[Radioiodine therapy for women with Graves' disease and the risk of foetal hypothyroidism if they are later found to be pregnant]. / Behandeling van een vrouw met de ziekte van graves door middel van radioactief jodium en het risico op foetale hypothyreoïdie als zij later zwanger blijkt te zijn.

Three fertile female patients aged 33, 29 and 38 years, respectively, were treated with radioiodine 1-131 for Graves' disease. In retrospect, the first woman was 14 weeks pregnant at the time of treatment, and the other 2 women were treated around the time of conception. All 3 women decided to continue their pregnancies after being counselled about the potential adverse health risks of radioiodine therapy for the infant. The first woman was delivered at term of an infant diagnosed with hypothyroidism that was ascribed to radioiodine. The other 2 women delivered euthyroid infants. According to international standards, radioiodine should not be given during pregnancy because of its toxic effects. An interval of at least 4 months is advised between maternal radioiodine therapy and conception. This should be discussed with the patient. Prior to the initiation of radioiodine therapy, menstrual and contraceptive history should be ascertained in fertile female patients. Pregnancy testing should be performed where indicated, and the result should be verified before radioiodine therapy is initiated.

Comparison of (111)In-labeled somatostatin analogues for tumor scintigraphy and radionuclide therapy.

We evaluated the following (111)In-labeled somatostatin (SS) analogues (diethylenetriaminepentaacetic acid, DTPA; tetraazacyclododecanetetraacetic acid, DOTA): [DTPA0]octreotide, [DTPA0,Tyr3]octreotide, [DTPA0,D-Tyr1]octreotide, [DTPA0,Tyr3]octreotate [Thr(ol) in octreotide replaced with Thr], and [DOTA0,Tyr3]octreotide, in vitro and in vivo. In vitro, all compounds showed high and specific binding to SS receptors in mouse pituitary AtT20 tumor cell membranes, and IC50s were in the nanomolar range. Furthermore, all compounds showed specific internalization in rat pancreatic tumor cells; uptake of [(111)In-DTPA0,Tyr3]octreotate was the highest of the compounds tested, and that of [(111)In-DTPA0,D-Tyr1]octreotide was the lowest. Biodistribution experiments in rats showed that, 4, 24, and 48 h after injection of [(111)In-DTPA0,Tyr3]octreotide, [(111)In-DTPA0,Tyr3]octreotate, and [(111)In-DOTA0,Tyr3]octreotide, radioactivity in the octreotide-binding, receptor-expressing tissues and tumor-to-blood ratios were significantly higher than those after injection of [(111)In-DTPA0]octreotide. Uptake of [(111)In-DTPA0,Tyr3]octreotate in the target organs was also, in vivo, the highest of the radiolabeled peptides tested, whereas that of [(111)In-DTPA0,D-Tyr1]octreotide was the lowest. Uptake of [(111)In-DTPA0,Tyr3]octreotide, [(111)In-DTPA0,Tyr3]octreotate, and [(111)In-DOTA0,Tyr3]octreotide in target tissues was blocked by >90% by 0.5 mg of unlabeled octreotide, indicating specific binding to the octreotide receptors. Blockade of [(111)In-DTPA0,D-Tyr1]octreotide was >70%. In conclusion, radiolabeled [DTPA0,Tyr3]octreotide and, especially, [DTPA0,Tyr3]octreotate and their DOTA-coupled counterparts are most promising for scintigraphy and radionuclide therapy of SS receptor-positive tumors in humans.

Parallel in vivo and in vitro detection of functional somatostatin receptors in human endocrine pancreatic tumors: consequences with regard to diagnosis, localization, and therapy.

