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Uptake and retention of hexakis (2-methoxyisobutyl isonitrile) technetium(I) in cultured chick myocardial cells. Mitochondrial and plasma membrane potential dependence.

The fundamental myocellular uptake and retention mechanisms of hexakis (2-methoxyisobutyl isonitrile) technetium(I) (Tc-MIBI), a technetium-99m-based myocardial perfusion imaging agent, are unresolved. Because of the lipophilic cationic nature of Tc-MIBI, it may be distributed across biological membranes in response to transmembrane potential. To test this hypothesis, net uptake and retention of Tc-MIBI in cultured chick embryo ventricular myocytes were determined under conditions known to alter mitochondrial and plasma membrane potentials. Isovolumic depolarization of plasma membrane potentials in 130 mM extracellular K (Ko) 20 mM extracellular Cl buffer reduced net accumulation of Tc-MIBI from 171 +/- 16 (control) to 29 +/- 3.3 fmol intracellular Tc-MIBI/mg protein.nM extracellular Tc-MIBI. Unidirectional influx of Tc-MIBI in cells depolarized in 30 mM Ko buffer was also reduced; a resting plasma membrane potential of -87 +/- 6 mV was calculated from the Goldman flux equation using normal Ko/high Ko Tc-MIBI influx ratios. Addition of the potassium ionophore valinomycin to cells incubated in 130 mM Ko buffer to additionally depolarize mitochondrial membrane potentials further reduced net uptake of Tc-MIBI to levels comparable to that found in nonviable freeze-thawed preparations ([Tc-MIBI]i/[Tc-MIBI]o = 1). By depolarizing mitochondrial (and in part plasma membrane) potentials with the protonophores 2,4-dinitrophenol and carbonyl cyanide m-chlorophenylhydrazone (CCCP) Tc-MIBI was rapidly depleted from 181 +/- 16 (control) to 16 +/- 2.6 and 31 +/- 4.2 fmol/mg protein.nMo, respectively, with kinetics that did not correlate with loss of cellular ATP content. CCCP alone inhibited 90 +/- 3% of net accumulation or 66 +/- 3% of unidirectional influx of Tc-MIBI in a concentration-dependent manner. By hyperpolarizing mitochondrial membrane potentials with the K+/H+ ionophore nigericin or the ATP synthase inhibitor oligomycin, net uptake and retention of Tc-MIBI were increased by 60 +/- 9% and 375 +/- 20%, respectively. Caffeine, as well as the respiratory chain electron transport inhibitor rotenone, did not significantly alter net cell uptake (p greater than 0.2). These data indicate that the fundamental myocellular uptake mechanism of Tc-MIBI involves passive distribution across plasma and mitochondrial membranes and that at equilibrium Tc-MIBI is sequestered within mitochondria by the large negative transmembrane potentials.

Animals↗

Preparation, characterization, and biodistribution study of technetium-99m -labeled leuprolide acetate-loaded liposomes in Ehrlich ascites tumor-bearing mice.

The purpose of this study was to prepare conventional and sterically stabilized liposomes containing leuprolide acetate in an attempt to prolong the biological half life of the drug, to reduce the uptake by reticuloendothelial system (RES), and to reduce the injection frequency of intravenously administered peptide drugs. The conventional and sterically stabilized liposomes containing leuprolide acetate were prepared by reverse phase evaporation method and characterized for entrapment efficiency and particle size. Radiolabeling of leuprolide acetate and its liposomes was performed by direct labeling with reduced technetium-99m. Its biodistribution and imaging characteristics were studied in ehrlich ascites tumor (EAT)-bearing mice after labeling with technetium-99m. The systemic pharmacokinetic studies were performed in rabbits. A high uptake by tumor was observed by sterically stabilized liposome containing leuprolide acetate compared with free drug and conventional liposomes. The liver/tumor uptake ratio of free drug, conventional (LL), and sterically stabilized liposomes (SLL5000 and SLL2000) was found to be 20, 7.99, 1.63, and 1.23, respectively, which showed the increased accumulation of sterically stabilized liposomes in tumor compared with the free drug and conventional liposomes at 24 hours postinjection. Liver uptake of sterically stabilized liposomes was still 7-fold less than the conventional liposomes. The marked accumulation of liposomes in the tumor-bearing mice was also documented by gamma scintigraphic studies. The findings demonstrate the distribution of these liposomes within solid tumor and prove that the sterically stabilized liposomes experience increased tumor uptake and prolonged circulation half life. Hence these findings will be relevant for the optimal design of long circulating liposomes for the peptide drugs and for targeting of liposomes toward tumor.

