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Preparation and characterization of anti-tenascin monoclonal antibody-streptavidin conjugates for pretargeting applications.

Radioimmunopretargeting is based on the separate injection of a modified mAb and the radionuclide and most frequently exploits the very high avidity of biotin for streptavidin (SA). Currently, we are evaluating the therapeutic potential of directly labeled monoclonal antibody (mAb) 81C6, reactive with the extracellular matrix protein tenascin, in surgically created glioma resection cavity patients. To be able to investigate pretargeting in this setting, the synthesis of 81C6 mAb-SA conjugates was required. In the current study, we have evaluated five methods for preparing both murine 81C6 (m81C6) and human/mouse chimeric 81C6 (c81C6) SA conjugates with regard to yield, biotin-binding capacity, immunoreactivity, and molecular weight. The 81C6 mAb and SA were coupled by covalent interaction between sulfhydryl groups generated on the mAb via N-succinimidyl-S-acetylthioacetate, dithiothreitol or 2-iminothiolane (2IT), and maleimido-derivatized SA, prepared via sulfosuccinimidyl 4-(N-maleimidomethyl)cyclohexane-1-carboxylate (SMCC) or N-succinimidyl-3-(2-pyridyldithio)-propionate. A noncovalent approach involving reaction of a biotinylated mAb, prepared using biotin caproate, and SA also was studied. The evaluation criteria were yield of mAb-SA 215 kDa monomer, as well as conjugate biotin-binding capacity and immunoreactive fraction. The optimal procedure involved activation of m81C6 or c81C6 with 30 equiv of 2IT and reaction of SA with 10 equiv of SMCC and yielded a conjugate with excellent biotin-binding capacity and immunoreactivity. The ((125)I-labeled m81C6)-2IT-SMCC-SA was stable and did not lose biotin-binding capacity after a 72 h incubation in human glioma cyst fluid in vitro. Although the conjugate was stable in murine serum in vivo, its biotin-binding capacity declined rapidly, consistent with high endogenous biotin levels in the mouse. After injection of the radioiodinated conjugate into athymic mice with subcutaneous D-54 MG human glioma xenografts, high tumor uptake (36.0 +/- 10.7% ID/g at 3 days) and excellent tumor:normal tissue ratios were observed.

Animals↗

A clinical evaluation of the RNCA study using Fourier filtering as a preprocessing method.

Forty-one patients (25 male, 16 female) were studied by RNCA in our institution. There were 42 rest studies and 24 stress studies (66 studies total). Sixteen patients were normal, 15 had ASHD, seven had a cardiomyopathy, and three had left-sided valvular regurgitation. Each study was preprocessed using both the standard nine-point smoothing method and Fourier filtering. Amplitude and phase images were also generated. Both preprocessing methods were compared with respect to image quality, border definition, reliability and reproducibility of the LVEF, and cine wall motion interpretation. Image quality and border definition were judged superior by the consensus of two independent observers in 65 of 66 studies (98%) using Fourier filtered data. The LVEF differed between the two processes by greater than .05 in 17 of 66 studies (26%) including five studies in which the LVEF could not be determined using nine-point smoothed data. LV wall motion was normal by both techniques in all control patients by cine analysis. However, cine wall motion analysis using Fourier filtered data demonstrated additional abnormalities in 17 of 25 studies (68%) in the ASHD group, including three uninterpretable studies using nine-point smoothed data. In the cardiomyopathy/valvular heart disease group, ten of 18 studies (56%) had additional wall motion abnormalities using Fourier filtered data (including four uninterpretable studies using nine-point smoothed data). We conclude that Fourier filtering is superior to the nine-point smooth preprocessing method now in general use in terms of image quality, border definition, generation of an LVEF, and cine wall motion analysis. The advent of the array processor makes routine preprocessing by Fourier filtering a feasible technologic advance in the development of the RNCA study.

Adult↗

[The morphologic and functional state of the kidneys exposed to focused waves during remote nephro-lithotripsy].

Clinical and experimental research has shown that complications connected with negative influence of focused waves in distant lithotripsy in litotripters with an electrohydravlic system of focused waves generation depend on many factors, including the regime of wave generator work, an electrode interval, defocusing the wave as a result of an electrode interval center displacement, the amplitude of pressure and the length of a wave impulse in positive and negative phases. The wave impulse is distorted, which leads to kidney tissue damage.

Adult↗

Automated comparison of scintigraphic images.