The effects of octreotide in vivo and in vitro on hormone release, in vivo [123I]Tyr3-octreotide scanning, and in vitro [125I]Tyr3-octreotide autoradiography were compared in five patients with endocrine pancreatic tumors. [123I]Tyr3-octreotide scanning localized the primary tumor and/or previously unknown metastases in four of the five patients. The patient with a negative scan had an insulinoma that did not respond to octreotide in vivo. No Tyr3-octreotide-binding sites were subsequently found at autoradiography of the tumor, whereas somatostatin-14 receptors were present at a high density. In parallel, culture studies with the cells prepared from this adenoma showed that insulin release was not affected by octreotide, while both somatostatin-14 and -28 significantly suppressed hormone release. Culture studies of the tumor cells from two gastrinomas showed a dose-dependent inhibition of gastrin release by octreotide. Octreotide exerted direct antiproliferative effects in one of these gastrinomas, which had been shown to be rapidly growing in vivo. Both gastrinomas had specific somatostatin receptors, as measured by in vitro receptor autoradiography. Somatostatin release by the cultured somatostatinoma cells from one of these patients was suppressed by octreotide. In conclusion, 1) the [123I]Tyr3-octreotide scanning procedure is valuable in the localization of primary endocrine pancreatic tumors as well their often clinically not yet recognized metastases; 2) the in vitro detection of somatostatin receptors in those tumors that were also visualized in vivo after injection of [123I] Tyr3-octreotide indicates that the ligand binding to the tumor in vivo indeed represents binding to specific somatostatin receptors; and 3) the parallel between the presence of somatostatin receptors on tumors and in in vivo and in vitro effects of octreotide on hormonal release from these tumors indicate that a positive scan predicts a good suppressive effect of octreotide on hormonal hypersecretion by these tumors.

Comparison of 111In-DOTA-Tyr3-octreotide and 111In-DTPA-octreotide in the same patients: biodistribution, kinetics, organ and tumor uptake.

UNLABELLED: Scintigraphy with [111In-diethylenetriamine pentaacetic acid0-D-Phe1]-octreotide (DTPAOC) is used to demonstrate neuroendocrine and other somatostatin-receptor-positive tumors. Despite encouraging results, this 111In-labeled compound is not well suited for peptide-receptor-mediated radiotherapy of somatostatin-receptor-positive tumors. Another somatostatin analog, [1,4,7,10-tetraazacyclododecane-N,N',N",N'''-tetraacetic acid0, D-Phe1, Tyr3]-octreotide (DOTATOC), can be labeled with the beta-emitter 90Y in a stable manner. METHODS: We compared the distribution, kinetics and dosimetry of 111In-DTPAOC and 111In-DOTATOC in eight patients to predict the outcomes of these parameters in patients who will be treated with 90Y-DOTATOC. RESULTS: Serum radioactivity levels for the radiopharmaceuticals did not differ significantly 2-24 h after injection (P>0.05). Up to 2 h postinjection they were slightly, but significantly, lower after administration of 111In-DOTATOC (P < 0.01 at most time points). The percentage of peptide-bound radioactivity in serum did not differ after administration of either compound. Urinary excretion was significantly lower after administration of 111In-DOTATOC (P < 0.01). The visualization of known somatostatin-receptor-positive organs and tumors was clearer after administration of 111In-DOTATOC than after administration of 111In-DTPAOC. This was confirmed by significantly higher calculated uptakes in the pituitary gland and spleen. The uptake in the tumor sites did not differ significantly (P > 0.05), although in three of the four patients in whom tumor uptake could be calculated, it was higher after administration of 111In-DOTATOC. CONCLUSION: The distribution and excretion pattern of 111In-DOTATOC resembles that of 111In-DTPAOC, and the uptake in somatostatin-receptor-positive organs and most tumors is higher for 111In-DOTATOC. If 90Y-DOTATOC shows an uptake pattern similar to 111In-DOTATOC, it is a promising radiopharmaceutical for peptide-receptor-mediated radiotherapy in patients with somatostatin-receptor-positive tumors.

Radioiodinated somatostatin analog scintigraphy in small-cell lung cancer.

