Therapeutic Radiometals: Global Trends Analysis of Scientific Literature (2008 -2018)

Background-aim: Academic journals have published a large number of papers in the therapeutic NM research field in the last 10 years. Despite this, a literature analysis has never been made before to point out the research interest in therapeutic radionuclides (RNs). For this reason, the present study has the aim to specifically analyze the research output on therapeutic radiometals from 2008 (January) to 2018 (October) with the aim to quantify and identify the global trend of scientific literature and emphasize the interdisciplinary nature of this research field. Methods: The data search has been targeted on conventional (I-131, Y-90, Lu-177, Re-188, Re-186, Sm-153, Sr-89, Er-186) and emergent (Cu-67, Sc-47, Ra-223, Ho-166, Tb-161, Tb-149, Pb-212/Bi-212, Ac225, Bi-213, At-211, Sn-117) RNs. Authors, starting from this time frame data, have been quantitatively first, and qualitatively after, analyzed and interpreted the scientific trend of this topic. Bibliometric data have been exported from Scopus database and elaborated with Excel. The number of article, article in press, note, short survey, review and letter, have been divided per year and RN with the aim to make perceptible the trend of the last decade. Data have been categorized also in terms of Journal Subject Areas in order to bring out the multidisciplinary nature of the research in this field. Finally, for each publication, authors country provenience have been extrapolated and elaborated to map the global researcher interest and involvement of human and financial resources. Results: A total of 12.717 publications have been analyzed. 81.3% of the publications regards conventional RNs while 18.7% regards emergent RNs. The most investigated therapeutic RNs are I-131, Y-90, Lu-177 among conventional, Ra-223, followed by Sn-117, Bi213 and Ac-225 among emergent RNs. From the analysis, it is evident the multidisciplinary contribution to this field but in particular, as expected, in the case of conventional RN most publications comes from preclinical and clinical fields while for the emergents the contribution is unbalanced for Physics, Engineering, Material Science fields mainly focused on emergent RNs production studies. From the geographical point of view we can see how almost half of the total works have been published by European in both conventional and Clin Transl Imaging (2019) 7 (Suppl 1):S1–S138 S127 123 emergent RNs categories. It is also evident the high collaboration grade between countries characteristics in line with the multidisciplinarity of this medical sector. Moreover, we extrapolated a countries top 20 for each category. On the podium for the conventional RNs are USA, Germany and China, while for emergent RNs are USA, Germany, United Kingdom. And much more. Conclusions: From this analysis arise that the success of NM has been intimately linked to the availability of new RNs and the radiopharmaceuticals field is constantly evolving thanks to the contribution of specialists coming from different disciplines and the collaboration between countries. In recent years the focus of the research shifted on the field of emergent therapeutic radioisotope production and application, such as Cu-67, Sc-47, for the interest in new treatment strategies such as the theranostics personalized approach. Alpha emitters, in particular Ra-223 and Ac-225 are also gaining attention in particular in USA and Germany. Instead, among conventional radionuclides the research on Lu-177 is constantly growing

Relationship between retinal inner nuclear layer, age, and disease activity in progressive MS

Objective: To investigate whether inner nuclear layer (INL) thickness as assessed with optical coherence tomography differs between patients with progressive MS (P-MS) according to age and disease activity. Methods: In this retrospective longitudinal analysis, differences in terms of peripapillary retinal nerve fiber layer (pRNFL), ganglion cell layer + inner plexiform layer (GCIPL), INL and T1/T2 lesion volumes (T1LV/T2LV) were assessed between 84 patients with P-MS and 36 sex- and age-matched healthy controls (HCs) and between patients stratified according to age (cut-off: 51 years) and evidence of clinical/MRI activity in the previous 12 months RESULTS: pRNFL and GCIPL thickness were significantly lower in patients with P-MS than in HCs (p = 0.003 and p < 0.0001, respectively). INL was significantly thicker in patients aged < 51 years compared to the older ones and HCs (38.2 vs 36.5 and 36.7 μm; p = 0.038 and p = 0.04, respectively) and in those who presented MRI activity (new T2/gadolinium-enhancing lesions) in the previous 12 months compared to the ones who did not and HCs (39.5 vs 36.4 and 36.7 μm; p = 0.003 and p = 0.008, respectively). Recent MRI activity was significantly predicted by greater INL thickness (Nagelkerke R2 0.36, p = 0.001). Conclusions: INL thickness was higher in younger patients with P-MS with recent MRI activity, a criterion used in previous studies to identify a specific subset of patients with P-MS who best responded to disease-modifying treatment. If this finding is confirmed, we suggest that INL thickness might be a useful tool in stratification of patients with P-MS for current and experimental treatment choice

