine and histidine was investigated. The immunoreactivity and binding affinity were determined on Ramos and/or Raji cells expressing CD20. Biodistribution was performed in mice bearing subcutaneous Ramos lymphoma xenografts. RESULTS: The radiolabeling efficiency and kinetics of RTX(red) were superior to that of RTX(wt) ((99m)Tc: 98% after 3 h for RTX(red) vs. 70% after 24 h for RTX(wt)). (99m)Tc(CO)(3)-RTX(red) was used without purification for in vitro and in vivo studies whereas (188)Re(CO)(3)-RTX(red) was purified to eliminate free (188)Re-precursor. Both radioimmunoconjugates were stable in human plasma for 24 h at 37 °C. In contrast, displacement experiments with excess cysteine/histidine showed significant transchelation in the case of (99m)Tc(CO)(3)-RTX(red) but not with pre-purified (188)Re(CO)(3)-RTX(red). Both conjugates revealed high binding affinity to the CD20 antigen (K(d) = 5-6 nM). Tumor uptake of (188)Re(CO)(3)-RTX(red) was 2.5 %ID/g and 0.8 %ID/g for (99m)Tc(CO)(3)-RTX(red) 48 h after injection. The values for other organs and tissues were similar for both compounds, for example the tumor-to-blood and tumor-to-liver ratios were 0.4 and 0.3 for (99m)Tc(CO)(3)-RTX(red) and for (188)Re(CO)(3)-RTX(red) 0.5 and 0.5 (24 h pi). CONCLUSION: Rituximab could be directly and stably labeled with the matched pair (99m)Tc/(188)Re using the IsoLink technology under retention of the biological activity. Labeling kinetics and yields need further improvement for potential routine application in radioimmunodiagnosis and therapy.

Implantes curtos associados à prótese tipo barra clip na reabilitação de rebordo mandibular severamente reabsorvido / Short dental implants for a bar-clip, implant-supported prosthesis in the severely resorbed mandibular arch

A reabilitação protética de mandíbulas edêntulas severamente atrofiadas tem sido um grande desafio para a Implantodontia. A literatura descreve para a solução destes casos a utilização de técnicas de enxertia e distração osteogênica para aumento da disponibilidade óssea, instalação de implantes transmandibulares ou a utilização de implantes curtos. Contudo, as reabilitações protéticas suportadas por implantes curtos têm apresentado resultados excelentes e morbidade reduzida frente às demais técnicas. O presente artigo refere-se a um caso clínico de mandíbula severamente atrofiada com cerca de 6,5 mm de altura entre os forâmenes mentuais, na qual foram instalados dois implantes curtos na região interforaminal para a reabilitação com overdenture retida por barra clip.

The solution for mandibular atrophy cases has been a great challenge for Implantology regarding rehabilitation of edentulous mandibles. This paper reports an extreme mandibular atrophic bone with 6.5 mm of height between the mental foramina. The literature describes augmentation techniques with grafts, distraction osteogenics, transmandibular, or short dental implants. However, prosthetic-surgical rehabilitation with short-implants has been associated to good success rates and reduced morbidity compared to other techniques. This clinical case reports the installation of two short dental implants between the mental foramina for rehabilitation of an atrophic mandible with a bar-clip prosthesis.

A "click chemistry" approach to the efficient synthesis of multiple imaging probes derived from a single precursor.

Different imaging modalities can provide complementary information on biological processes at the cellular or molecular level in vitro and in vivo. However, specific molecular probes suitable for a comparison of different imaging modalities are often not readily accessible because their preparation is usually accomplished by individually developed and optimized syntheses. Herein, we present a general, modular synthetic approach that provides access to multiple probes derived from a single precursor by application of the same, efficient functionalization strategy, the Cu(I)-catalyzed cycloaddition of terminal alkynes and azides (click chemistry). To demonstrate the viability and efficiency of this approach, folic acid (FA) was selected as a targeting vector because the preparation of FA-based imaging probes used for SPECT, PET, MRI, and NIRF by reported synthetic strategies is usually difficult to achieve and often results in low overall yields. We prepared a versatile γ-azido-FA precursor as well as a set of alkyne functionalized probes and precursors including ligand systems suitable for the chelation of various (radio)metals, an NIR dye and (18)F- and (19)F-derivatives, which enabled the parallel development of new FA-imaging probes. The Cu(I)-mediated coupling of the alkynes with the γ-azido-FA precursor was accomplished in high yields and with minimal use of protective groups. The various probes were fully characterized spectroscopically as well as in vitro and in vivo. In vitro, all new FA-derivatives exhibited high affinity toward the folic acid receptor (FR) and/or were specifically internalized into FR-overexpressing KB cells. In vivo experiments with nude mice showed that all probes (except the MRI probes which have not been tested yet) accumulated specifically in FR-positive organs and human KB-cell xenografts. However, in vivo imaging revealed significant differences between the various FA-derivatives with respect to unspecific, off-target localization. In general, the comparison of different probes proved the superiority of the more hydrophilic, radiometal-based imaging agents, a result which will guide future efforts for the development of FA-based imaging probes and therapeutic agents. In addition, the strategy presented herein should be readily applicable to other molecules of interest for imaging and therapeutic purposes and thus represents a valuable alternative to other synthetic approaches.