Somatostatin receptors have been characterized on biopsy specimens from small-cell lung carcinoma (SCLC) and on cultured human SCLC cells. We recently described the in vivo visualization of various somatostatin receptor-positive tumors, such as carcinoids and endocrine pancreatic tumors, after injection of 123I-Tyr-3-octreotide, a radiolabeled somatostatin analog. In the present study, this imaging procedure using 123I-Tyr-3-octreotide is reported in 11 patients with lung tumors. In five of eight patients with SCLC (63%), we were able to demonstrate tumor deposits using 123I-Tyr-3-octreotide scintigraphy. Unexpected metastases were found in two patients. In one of three patients with SCLC in whom tumor was not visualized, nonvisualization may have been caused by tumor necrosis and recent radiotherapy. In one of two patients with malignant small-cell tumors as described by Askin, the neoplasm was visualized. Like SCLC, these tumors are thought to derive from neuroendocrine cells. In one patient, a squamous-cell carcinoma and a bronchial adenoma were not visualized. We conclude that in the majority of patients with SCLC, the tumor and its metastases can be visualized using 123I-Tyr-3-octreotide scintigraphy. However, the value of this new technique in terms of specificity and sensitivity requires further studies in a larger group of patients.

Hepatobiliary handling of iodine-125-Tyr3-octreotide and indium-111-DTPA-D-Phe1-octreotide by isolated perfused rat liver.

Radiolabeled bioactive peptides may show receptor-mediated binding to tumors, making them suitable for scintigraphic imaging. The liver is an important organ for peptide clearance. To gain insight into the uptake and intracellular processing of somatostatin analogs, we compared the hepatobiliary handling of 125I-Tyr3-octreotide and 111In-DTPA-D-Phe1-octreotide, which are successfully used to image somatostatin receptor-positive tumors in vivo in isolated recirculating perfused rat livers. Sixty minutes following administration of the radiolabeled peptides, perfusion medium and biliary radioactivity were analyzed. Radioiodinated Tyr3-octreotide was rapidly cleared by the liver and 60% of the dose was excreted intact into the bile after 60 min. In contrast, 111In-DTPA-D-Phe1-octreotide was not cleared by the liver; medium radioactivity levels remained about constant and only 2% of the dose was found in the bile. These results are in agreement with in vivo findings in rats and humans. We concluded that isolated rat liver perfusion is a good system to rapidly gain insight into the hepatic handling of radiopharmaceuticals.

Tumor response after [(90)Y-DOTA(0),Tyr(3)]octreotide radionuclide therapy in a transplantable rat tumor model is dependent on tumor size.

UNLABELLED: A promising application of radiolabeled somatostatin analogs is peptide receptor-targeted radionuclide therapy of somatostatin receptor-expressing tumors. A suitable radionuclide is (90)Y, which emits high-energy beta-particles with a pathlength of several millimeters in tissue, making it especially promising for treatment of large tumors. METHODS: We investigated the radiotherapeutic effect of different activities (111 and 370 MBq) of [(90)Y-1,4,7,10-tetraazacyclododecane-N,N',N",N"'-tetraacetic acid (DOTA)(0),Tyr(3)]octreotide in Lewis rats bearing somatostatin receptor-positive rat pancreatic CA20948 tumors of different size (0.08-15 cm(2)) in their flank. RESULTS: Dose-dependent radiotherapeutic effects of (90)Y-labeled octreotide in this rat tumor model were found. Tumor control (100% complete response) was found in animals bearing tumors of 3-9 cm(2) (mean, 7.8 cm(2)) after intravenous injection of the highest activity (370 MBq [(90)Y-DOTA(0),Tyr(3)]octreotide). In rats bearing tumors of < or =1 cm(2) or > or =14 cm(2), the effects were less pronounced (50% and 0% complete response, respectively). In tumors of < or =1 cm(2) the (90)Y radiation energy will not be absorbed completely in the tumor, whereas in tumors of > or =14 cm(2) the increased number of clonogenic and probably hypoxic tumor cells may explain the failure to reach a cure. CONCLUSION: This study shows the ability of [(90)Y-DOTA(0),Tyr(3)]octreotide to control tumor growth, especially in medium-sized tumors. The effect of radionuclide therapy appeared to be dependent on tumor size at the onset of therapy.

Inhibition of renal uptake of indium-111-DTPA-octreotide in vivo.