Radioligand therapy (RLT) as neoadjuvant treatment for inoperable pancreatic neuroendocrine tumors: a literature review

In the last 10 years, several literature reports supported radioligand therapy (RLT) in neoadjuvant settings for pancreatic neuroendocrine tumors (PanNETs). Indeed, primary tumor shrinkage has been frequently reported following RLT in unresectable or borderline resectable PanNETs. Moreover, RLT-induced intratumoral modifications facilitate surgery, both on primary tumor and metastasis, having a great impact on progression free survival (PFS), overall survival (OS) and quality of life (QoL). However, prospective controlled investigations are necessary to confirm preliminary data and to define the best RLT scheme and the ideal patient that, in a multidisciplinary approach, should be referred to neoadjuvant RLT

Composite MRI measures and short-term disability in patients with clinically isolated syndrome suggestive of MS

The use of composite magnetic resonance imaging (MRI) measures has been suggested to better explain disability in patients with multiple sclerosis (MS). However, little is known about the utility of composite scores at the earliest stages of the disease

Radioisotopic purity and imaging properties of cyclotron-produced 99mTc using direct 100Mo(p,2n) reaction

Evaluation of the radioisotopic purity of technetium-99m (99mTc) produced in GBq amounts by proton bombardment of enriched molibdenum-100 (100Mo) metallic targets at low proton energies (i.e. within 15\u201320 MeV) is conducted. This energy range was chosen since it is easily achievable by many conventional medical cyclotrons already available in the nuclear medicine departments of hospitals. The main motivation for such a study is in the framework of the research activities at the international level that have been conducted over the last few years to develop alternative production routes for the most widespread radioisotope used in medical imaging. The analysis of technetium isotopes and isomeric states (9xTc) present in the pertechnetate saline Na99mTcO4 solutions, obtained after the extraction/purification procedure, reveals radionuclidic purity levels basically in compliance with the limits recently issued by European Pharmacopoeia 9.3 (2018 Sodium pertechnetate (99mTc) injection 4801\u20133). Moreover, the impact of 9xTc contaminant nuclides on the final image quality is thoroughly evaluated, analyzing the emitted high-energy gamma rays and their influence on the image quality. The spatial resolution of images from cyclotron-produced 99mTc acquired with a mini-gamma camera was determined and compared with that obtained using technetium-99m solutions eluted from standard 99Mo/99mTc generators. The effect of the increased image background contribution due to Compton-scattered higher-energy gamma rays (E \u3b3 \u2009\u2009>\u2009\u2009200\u2009keV), which could cause image-contrast deterioration, was also studied. It is concluded that, due to the high radionuclidic purity of cyclotron-produced 99mTc using 100Mo(p,2n)99mTc reaction at a proton beam energy in the range 15.7\u201319.4 MeV, the resulting image properties are well comparable with those from the generator-eluted 99mTc

Defining the role of NG2-expressing cells in experimental models of multiple sclerosis. A biofunctional analysis of the neurovascular unit in wild type and NG2 null mice

During experimental autoimmune encephalomyelitis (EAE), a model for multiple sclerosis associated with blood-brain barrier (BBB) disruption, oligodendrocyte precursor cells (OPCs) overexpress proteoglycan nerve/glial antigen 2 (NG2), proliferate, and make contacts with the microvessel wall. To explore whether OPCs may actually be recruited within the neurovascular unit (NVU), de facto intervening in its cellular and molecular composition, we quantified by immunoconfocal morphometry the presence of OPCs in contact with brain microvessels, during postnatal cerebral cortex vascularization at postnatal day 6, in wildtype (WT) and NG2 knock-out (NG2KO) mice, and in the cortex of adult naive and EAE-affected WT and NG2KO mice. As observed in WT mice during postnatal development, a higher number of juxtavascular and perivascular OPCs was revealed in adult WT mice during EAE compared to adult naive WT mice. In EAE-affected mice, OPCs were mostly associated with microvessels that showed altered claudin-5 and occludin tight junction (TJ) staining patterns and barrier leakage. In contrast, EAE-affected NG2KO mice, which did not show any significant increase in vessel-associated OPCs, seemed to retain better preserved TJs and BBB integrity. As expected, absence of NG2, in both OPCs and pericytes, led to a reduced content of vessel basal lamina molecules, laminin, collagen VI, and collagen IV. In addition, analysis of the major ligand/receptor systems known to promote OPC proliferation and migration indicated that vascular endothelial growth factor A (VEGF-A), platelet-derived growth factor-AA (PDGF-AA), and the transforming growth factor-beta (TGF-beta) were the molecules most likely involved in proliferation and recruitment of vascular OPCs during EAE. These results were confirmed by real time-PCR that showed Fgf2, Pdgfa and Tgfb expression on isolated cerebral cortex microvessels and by dual RNAscope-immunohistochemistry/ in situ hybridization (IHC/ISH), which detected Vegfa and Vegfr2 transcripts on cerebral cortex sections. Overall, this study suggests that vascular OPCs, in virtue of their developmental arrangement and response to neuroinflammation and growth factors, could be integrated among the classical NVU cell components. Moreover, the synchronized activation of vascular OPCs and pericytes during both BBB development and dysfunction, points to NG2 as a key regulator of vascular interactions