Animals↗

Liposomes prepared from synthetic amphiphiles. I. Their technetium labeling and stability.

In order to apply liposomes prepared from synthetic amphiphiles containing amino acid residues to radiopharmaceuticals, their labeling with 99Tc or 99mTc and stability in saline or in serum were investigated. These liposomes were highly labeled by embedding stearylamine-diethylenetriamine pentaacetic acid as a ligand of technetium. The labeling was more efficient at pH 7.0 than at pH 4.0 or 8.5. Among these technetium-labeled liposomes tested, liposomes containing the alanine residue were stable in saline or in 50% serum at 37 degrees C for at least 24 h, in contrast to liposomes (phosphatidylcholine: cholesterol = 1:1 molar ratio) whose stability had been enhanced by adding cholesterol.

Chemical Phenomena↗

Technetium-labelled liposome imaging for deep-seated infection.

Negatively charged phospholipid liposomes were labelled with technetium 99m and used as a radioisotopic tracer to detect focal inflammatory lesions in deep-seated sepsis and rheumatoid arthritis. Patients received an intravenous injection of the radiolabelled liposome preparation and were submitted to scintigraphy on the following day. Both the human volunteer and patients showed uptake in liver and spleen but no radioactivity was observed associated with the intestines. Radioactive uptake was visualised in infected prosthetic joints, tubo-ovarian abscess and osteomyelitis. In a patient with active rheumatoid arthritis radioactive uptake was confined to clinically affected joints. The preliminary findings suggest potential for technetium labelled liposomes as a diagnostic tracer.

Abscess↗

Can (99m)technetium methylene diphosphonate bone scans objectively document costochondritis?

STUDY OBJECTIVES: To determine whether bone imaging with 99mTc methylene diphosphonate is a specific method of making the diagnosis of costochondritis in patients with chest pain who rule out for myocardial infarction. DESIGN: Nonblinded prospective controlled study in 20 patients and 10 control subjects. SETTING: Inpatient medical service of a tertiary teaching hospital. PATIENTS: Two hundred consenting patients admitted to the hospital with chest pain and suspected myocardial infarction were examined. Those in whom acute myocardial infarction was ruled out were evaluated for the clinical signs of costochondritis, ie, tenderness over one or more costochondral junctions. Twenty patients who met the clinical criterion gave informed consent and were subjected to bone imaging. Ten control subjects with cancer who did not have clinical signs of costochondritis underwent bone imaging to rule out metastatic disease (normal in all cases). INTERVENTIONS: Bone imaging with I.V. 99mTc methylene diphosphonate. MEASUREMENTS: Bone scans of the investigative patients and the control subjects were read by two independent nuclear medicine specialists. RESULTS: Sixteen of the 20 patients with clinically diagnosed costochondritis showed increased technetium uptake at all costochondral junctions bilaterally; six of them also had increased uptake elsewhere on the chest wall (sternum, manubrium, or first rib). All 10 of the control patients likewise showed increased technetium uptake at all costochondral junctions bilaterally. CONCLUSIONS: Bone imaging with 99mTc methylene diphosphonate is not a specific method of making the diagnosis of costochondritis.