UNLABELLED: Indium-111-DTPA-octreotide has been successfully used for imaging of somatostatin receptor-positive lesions. However, significant renal uptake of 111In-DTPA-octreotide exists, reducing the scintigraphic sensitivity for detection of small tumors in the perirenal region and the possibilities for radiotherapy. The aim of the present study was to determine whether renal uptake of 111In-DTPA-octreotide could be reduced in vivo in rats. METHODS: Male Wistar rats (200-250 g) were placed in metabolic cages and injected with 111In-DTPA-octreotide (0.2 MBq and 0.5 microgram octreotide), in the presence or absence of re-uptake blockers. At time t = 20 hr after injection, rats were sacrificed and organs were isolated and counted for radioactivity. RESULTS: Adding NH4Cl or NaHCO3 to the food, resulting in the production of more acid or alkaline urine respectively, resulted in less radioactivity in the kidneys 20 hr after injection compared to controls. Lysine in a single dose of 400 mg/kg resulted in an inhibition of kidney uptake of 40%. When lysine was injected 30 min before 111In-DTPA-octreotide, the inhibition was 25%. Arginine had less effect on tubular uptake of 111In-DTPA-octreotide than lysine (20% inhibition). Sodium maleate inhibited kidney uptake of 111In-DTPA-octreotide most successfully. Acetazolamide (100 mg/kg), succinylacetone (100 mg/kg), cystine dimethylester (340 mg/kg) and increase in urinary flow did not influence 111In-DTPA-octreotide retention in the kidneys. CONCLUSION: It appeared possible to reduce re-uptake of 111In-DTPA-octreotide in the rat kidney in vivo. The most pronounced effects were seen after administration of sodium maleate or lysine but, because of the described toxic effects of maleate, we will study further only the effects of lysine in a clinical setting.

Radiation dosimetry for indium-111-pentetreotide.

UNLABELLED: We present radiation dose estimates for 111In-pentetreotide. METHODS: Kinetic data were gathered in 10 subjects at two different sites. A compartmental model was used to fit the data, including retention, in three major organs and excretion. RESULTS: The data were consistent for the subjects at both sites. The organ receiving the highest dose was the kidneys (0.52 mGy/MBq); the effective dose equivalent was 0.1 mSv/MBq, and the effective dose was 0.073 mSv/MBq. CONCLUSION: The results of this study provide the basis for evaluation of radiation safety of this drug.

D-lysine reduction of indium-111 octreotide and yttrium-90 octreotide renal uptake.

UNLABELLED: Indium-111-DTPA-octreotide (111In-DTPAOC) is used successfully for imaging somatostatin receptor-positive lesions. A new and promising application is its use in peptide-receptor radionuclide therapy (PRRT). For the latter purpose, [DOTA0,D-Phe1,Tyr3]octreotide (DOTATOC), which is suitable for stable radiolabeling with 90Y, is probably even more promising. Significant renal uptake of these octreotide analogs exists, however, reducing the scintigraphic sensitivity for detection of small tumors in the perirenal region and limiting the possibilities for PRRT. We showed that the renal uptake of 111In-DTPAOC could be reduced to about 50% of control by L-lysine administration in vivo in rats. This study compares the effects of several doses and different methods of administration of D- and L-lysine, in addition to time-related effects of D-lysine, on kidney uptake of 111In-DTPAOC and 90Y-DOTATOC. METHODS: Male Wistar rats (200-250 g) were given 111In-DTPAOC (0.2 MBq, 0.5 microg-0.5 mg intravenously, intraperitoneally or orally) in the presence or absence of D- or L-lysine. At 1, 4 or 24 hr, the rats were killed, and the organs were isolated and counted for radioactivity. In different experiments, male Wistar rats (200-250 g) were given 90Y-DOTATOC (1 MBq, 0.5 microg intravenously) in the presence or absence of D-lysine. At 24 hr, the rats were killed, and the organs were isolated and counted for radioactivity. RESULTS: Administration of D- or L-lysine in a single intravenous dose of 400 mg/kg, resulted in more than 50% inhibition of kidney uptake of 111In-DTPAOC at all time points tested, independently of the mass of 111In-DTPAOC used. Higher or repeated doses of lysine did not give a significantly higher percentage inhibition. D-lysine, given orally in a dose of 400 mg/kg at 30 or 15 min before 111In-DTPAOC injection, resulted in 30% and 20% inhibition of kidney uptake, respectively. L-lysine, given orally 30 min before 111In-DTPAOC administration, resulted in 30% inhibition as well. Inhibition of kidney uptake of 111In-DTPAOC by L-lysine after intraperitoneal administration was 40%. After L-lysine administration, 111In-DTPAOC was decreased in the kidneys and in somatostatin receptor-positive organs such as the pancreas and adrenal glands. In contrast, D-lysine did not have a significant effect on uptake in octreotide receptor-positive organs. Renal uptake of 90Y-DOTATOC was reduced by 65% by intravenous D-lysine, whereas radioactivity in blood, pancreas and adrenal glands was not affected. CONCLUSION: D-lysine may be preferred to L-lysine for reduction of renal uptake of radioactivity during scintigraphy and PRRT because of its lower toxicity and because it should not interfere with the natural amino acid metabolic balance.