Regeneração óssea em Odontologia com a utilização do substituto ósseo composto xenogênico Gen Mix / Bone regeneration in Dentistry with use of composed bone substitute Gen Mix

O presente estudo avaliou quatro casos clínicos onde um xenoenxerto bovino composto osteossubstituto foi usado para regeneração da perda óssea. Três casos de alvéolos dentais pós-extração atraumática e um caso de procedimento de elevação de seio maxilar usando técnica de reposição lateral, objetivando a colocação de implante, foram tratados com xenoenxerto composto. Quatro a oito meses, previamente à colocação de implante, as áreas enxertadas foram reoperadas e biópsias ósseas removidas por brocas trefinas. Após seis meses da colocação dos implantes, os elementos protéticos estiveram em função e mostrando sucesso clínico. A análise histológica das biópsias mostrou ausência de infiltrado inflamatório e presença de tecido ósseo neoformado fora e dentro de poros e fendas do biomaterial. O xenoenxerto foi biocompatível e permitiu a aposição de novo osso, indicando seu uso antes da colocação de implantes osseointegrados.

The present study evaluated four clinical cases where a xenograft bovine compound bone substitute was used for regeneration of bone loss. Three cases of dental sockets after non-traumatic tooth extractions and one case of maxillary sinus augmentation procedure using the lateral approach technique, aiming further implant placement, were treated with xenograft compound. Four to eight months before implant placement, the grafted areas were reopened and bone biopsies carried out by trephine burs. Six months after implant placement, the prosthetic elements were in function showing clinical success. Histological analysis of biopsies showed absence of inflammatory infiltrate and the presence of new bone tissue over and inside pores and grooves of the biomaterial as well. The xenograft was biocompatible and allowed the apposition of new bone, supporting its use before dental implant placement.

Implantes curtos / Short implants: a literature review

A disponibilidade de altura óssea é frequentemente um fator determinante do comprimento dos implantes. Em situações de volume ósseo extremamente reduzido, o cirurgião pode realizar procedimentos de enxertia óssea, que resultam em maior custo, maior morbidade e tratamento mais longo. Outra possibilidade para essas limitações anatômicas é o uso de implantes curtos com os quais é possível alcançar taxas de sucesso altas. Essa evidência é relatada em estudos que têm revelado resultados similares para implantes curtos e longos. O propósito deste estudo é revisar a literatura sobre implantes curtos instalados em ambos os arcos dentários, avaliando suas vantagens, desvantagens, indicações, contraindicações e suas taxas de sucesso.

Enxerto de seio maxilar com substituto ósseo bovino (Gen Mix) / Maxillary sinus' graft with bone substitute (Gen Mix)

Com a perda dos elementos dentários, há um processo de reabsorção que, somado à pneumatização do seio maxilar, resulta em um remanescente ósseo inferior a oito milímetros na região posterior da maxila, o que impossibilita a instalação de implantes. Neste trabalho, buscou-se por meio da revisão da literatura e de relato de um caso enumerar as técnicas utilizadas para a enxertia e elevação do seio maxilar bem como os materiais empregados.

Evaluation of anti-VEGFR-3 specific scFv antibodies as potential therapeutic and diagnostic tools for tumor lymph-angiogenesis.