Bone Neoplasms↗

Comparison of exercise stress testing with dobutamine stress echocardiography and exercise technetium-99m isonitrile single photon emission computerized tomography for diagnosis of coronary artery disease.

To compare the value of exercise electrocardiography with dobutamine stress echocardiography and exercise technetium-99m isonitrile single-photon emission computed tomography for coronary artery disease, 70 patients with either suspected or proven coronary artery disease underwent dobutamine stress echocardiography, exercise technetium-99m isonitrile single-photon emission computed tomography (mibi-SPECT) and treadmill exercise electrocardiography (ECG). Dobutamine echocardiography and exercise mibi-SPECT revealed a higher overall sensitivity than exercise testing (90 vs 57%, p < 0.001; 96 vs 57%, p < 0.001, respectively). Dobutamine stress echocardiography showed a higher specificity than both exercise mibi-SPECT and treadmill exercise electrocardiography (90 vs 71%, p > 0.05; 90 and 62% p < 0.05, respectively) but the difference between dobutamine stress echocardiography and exercise mibi-SPECT was not statistically significant. Diagnostic accuracy of dobutamine stress echocardiography and exercise mibi-SPECT was higher than that of exercise testing (90 vs 59%, p < 0.001; 89 vs 59%, p < 0.001, respectively). Dobutamine stress echocardiography and exercise mibi-SPECT have superiority over exercise testing in the diagnosis of coronary artery disease and dobutamine stress echocardiography is an alternative for exercise mibi-SPECT.

Adult↗

Prognostic value of technetium-99m-labeled single-photon emission computerized tomography in the follow-up of patients after their first myocardial revascularization surgery.

OBJECTIVE: To assess the prognostic value of Technetium-99m-labeled single-photon emission computerized tomography (SPECT) in the follow-up of patients who had undergone their first myocardial revascularization. METHODS: We carried out a retrospective study of 280 revascularized patients undergoing myocardial scintigraphy under stress (exercise or pharmacological stress with dipyridamole) and at rest according to a 2-day protocol. A set of clinical, stress electrocardiographic and scintigraphic variables was assessed. Cardiac events were classified as "major" (death, infarction, unstable angina) and "any" (major event or coronary angioplasty or new myocardial revascularization surgery). RESULTS: Thirty-six major events occurred as follows: 3 deaths, 11 infarctions, and 22 unstable anginas. In regard to any event, 22 angioplasties and 7 new surgeries occurred in addition to major events, resulting a total of 65 events. The sensitivity of scintigraphy in prognosticating a major event or any event was, respectively, 55% and 58%, showing a negative predictive value of 90% and 83%, respectively. Diabetes mellitus, inconclusive stress electrocardiography, and a scintigraphic visualization of left ventricular enlargement were significant variables for the occurrence of a major event. On multivariate analysis, abnormal myocardial scintigraphy was a predictor of any event. CONCLUSION: Myocardial perfusion tomography with Technetium-99m may be used to identify high-risk patients after their first myocardial revascularization surgery.

Adult↗

Technetium labeled small peptide radiopharmaceuticals in the identification of lung cancer.

Globally, lung cancer has risen to the leading cause of cancer mortality in both sexes. Currently, the only potentially curable stage of the disease is the pulmonary nodule. Since numerous studies have documented that in any population of nodules only approximately fifty percent ultimately prove to be neoplastic, non-invasive evaluation of nodules to reduce surgical morbidity, mortality and cost is desirable. Recent nuclear medicine imaging modalities have shown promise in the accurate non-invasive characterization of pulmonary nodules. These new technologies exploit the biomolecular alterations of neoplastic cells. The somatostatin receptor is relatively over-expressed in pulmonary neoplastic tissue when compared to most benign tissue processes. A somatostatin analog-technetium ligand ((99m)Tc depreotide) has shown significant promise in the rapid, convenient, accurate and cost effective characterization of lung nodules with conventional gamma camera systems. The development of this agent required synthesis of a somatostatin receptor ligand of high affinity for the receptor subtypes operative in pulmonary neoplasia and the incorporation of technetium without loss of pharmacore specificity.