Preclinical and initial clinical evaluation of 111In-labeled nonsulfated CCK8 analog: a peptide for CCK-B receptor-targeted scintigraphy and radionuclide therapy.

UNLABELLED: The presence of cholecystokinin (CCK)-B (gastrin) receptors has been shown in more than 90% of medullary thyroid cancers (MTCs) and in a high percentage of small cell lung cancers, stromal ovarium cancers and several other tumor types. METHODS: The aim of this study was to evaluate in vitro and in vivo whether 111In-labeled CCK-B receptor-specific CCK8 analog [D-Asp26,Nle28,31]CCK26-33 (D-Asp-Tyr-Nle-Gly-Trp-Nle-Asp-Phe-NH2) is suitable for CCK-B receptor scintigraphy based on the finding that unlabeled nonsulfated diethylenetriamine pentaacidic acid [DTPA0]CCK8 and tetraazacyclododecanetetraacetic acid [DOTA0]CCK8 analogs show high and specific binding for CCK-B receptors in human tumors. Fifty percent inhibitory concentrations were in the low nanomolar range. RESULTS: In vitro, [111In-DOTA0]CCK8 showed specific internalization in CCK-B receptor-positive rat pancreatic tumor cells AR42J. Internalization of the analog appeared to be time and temperature dependent and receptor specific. From the data obtained with [111In-DOTA0]CCK8 and (125I)I-gastrin, the latter being a specific ligand for the CCK-B receptor, the rat pancreatic cell line CA20948 also appeared to be CCK-B receptor positive. This provides an in vitro and in vivo rat tumor model because this cell line can be grown to solid tumors in Lewis rats. In vivo biodistribution experiments in CA20948 tumor-bearing Lewis rats showed rapid clearance of [111In-DOTA0]CCK8, and specific uptake was found in the CCK-B receptor-expressing stomach and tumor. Furthermore, comparing [111In-DOTA0]CCK8 with the radioiodinated nonsulfated CCK10 analog (D-Tyr-Gly-Asp-Tyr-Nle-Gly-Trp-Nle-Asp-Phe-NH2), both ligands having high affinity for the CCK-B receptor, tumor-to-blood ratios were significantly higher for [111In-DOTA0]CCK8 than for 125I-CCK10, analogous to the findings with radioiodinated and 111In-labeled octreotide. The study in humans with [111In-DTPA0]CCK8 showed receptor-specific uptake in the CCK-B receptor-positive stomach and in metastases in the neck region up to 48 h after injection. CONCLUSION: [111In-DOTA0]CCK8 is most promising for scintigraphy and, after coupling to therapeutic radionuclides, for radionuclide therapy of human CCK-B receptor-positive tumors such as MTC and small cell lung cancer.