New algorithms for automated comparison of scintigraphic images have been developed and are described here. The first step presented here is the registration of the images, performed by optimizing, with respect to the registration parameters (two translational shifts, one angle of rotation, the two parameters of a linear transformation of the gray levels), the stochastic sign change (SSC) criterion. The optimization of this criterion is demonstrated to be efficiently performed using the adaptative random search strategy; a more limited but less time-consuming method is also presented. The second step described is the point-by-point comparison of the registered images. The pixel-by-pixel application of Poisson variable statistical tests permits the generation of the significant image differences. From such images it is possible to detect modifications which escape visual inspection. Examples of applications are given in controlled and routine conditions. These algorithms are useful for the processing of many investigations and are proposed for implementation on all nuclear medicine data processing systems.

Bone and Bones↗

Preload-independent mechanisms contribute to increased stroke volume following large volume saline infusion in normal volunteers: a prospective interventional study.

INTRODUCTION: Resuscitation with saline is a standard initial response to hypotension or shock of almost any cause. Saline resuscitation is thought to generate an increase in cardiac output through a preload-dependent (increased end-diastolic volume) augmentation of stroke volume. We sought to confirm this to be the mechanism by which high-volume saline administration (comparable to that used in resuscitation of shock) results in improved cardiac output in normal healthy volunteers. METHODS: Using a standardized protocol, 24 healthy male (group 1) and 12 healthy mixed sex (group 2) volunteers were infused with 3 l normal (0.9%) saline over 3 hours in a prospective interventional study. Individuals were studied at baseline and following volume infusion using volumetric echocardiography (group 1) or a combination of pulmonary artery catheterization and radionuclide cineangiography (group 2). RESULTS: Saline infusion resulted in minor effects on heart rate and arterial pressures. Stroke volume index increased significantly (by approximately 15-25%; P < 0.0001). Biventricular end-diastolic volumes were only inconsistently increased, whereas end-systolic volumes decreased almost uniformly. Decreased end-systolic volume contributed as much as 40-90% to the stroke volume index response. Indices of ventricular contractility including ejection fraction, ventricular stroke work and peak systolic pressure/end-systolic volume index ratio all increased significantly (minimum P < 0.01). CONCLUSION: The increase in stroke volume associated with high-volume saline infusion into normal individuals is not only mediated by an increase in end-diastolic volume, as standard teaching suggests, but also involves a consistent and substantial decrease in end-systolic volumes and increases in basic indices of cardiac contractility. This phenomenon may be consistent with either an increase in biventricular contractility or a decrease in afterload.

Adolescent↗

Inhalation delivery systems with compliance and disease management capabilities.

Non-compliance with prescribed medication is a major reason for poor therapeutic outcomes, leading to unnecessary contributions to healthcare costs. Poor technique in self-administration of inhalation therapy is a special type of non-compliance associated with this route of administration. However, pulmonary drug delivery has fundamental advantages for therapy of diseases of the respiratory tract because it is site-directed. The lung is also a promising portal for drug delivery into the systemic circulation. Incorporation of microprocessors into pulmonary drug delivery systems facilitates sophisticated compliance management of chronic diseases such as asthma and diabetes. Microprocessor-assisted systems afford control of patients' administration technique during the therapeutic inhalation event, thus leading to efficient and reproducible regional deposition of the inhaled drug or diagnostic agent. SmartMist is a hand-held asthma disease management device that aids patients to use optimally metered dose inhalers. It also measures pulmonary lung function and provides a long term downloadable electronic record of the therapeutic and diagnostic events. The AERx pulmonary delivery system utilizes similar microprocessor capabilities; however, it employs a novel means of generating aqueous aerosols from unit dose packages, thus providing a broad inhalation technology base for delivery of a wide variety of therapeutic and diagnostic agents into the respiratory tract, and via the lung into the systemic circulation.

Administration, Inhalation↗

[Predictive value of thyrotropin receptor antibodies using the second generation TRAb human assay after radioiodine treatment in Graves' disease].

UNLABELLED: The detection of TSH-receptor antibodies (TRAb) in patients with Graves' disease is routinely used in nuclear medicine laboratories. This determination has been possible for approximately 3 years with a second generation human TRAb assay. Studies showed that this TRAb determination is diagnostically more sensitive compared to established, porcine TRAb assays. OBJECTIVE: The aim of our study was to investigate, based on a ROC analysis, whether TRAb determination with the new, second generation assay allows a dependable statement about probability of occurrence of relapse after radioiodine therapy in patient suffering from Graves' disease. METHODS: 57 patients were examined with the DYNOtest TRAKhuman (BRAHMS Diagnostica AG, Hennigsdorf) directly before and six months after therapy with radioiodine (dose: 150 Gy). A ROC-analysis was performed to determine positive/negative predictive values depending on different cut-off values. RESULTS: Whereas 21/57 patients became eu- or hypothyroid after six months, 36/57 patients relapsed. Non-relapsed patients showed a significant lower median TRAb titer (4.2 IU/l vs. 19.2 IU/l; p <0.05) compared to relapsed patients. But the positive predictive value conducted 63 and 66, 62 and 66 as well as 63 and 69% (before and after therapy) linked with the cut-offs 1.0, 1.5, and 2.0 IU/l. So it was in areas also achieved by the first generation porcine radio receptor assay. CONCLUSION: An increased sensitivity is achieved undoubtedly with the new DYNOtest TRAKhuman in the diagnostic of Graves' disease. It is not held over the established radio receptor assay concerning the positive predictive value for relapsing patients.