Humans↗

[Technetium-99m radiopharmaceuticals for in vivo diagnostics].

INTRODUCTION: Technetium-99m is an ideal radionuclide with optimum decay characteristics. It can be obtained in sterile, pyrogen-free and carrier-free condition, as sodium pertechnetate (Na99mTcO4), from 99Mo/99mTc generator. Because of its six-hour physical half-life and monochromatic 140 keV photons free of -radiation, administration of small amounts of 99mTc solution is possible, without a significant radiation damage to the patient. Technetium eluted from the 99Mo/99mTc generator is in the highest oxidation form (+ 7). It can be used for diagnostic purposes alone, but it is often used for labeling different organic and inorganic compounds. As it is unreactive, reduction with a chemical reductant, (+1), (+3) and (+5) oxidation are necessary before use. Nowadays almost 80% of radiopharmaceuticals are based on 99mTc. RADIOPHARMACEUTICALS: Radiopharmaceuticals are radionuclides or radioactive compounds used in diagnosis and therapy of human diseases. A pharmaceutical is chosen based on its localization in the organ, or its participation in its physiological function. Radiation emitted from a radionuclide is detected by a radiation detector. The ability to incorporate available radionuclides into tracer molecules has been the main goal in developing radiopharmaceuticals. As radionuclides with nuclear characteristcs used as either diagnostic or therapeutic radiopharmaceuticals, are predominantly metals, they can be designed as metal essential, whereby biological distribution is determined by coordination compound, or metal tagged, in which case the properties of the carrier molecule (ligand system) determine the biological distribution. This paper reviews the development of 99mTc-radiopharmaceuticals.

Humans↗

[Use of redox polymers for insulin labeling with technetium (99mTc)].

The paper describes a method for porcine insulin labelling with technetium(99mTc). When preparing this peptide, an insoluble redox polymer on the basis of cross-linked dextran (RP G25-IDA) was used for labelling. The prepared kits were labelled with 99mTc with a high labelling efficiency (more than 95%) and stability, as assessed using methods of chromatography. 99mTc-insulin biodistribution in rats with experimentally induced diabetes--compared with a control group--did not demonstrate specific accumulation of the labelled substance in any organ. The method for kit preparation and its labelling are mild, HPLC and SEC did not reveal any products of insulin degradation and insulin content met the standards of Ph.B. 97. This is the first case of insulin labelling with technetium(99Tc) and, also, the first use of a redox polymer for this purpose.

Animals↗

Reverse mismatched ventilation-perfusion pulmonary imaging with accumulation of technetium-99m-DTPA in a mucous plug in a main bronchus: a case report.

The phenomenon of reverse mismatched ventilation-perfusion on pulmonary scintigraphy is a fairly common occurrence. We present a patient who was experiencing decreasing oxygen saturation and had a reverse mismatched ventilation-perfusion imaging pattern associated with radiotracer retention in a main bronchus. Technetium-99m-DTPA aerosol lung imaging showed tracer retention in the trachea and right main bronchus, absent ventilation in the right lung, and normal ventilation in the left lung. Technetium-99m-MAA perfusion lung images showed normal perfusion of the left lung and some perfusion in the right lung. These findings represented a reverse ventilation-perfusion mismatch. Reverse mismatched ventilation-perfusion, or totally absent ventilation with preservation of some perfusion in the right lung, resulted in functional intrapulmonary shunting, which explained the decreasing oxygen saturation observed in this patient. A concurrent portable chest radiograph showed elevation of the right hemidiaphragm, a shift of the mediastinum to the right, deviation of the endotracheal tube, narrowing of the intercostal space of the right thorax, and collapse of the right lower lobe. The radiographic findings of underventilation of the right lung with atelectasis of the right lower lobe were due to mucous plugging the right main bronchus.