Clinical validation of fully automated computation of ejection fraction from gated equilibrium blood-pool scintigrams.

A fully automated procedure for the computation of left-ventricular ejection fraction (EF) from cardiac-gated Tc-99m blood-pool (GBP) scintigrams with fixed, dual, and variable ROI methods is described. By comparison with EF data from contrast ventriculography in 68 patients, the dual-ROI method (separate end-diastolic and end-systolic contours) was found to be the method of choice; processing time was 2 min. Success score of dual-ROI procedure was 92% as assessed from 100 GBP studies. Overall reproducibility of data acquisition and analysis was determined in 12 patients. Mean value and standard deviation of differences between repeat studies (average time interval 27 min) were 0.8% and 4.3% EF units, respectively, (r = 0.98). We conclude that left-ventricular EF can be computed automatically from GBP scintigrams with minimal operator-interaction and good reproducibility; EFs are similar to those from contrast ventriculography.

In vivo use of a radioiodinated somatostatin analogue: dynamics, metabolism, and binding to somatostatin receptor-positive tumors in man.

Somatostatin analogues, labeled with gamma-emitting radionuclides, are of potential value in the localization of somatostatin receptor-positive tumors with gamma camera imaging. We investigated the application in man of a radioiodinated analogue of somatostatin, 123I-Tyr-3-octreotide, which has similar biologic characteristics as the native peptide. The radiopharmaceutical is cleared rapidly from the circulation (up to 85% of the dose after 10 min) mainly by the liver. Liver radioactivity is rapidly excreted into the biliary system. Until 3 hr after injection, radioactivity in the circulation is mainly in the form of 123I-Tyr-3-octreotide. Thereafter, plasma samples contain increasing proportions of free iodide. Similarly, during the first hours after injection, radioactivity in the urine exists mainly in the form of the unchanged peptide. Thereafter, a progressive increase in radioiodide excretion is observed, indicating degradation of the radiopharmaceutical in vivo. Fecal excretion of radioactivity amounts to only a few percent of the dose. The calculated median effective dose equivalent is comparable with values for applications of other 123I-radiopharmaceuticals (0.019 mSv/MBq).

Receptor scintigraphy with a radioiodinated somatostatin analogue: radiolabeling, purification, biologic activity, and in vivo application in animals.

Radioiodinated Tyr-3-octreotide, a somatostatin analogue, is a useful ligand for the in vitro detection of somatostatin receptors. In this study, we have investigated the possible in vivo application of this radioligand in the detection of somatostatin receptor-bearing tumors by scintigraphy. The specific somatostatin-like biologic activity of radioiodinated Tyr-3-octreotide was confirmed in vitro: (a) radioiodinated Tyr-3-octreotide competes in the nanomolar range with specific receptor binding of somatostatin to suspended human meningioma membranes and (b) the secretion of growth hormone by cultured rat pituitary cells was similarly inhibited by iodinated Tyr-3-octreotide and somatostatin. In rats, intravenously injected 123I-Tyr-3-octreotide is rapidly cleared from the circulation mainly by the liver. Although this rapid clearance limits the amount of tracer available for somatostatin receptor-bearing tumors, the advantage of this rapid clearance is that the background level is rapidly reduced in favor of scintigraphic imaging of these tumors. Pancreatic tumors in rats were localized by scintigraphy after intravenous injection of 123I-Tyr-3-octreotide.

Somatostatin receptor scintigraphy with indium-111-DTPA-D-Phe-1-octreotide in man: metabolism, dosimetry and comparison with iodine-123-Tyr-3-octreotide.