Detrimental and protective action of microglial extracellular vesicles on myelin lesions: astrocyte involvement in remyelination failure

Microglia are highly plastic immune cells which exist in a continuum of activation states. By shaping the function of oligodendrocyte precursor cells (OPCs), the brain cells which differentiate to myelin-forming cells, microglia participate in both myelin injury and remyelination during multiple sclerosis. However, the mode(s) of action of microglia in supporting or inhibiting myelin repair is still largely unclear. Here, we analysed the effects of extracellular vesicles (EVs) produced in vitro by either pro-inflammatory or pro-regenerative microglia on OPCs at demyelinated lesions caused by lysolecithin injection in the mouse corpus callosum. Immunolabelling for myelin proteins and electron microscopy showed that EVs released by pro-inflammatory microglia blocked remyelination, whereas EVs produced by microglia co-cultured with immunosuppressive mesenchymal stem cells promoted OPC recruitment and myelin repair. The molecular mechanisms responsible for the harmful and beneficial EV actions were dissected in primary OPC cultures. By exposing OPCs, cultured either alone or with astrocytes, to inflammatory EVs, we observed a blockade of OPC maturation only in the presence of astrocytes, implicating these cells in remyelination failure. Biochemical fractionation revealed that astrocytes may be converted into harmful cells by the inflammatory EV cargo, as indicated by immunohistochemical and qPCR analyses, whereas surface lipid components of EVs promote OPC migration and/or differentiation, linking EV lipids to myelin repair. Although the mechanisms through which the lipid species enhance OPC maturation still remain to be fully defined, we provide the first demonstration that vesicular sphingosine 1 phosphate stimulates OPC migration, the first fundamental step in myelin repair. From this study, microglial EVs emerge as multimodal and multitarget signalling mediators able to influence both OPCs and astrocytes around myelin lesions, which may be exploited to develop novel approaches for myelin repair not only in multiple sclerosis, but also in neurological and neuropsychiatric diseases characterized by demyelination

The visibility of IQHE at sharp edges: Experimental proposals based on interactions and edge electrostatics

The influence of the incompressible strips on the integer quantized Hall effect (IQHE) is investigated, considering a cleaved-edge overgrown (CEO) sample as an experimentally realizable sharp edge system. We propose a set of experiments to clarify the distinction between the large-sample limit when bulk disorder defines the IQHE plateau width and the small-sample limit smaller than the disorder correlation length, when self-consistent edge electrostatics define the IQHE plateau width. The large-sample or bulk QH regime is described by the usual localization picture, whereas the small-sample or edge regime is discussed within the compressible/incompressible strips picture, known as the screening theory of QH edges. Utilizing the unusually sharp edge profiles of the CEO samples, a Hall bar design is proposed to manipulate the edge potential profile from smooth to extremely sharp. By making use of a side-gate perpendicular to the two dimensional electron system, it is shown that the plateau widths can be changed or even eliminated altogether. Hence, the visibility of IQHE is strongly influenced when adjusting the edge potential profile and/or changing the dc current direction under high currents in the non-linear transport regime. As a second investigation, we consider two different types of ohmic contacts, namely highly transmitting (ideal) and highly reflecting (non-ideal) contacts. We show that if the injection contacts are non-ideal, however still ohmic, it is possible to measure directly the non-quantized transport taking place at the bulk of the CEO samples. The results of the experiments we propose will clarify the influence of the edge potential profile and the quality of the contacts, under quantized Hall conditions.Comment: Substantially revised version of manuscript arXiv:0906.3796v1, including new figures et