Adult↗

Use of technetium Tc 99m sestamibi scintigraphy for recurrent tertiary hyperparathyroidism from a parathyroid forearm graft.

Technetium Tc 99m sestamibi scintigraphy is a sensitive technique for localizing recurrent parathyroid disease in the neck or mediastinum. We report the case of a 60-year-old woman with recurrent tertiary hyperparathyroidism after total parathyroidectomy. Technetium Tc 99m sestamibi images of the neck and mediastinum were negative; however, images of the right arm revealed a hyperfunctioning parathyroid autotransplant. Partial resection of the autograft resulted in prompt resolution of the hyperparathyroidism.

Arm↗

[Renoscintigraphy applied with etylenedicysteine labeled with technetium 99m and SPECT technique as a method of examining kidneys in children with vesicoureteric reflux].

Vesicoureteric reflux (VUR) can lead to renal parenchymal damage. Renal scarring is an important cause of chronic renal failure and hypertension in children. The significance of possible effects determines the necessity of early diagnosis of urinary tract pathology. The aim of the paper was to evaluate the morphology and function of kidneys with VUR using selected radioisotope techniques, and to compare the sensitivity of planar technique and single-photon emission computed tomography (SPECT) technique in detection of renal scarring. In 45 children with VUR the following test were performed: ultrasonography, renoscintigraphy with technetium-99m-ethylenedicysteine (EC-Tc-99m) and technetium-99m-dimercaptosuccinic acid (DMSA-Tc-99m) scintigraphy with planar and SPECT mode. Stage of VUR correlates with stage of cortical lesions estimated as a value of effective renal plasma flow (ERPF) in kidney, as well as scarring intensity in static scintigraphy. The use of SPECT increases sensitivity of examination for detection small, single scars. It seems that SPECT should be used more frequently in children in the group of scarring risk. That would allow for earlier diagnosis of renal scarring, enabling efficient treatment. Due to the correlation between ERPF and parameters obtained in DMSA scintigraphy, renoscintigraphy with EC-Tc-99m may be applied to monitor the progress of renal scarring.

Adolescent↗

Detection of esophageal carcinoma using single photon emission computed tomography with technetium-99m tetrofosmin.

Technetium-99m tetrofosmin (Tc-TF) a thallium-201 (Tl-201) and technetium-99m methoxy-isobutyl-isonitrile (Tc-MIBI) competitor, being used as a new radiopharmaceuticalfor myocardial imaging was assessed to understand its value in detecting esophageal carcinoma (Eso-Ca). Forty patients with Eso-Ca underwent Tc-TF single photon emission computed tomography (SPECT) of the chest. Meanwhile 15 controls also accepted Tc-TF SPECT of the chest for comparison. Among the 40 patients Tc-TF chest SPFCT detected Eso-Ca in 33 (82.5%) but not in 7 (17.5%). In contrast all 15 normal controls (100.0%) had negative Tc-TF chest SPECT Detection sensitivities were higher for tumors located in the middle portion of the esophagus for epidermoid ca and for tumors with poor differentiation when compared with tumors in the upper or lower portion for adenocarcinoma and tumors with moderate differentiation. However, the differences were not significant (p values < 0.05). Significantly higher detection sensitivity was found for tumors of larger size than for tumors of smaller size (p value < 0.05). Our results suggest that Tc-TF chest SPECT is a helpful test for detecting Eso-Ca especially larger tumors.

Adenocarcinoma↗

Inflammatory lesions localized with technetium Tc 99m-labeled leukocytes.