Scintigraphy with 123I-Tyr-3-octreotide has several major drawbacks as regards its metabolic behavior, its cumbersome preparation and the short physical half-life of the radionuclide. The use of another radiolabeled analog of somatostatin, 111In-DTPA-D-Phe-1-octreotide, has consequently been proposed. DTPA-D-Phe-1-octreotide can be radiolabeled with 111In in an easy single-step procedure. DTPA-D-Phe-1-octreotide is cleared predominantly via the kidneys. Fecal excretion of radioactivity amounts to only a few percent of the administered radioactivity. For the radiation dose to normal tissues, the most important organs are the kidneys, the spleen, the urinary bladder, the liver and the remainder of the body. The calculated effective dose equivalent is 0.08 mSv/MBq. Optimal 111In-DTPA-D-Phe-1-octreotide scintigraphic imaging of various somatostatin receptor-positive tumors was obtained 24 hr after injection. In the six patients studied, tumor localization with 123I-Tyr-3-octreotide and with 111In-DTPA-D-Phe-1-octreotide were found to be similar. However, the normal pituitary is more frequently visualized with the latter radiopharmaceutical. In conclusion, 111In-DTPA-D-Phe-1-octreotide appears to be a sensitive somatostatin receptor-positive tissue-seeking radiopharmaceutical with some remarkable advantages: easy preparation, general availability, appropriate half-life and absence of major interference in the upper abdominal region, because of its renal clearance. Therefore, 111In-DTPA-D-Phe-1-octreotide may be suitable for use in SPECT of the abdomen, which is important in the localization of small endocrine gastroenteropancreatic tumors.

Effect of dose and specific activity on tissue distribution of indium-111-pentetreotide in rats.

UNLABELLED: To increase the target-to-background ratio in receptor scintigraphy, we hypothesized that receptor scintigraphy is best performed using the lowest possible mass with the highest possible specific radioactivity of the radioligand. METHODS: Rats were injected with 2 or 10 micrograms of unlabeled octreotide or 2 or 10 micrograms of 111In-pentetreotide. Scintigraphic images were then obtained from 10 min before to 20 min after the 111In injection. RESULTS: In some instances, there was a significant increase in 111In uptake in somatostatin receptor-positive organs. In others, there was a significant decrease. Since no significant differences were found in background radioactivity in the percent dose uptake of 111In in receptor-negative organs, these data indicate that target-to-background ratios can be increased by the administration of nonradiolabeled peptides under select conditions. CONCLUSION: The uptake of 111In-pentetreotide in somatostatin receptor-positive organs results in a tissue-specific bell-shaped function of the injected mass of the radiopharmaceutical. This curve may also apply to somatostatin receptor-positive tumors, the visualization of which may be enhanced by optimizing the mass of 111In-pentetreotide.

In vitro and in vivo studies of substance P receptor expression in rats with the new analog [indium-111-DTPA-Arg1]substance P.

UNLABELLED: We evaluated the potential usefulness of a new radiolabeled substance P (SP) analog, [111In-DTPA-Arg1]SP, as a radiopharmaceutical for the in vivo detection of SP receptor-positive (SPR+) immunologic disorders (i.e., inflammatory bowel disease and arthritis) and tumors (i.e., carcinoid). METHODS: Substance P, [DTPA-Arg1]SP and [3-(p-hydroxyphenyl)propionyl-Arg1]SP (Bolton-Hunter-SP, [BH-SP]) were tested as competitors for 125I-BH-SP to SPR in rat brain cortex membranes. An autoradiographic displacement study of the submandibular gland of the rat with the 125I-BH-SP as radioligand and [DTPA-Arg1]SP as competitor was performed. Tissue distribution and ex vivo autoradiography were studied in rats, with and without pretreatment with the selective nonpeptide antagonist CP96,345 to quantify specific binding. In vivo metabolism of [111In-DTPA-Arg1]SP was performed in control rats. Gamma-camera scintigraphic studies were carried out with control rats to visualize the SPR+ salivary glands in rats bearing the SPR+ transplantable pancreatic tumor CA20948 and in rats with SPR+ adjuvant arthritic joints, which was induced after injection of a homogenate of Mycobacterium tuberculosis. RESULTS: Substance P, [DTPA-Arg1]SP and BH-SP dose-dependently inhibited binding of 125I-BH-SP to SPR in rat brain cortex membranes with IC50 values of 0.2, 4 and 2 nM, respectively. In an autoradiographic displacement study of the submandibular gland with 125I-BH-SP as radioligand, an IC50 of 2.7 nM was found for [DTPA-Arg1]SP. In vivo metabolism of the radiopharmaceutical in the rat revealed a renal clearance rate of 50% of the injected radioactive dose in 30 min and a rapid enzymatic degradation of the radiopharmaceutical, resulting in an effective half-life of the intact radiopharmaceutical in blood of approximately 3 min. Tissue distribution and ex vivo autoradiographic studies in rats showed uptake and specific binding of radioactivity in isolated tumors and submandibular and parotid glands. Optimum SPR+ target-to-background ratios were found 24 hr after injection of [111In-DTPA-Arg1]SP. Visualization of normal SPR+ tissues, such as the salivary glands by gamma camera scintigraphy, after administration of [111In-DTPA-Arg1]SP was demonstrated in untreated rats. Pathological SPR+ processes were visualized both in rats bearing the transplantable pancreatic tumor CA20948 and in those with adjuvant mycobacteria tuberculosis-induced arthritic joints. CONCLUSION: [Indium-111-DTPA-Arg1]SP can be used successfully to visualize SPR+ processes in vivo by gamma camera scintigraphy.