Follow-Up Studies↗

Generation of parametric images during routine Tc-99m PYP inhalation/Tc-99m MAA perfusion lung scintigraphy. Technical note.

A simple technique is described for generating ventilation/perfusion ratio and perfusion/ventilation ratio images from the posterior Tc-99m PYP aerosol inhalation and Tc-99m MAA perfusion images obtained during routine lung scintigraphy. These images highlight areas of ventilation/perfusion incongruence--mismatch or reverse mismatch--that may sometimes be difficult to detect on conventional images.

Aerosols↗

Comparison of supine, upright, and prone positions for liver scans.

We compared liver scan interpretations based on anterior images obtained in the upright, prone, and supine positions. Receiver-operating-characteristic curves were generated for three well trained observers. Results showed that reading the three different views together was more accurate than the reading of any individual image. Furthermore, interpretations based on either the prone or upright view were superior to those using the supine view alone. The prone and upright views should be used more often in liver scanning.

Humans↗

Waste package performance evaluations for the proposed high-level nuclear waste repository at Yucca Mountain.

The evaluation studies of the proposed repository for long-term storage of spent nuclear fuel and high-level nuclear waste at Yucca Mountain, Nevada, are underway. Fulfillment of the requirements for limiting dose to the public, which includes containment of the radioactive waste emplaced in the proposed repository and subsequent slow release of radionuclides from the Engineered Barrier System (EBS) into the geosphere, will rely on a robust waste container design, among other EBS components. Part of the evaluation process involves sensitivity studies aimed at elucidating which model parameters contribute most to the waste package and overlying drip shield degradation characteristics. The model parameters identified for this study include (1) general corrosion rate parameters and (2) stress corrosion cracking (SCC) parameters. Temperature dependence and parameter uncertainty are evaluated for the general corrosion rate model parameters while for the SCC model parameters, uncertainty treatment of stress intensity factor, crack initiation threshold, and manufacturing flaw orientations are evaluated. Based on these evaluations new uncertainty distributions are generated and recommended for future analyses. Also, early waste package failures due to improper heat treatment were added to the waste package degradation model. The results of these investigations indicate that the waste package failure profiles are governed by the manufacturing flaw orientation model parameters.

Journal Article↗

Pharmacokinetics of technetium-99m diphosphonate.

Increased diagnostic information may be derived with Tc-99m diphosphonate from a detailed kinetic analysis of blood disappearance, urinary excretion, and quantitative assessment of skeletal uptake. Blood and urine determinations were studied in three populations: normal volunteers, patients with negative bone scans, and patients with positive bone scans. Quantitative imaging studies were performed in normal volunteers and patients with a scintillation camera interfaced to a computer. All subjects were scanned in the lower lumbar region up to 1 hr after Tc-99m diphosphonate administration. Blood levels exhibited a triexponential clearance pattern. Significant (p less than 0.05) differences were observed for the 5-min blood and 0-1 hr urine values among the various groups. The computer-generated images showed an initial early uptake in bone, kidneys and soft tissue. Thereafter, a parallel fall-off in activity was observed in kidney and soft tissue, with a concomitant increase in bone. Skeletal uptake was different for normal and diseased bone.

Adult↗

A comparison of visual and semiquantitative analysis of stress thallium-201 myocardial images in patients with suspected ischemic heart disease.

Three methods of analyzing stress thallium-201 myocardial images were performed on 79 patients with suspected coronary artery disease. The results of visual analysis of unprocessed Polaroid images, background subtracted and contrast enhanced computer generated color television images, and a semiquantitative regions-of-interest method were each compared to the coronary arteriographic findings in all patients. Analysis by the semiquantitative method achieved the highest accuracy for the classification of patients as either having or not having coronary artery disease. This method of interpreting myocardial images appears worthy of further study.

Coronary Disease↗

Towards developing a non-SnCl2 formulation for RP444, a new radiopharmaceutical for thrombus imaging.