Canine leukocytes were labeled with a gamma-ray emitting isotope by permitting them to phagocytize technetium Tc 99m sulfur colloid particles in vitro and removing the unphagocytized particles by washing the cells. The labeled cells were reinfused intravenously into the donor dogs. Scintigraphic scans were performed 4 and 24 hours following the leukocyte infusion. In animals with sterile and infected intramuscular abscesses and pulmonary infections, it was possible to localize the lesions by scintigraphic scanning four hours following administration of labeled leukocytes. In one experiment, a positive scan was observed 24 hours after the leukocyte infusion. It was also shown that labeled leukocytes tend to concentrate in abscess fluid. These results suggest that technetium Tc 99m sulfur colloid-labeled leukocytes may be a useful diagnostic tool in localizing abscesses and inflammatory lesions in humans.

Abscess↗

[Radioimmunoimaging of bladder tumor with the intravesical administration of technetium -99m labelled monoclonal antibody].

OBJECTIVE: To make radioimmunoimaging of bladder tumor simple, safe and reliable. METHODS: Anti-human bladder carcinoma cell line BIU-87 monoclonal antibody-BDI-1 was labelled with technetium -99m by direct mercaptoethanol reducing method. RESULTS: The labelling rate was 69.6% and the radiochemistry pruity was higher than 95%. 33 patients received radioimmunoimaging of bladder tumor with the intravesical administration of technetium -99m labelled monoclonal antibody. The false positive rate was zero. 88.5% of all 29 bladder cancer patients had got positive immunoscintigraphy results, and 65.2% of them were confirmed by cystoscopic results. Both primary and recurrent tumor could be detected clearly and the smallest tumor detected was 0.5 cm in diameter. There were some differences between the radioimmunoimaging and cystoscopic results in 7 of 11 multitumor cases, which included tumor size, number and location. CONCLUSION: It is required to use more suitable isotopes and/or monoclonal antibodies to increase its sensitivity.

Administration, Intravesical↗

Immunoscintigraphy with a technetium-99m labelled anti-epithelial growth factor receptor antibody in patients with non-small cell lung cancer.

BACKGROUND: A variety of human tumours, including non-small cell lung cancer, overexpress epithelial growth factor (EGF) receptors. In this study we evaluated the feasibility of immunoscintigraphy with a technetium-99m-labelled monoclonal antibody directed towards the EGF receptor (MINT5). MATERIALS AND METHODS: The labelling with technetium-99m was performed using the glucoheptonate-iminothiolane method. Eight patients with non-small cell lung cancer were i.v. injected 740 MBq of MINT5. Neither side-effects, nor toxicity, nor HAMA response were observed. Each patient was submitted to total body planar images in anterior and posterior projections at 1-2 hours and at 4-6 hours after the injection. RESULTS: Uptake of MINT5 was mainly visible in liver, spleen and bone marrow; it proved stable in vivo. The primary lung cancer was imaged in 7 out of 8 patients and metastases were detected in 3 out of 3 cases. CONCLUSION: MINT5 is a safe and promising radiopharmaceutical for in vivo localization and biological characterization of non-small cell lung cancer.

Aged↗

A new electrophoretic method for determining ligand: technetium stoichiometry in carrier free 99mTc-radiopharmaceuticals.

An electrophoretic procedure is outlined for the determination of the number of ligands bound to technetium-99m radiopharmaceuticals. The approach involves use of ligands that will complex technetium in a similar fashion but that differ in charge. This approach was applied experimentally to dimercapto ligands in which the ligating sulfur atoms are separated by a flexible three-carbon chain (1,3-dimercapto compounds). Two such ligands studied are 1,3-dimercaptopropane (DMP) and dihydrothioctic acid (DHTA). The Tc compound of DHTA migrates much farther on electrophoresis than the Tc complex of DMP. However, when TcO4- is reduced by SnCl2 or NaBH4 in the presence of equimolar quantities of DHTA and DMP, a new compound is formed being twice as abundant as either the TcDMP or the TcDHTA compound and migrating an intermediate distance. The formation of this new complex and the 1:2:1 distribution indicates that two 1,3-dimercapto compounds are attached to the Tc-center in all three compounds.

Chemical Phenomena↗