Vascular endothelial growth factor receptor-3 (VEGFR-3) plays a major role in lymph-angiogenesis, tumor growth and metastatic tumor cell dissemination. The receptor is over-expressed on lymphatic vessels in the vicinity of tumors and on the tumor vasculature and therefore may be an excellent target for an effective cancer intervention. We generated and characterized single chain antibody fragments (scFv) recognizing VEGFR-3 by phage display technology and expression in P. pastoris and analyzed selected antibodies in vitro and in vivo. The scFvs were functionalized by the introduction of cysteines at the C-terminal end of the proteins. The scFvs are species cross-specific and bind to recombinant human and mouse VEGFR-3. ScFv AFC5 showed specific tumor accumulation in an hVEGFR-3 expressing F9 terato-carcinoma mouse model, which was also used for tumor visualization by combined single proton emission computed tomography (SPECT/CT) and immunohistochemical analysis. This antibody also inhibited binding of hVEGF-C to its receptor and reduced proliferation of human lymphatic endothelial cells. Thus, the generated VEGFR-3 specific scFv antibodies represent a valuable tool for novel cancer therapies and diagnostic applications.

Preclinical evaluation of novel organometallic 99mTc-folate and 99mTc-pteroate radiotracers for folate receptor-positive tumour targeting.

PURPOSE: The folate receptor (FR) is a valuable tumour marker, since it is frequently overexpressed on various cancer types. The purpose of the present study was to pre-clinically evaluate novel site-specifically modified (99m)Tc(CO)(3) folate (gamma-derivative 4, alpha-derivative 5) and pteroate (6) conjugates for FR targeting. METHODS: The (99m)Tc(CO)(3) radiotracers 4-6 were prepared by a kit-like procedure. In vitro characterisation (K (D) and B (max)) of the radiotracers was performed with FR-positive KB cells. Tissue distribution was studied in tumour-bearing mice. SPECT/CT experiments were performed with a dedicated small animal SPECT/CT scanner. RESULTS: The complexes 4-6 were formed in high yields (>92%). Binding constants of the radiotracers (K (D) in nM: 4: 2.09; 5: 2.51; 6: 14.52) were similar to those of (3)H-folic acid (K (D) in nM: 7.22). In vivo the folate derivatives showed significantly better tumour uptake (4: 2.3+/-0.4% ID/g and 5: 1.2+/-0.2% ID/g, 4 h p.i.) than the pteroate derivative (6: 0.4+/-0.2% ID/g, 4 h p.i.). Clearance of all radiotracers from the blood pool and from non-targeted tissues was efficient (tumour to blood ratio approx. 200-350, 24 h p.i.). FR-positive tissue and organs were successfully visualised via small animal SPECT/CT. CONCLUSION: Radiotracers 4-6 are the first (99m)Tc(CO)(3) tracers prepared via a kit formulation which exhibit full biological activity in vitro and in vivo. Folate derivatives 4 and 5 revealed significantly better pharmacokinetic properties than the pteroate derivative 6. Promising pre-clinical SPECT results warrant further assessment of (99m)Tc(CO)(3) radiofolates for detection of FR-positive tumours.

Double-stabilized neurotensin analogues as potential radiopharmaceuticals for NTR-positive tumors.

INTRODUCTION: Overexpression of neurotensin (NT) receptors in exocrine pancreatic cancer and other neuroendocrine cancers make them interesting targets for tumor imaging and therapy. Modifications at the cleavage bonds 8-9 and 11-12 led to the synthesis of NT-XII, NT-XIII and NT-XVIII, three new stabilized analogues. (NalphaHis)Ac was coupled to the N-terminus for labeling with [(99m)Tc]-tricarbonyl. METHODS: Stability was tested in vitro in human plasma and HT-29 cells. Binding to NT1 receptors and internalization/efflux were analyzed in intact HT-29 cells. Biodistribution studies were performed in nude mice bearing HT-29 xenografts. RESULTS: All analogues were very stable in human plasma, with half-lives of 20-21 days. Degradation in HT-29 cells was more rapid (t(1/2) of 6.5, 5 and 2.5 h for NT-XII, NT-XIII and NT-XVIII, respectively). They also showed high affinity and specificity for NT1 receptors. Bound activity was rapidly internalized at 37 degrees C. The pattern of externalization was different. NT-XII was released more slowly than NT-XIII and NT-XVIII (half of the activity still inside the cells after 24 h). Bigger differences were found in the biodistribution studies. NT-XII showed the highest tumor uptake as well as the best tumor to nontumor ratios. CONCLUSION: The modifications introduced in NT(8-13) increased plasma stability, maintaining unaffected the in vitro binding properties. The best biodistribution corresponded to NT-XII, which shows to be a good candidate for NT1 receptors overexpressing tumors. First clinical trials are ongoing.