Somatostatin receptor imaging in vivo localization of tumors with a radiolabeled somatostatin analog.

This paper presents the results of the visualization of somatostatin (SS) receptor positive tumors in man after the i.v. administration of the SS analog Tyr3-octreotide coupled to 123I. It is an easy, quick and harmless procedure which allows imaging of primary and (often unexpected) secondary deposits and/or multiple localizations of the majority of endocrine pancreatic tumors, metastatic carcinoids and pituitary tumors, as well as of a multitude of tumors with neuroendocrine characteristics and well-differentiated brain tumors and meningiomas. In the case of hormone-secreting tumors a positive scan in most instances also predicts the subsequent successful therapy with octreotide.

Treatment with Sandostatin and in vivo localization of tumors with radiolabeled somatostatin analogs.

The presence of high numbers of somatostatin receptors seems to be the basis for the successful control by Sandostatin of hormonal hypersecretion by most growth hormone-secreting pituitary adenomas, endocrine pancreatic tumors, and carcinoids. In this report, we present preliminary data on in vivo somatostatin receptor imaging with a 123I-coupled somatostatin analog (204-090) in patients with these types of tumors.

The role of radioactive somatostatin and its analogues in the control of tumor growth.

Peptide receptor scintigraphy with the radioactive somatostatin analogue [111In-DTPA-D-Phe1]octreotide is a sensitive and specific technique to show in vivo the presence and abundance of somatostatin receptors on various tumors. With this technique primary tumors and metastases of neuroendocrine cancers as well as of many other cancer types can be localized. This technique is currently used to assess the possibility of peptide receptor radionuclide therapy with repeated administration of high doses of [111In-DTPA-D-Phe1]octreotide. 111In emits Auger and conversion electrons, having a tissue penetration of 0.02-10 microns and 200-500 microns, respectively. Thirty end-stage patients with mostly neuroendocrine progressing tumors were treated with [111In-DTPA-D-Phe1]octreotide, up to a maximal cumulative patient dose of about 74 GBq, in a phase-I trial. There were no major clinical side effects after up to 2 years of treatment, except that in a few patients a transient decline in platelet counts and lymphocyte subsets occurred. Promising beneficial effects on clinical symptoms, hormone production, and tumor proliferation were found. Of the 21 patients who received a cumulative dose of more than 20 GBq, eight showed stabilization of disease and six others a reduction in tumor size. There is a tendency towards better results in patients whose tumors have a higher accumulation of the radioligand. Peptide receptor radionuclide therapy is also feasible with 111In as the radionuclide. Theoretically, depending on the homogeneity of distribution of tumor cells expressing peptide receptors and the size of the tumor, beta-emitting radionuclides, e.g., 90Y, labeled to DOTA-chelated peptides may be more effective than 111In for peptide receptor radionuclide therapy. The first peptide receptor radionuclide therapy trials with [90Y-DOTA-Tyr3]octreotide started recently.