There are many factors influencing the yield and radiochemical purity (RCP) of the radiopharmaceutical RP444. These include heating temperature, heating time, pH, the use of a buffering agent and a bulking agent, as well as the component (XV066, tricine, TPPTS, and Na99mTcO4) concentration. Through a series of radiolabeling experiments, we found that a formulation comprised of 20 microg of XV066, 6.5 mg of tricine, 40 mg of mannitol, 5 mg of TPPTS, and 0.1 mg of Pluronic acid dissolved in 1.0 mL of 250 mM succinate buffer (pH 5.0) gives the best RCP for RP444. The formulation can be lyophilized to form a stable crystal "cake". The radiolabeling is achieved by adding 1.5 mL generator eluant (33-133 mCi of Na99mTcO4) to a lyophilized vial and heating the reaction mixture at 100 degrees C for 10 min. Using this formulation, RP444 is prepared consistently in high yield with RCP > or = 90%. Formation of [99mTc]colloid is minimal (< 0.5%).

Chromatography, High Pressure Liquid↗

In situ calibration of a low-level, in-line, flow liquid scintillation analyzer.

A new method to calibrate a flow liquid scintillation detector in an in-line waste water monitor was developed and its operation was verified. The liquid scintillation detector for detecting low energy beta emitters was one of three detectors of the monitor that aimed to analyze radionuclide concentrations in the waste water before draining it into sewer. To calibrate the liquid scintillation detector, a 20-cm3 calibration vial containing a reference solution was connected to the water sampling channel with a three-way valve. Ten measurements needed to define a quench correction curve required only 200 cm3 solution. The counting efficiencies of the liquid scintillation detector for 3H and for 14C under the average quenching level of the waste waters were estimated at 27% and 58%, respectively. The calibration using the vial took into account the sampling and mixing system, which would not be the case with sealed quenched standards. Although active solution was used, the method was simple, generated little active waste, had low possibility of contamination, and reduced costs and labor for the calibration.

Calibration↗

Noninvasive assessment of renal artery stenosis.

Noninvasive diagnostic methods for evaluation of renal arteries continue to improve. Contrast arteriography is the reference standard to which other techniques are compared, and preoperative arteriography before operative or endovascular therapy remains the practice standard. However, noninvasive examination methods have supplanted arteriography as a screening test for renal artery occlusive disease, and they allow more selective use of the invasive technique. ACE inhibitor-enhanced renal scintigraphy has improved on the sensitivity of standard renal scintigraphy, but several investigators found it still lacks when significant renal dysfunction is present. A positive scan implies the renal artery lesion is functionally significant and is predictive of a response to therapy. Although ACE inhibitor-enhanced renal scintigraphy can detect significant renal artery disease, it can neither localize the arterial lesion nor can it characterize the severity of the stenosis. Renal scintigraphy therefore lacks utility as a method to follow progression of the arterial disease. Magnetic resonance and helical CT imaging are advanced technologies that acquire axial imaging data, but with advanced software and powerful image processing hardware, the anatomic information can be represented in multiple planes or with three-dimensional reconstructions. The anatomic information provided is not limited to the renal arteries, but can define relationships to the surrounding anatomy. Validation studies from several institutions suggest that although these methods for renal artery assessment may be sufficiently accurate for screening use, they remain relatively expensive and are just now becoming more widely available. Not all patients can be studied. Helical CT scanning requires a relatively large intravenous contrast dose, which is undesirable in patients with renal insufficiency, and it seems to underestimate severity of some renal artery stenoses. MRA is impractical or unsafe for patients with claustrophobia, cardiac dysrhythmias, pacemakers, certain types of metallic implants or clips, or for seriously ill patients requiring monitoring. Duplex scanning is both sensitive and specific. It is the least expensive of the available diagnostic modalities, and it is completely safe and noninvasive. Not only is the presence of a renal artery lesion detectable, the severity of the stenosis can be categorized and its hemodynamic significance or renal blood flow can be evaluated. Renal artery duplex scanning is the optimal method for renal artery assessment when it is available from a validated vascular laboratory. However, this last point is the key. The utility of the study is entirely dependent on the skill and experience of the examining technologist. Other drawbacks to duplex scanning include the fact that to yield the "whole picture" of the anatomy and pathology requires a mental synthesis. Real-time scanning generates a series of images and flow data that must be interpreted with a understanding of how the scan was performed. Clinical circumstances, local expertise, equipment availability, costs, and other important considerations will factor into the decision-making process of planning a work-up for suspected renal artery stenosis. The noninvasive diagnostic technologies continue to advance, and as new methods are validated, the need for arteriography may be further lessened.

Humans↗

Treatment of diabetic gastroparesis by high-frequency gastric electrical stimulation.

OBJECTIVE: To investigate the long-term efficacy of high-frequency gastric electrical stimulation (GES) for treating diabetic gastroparesis. RESEARCH DESIGN AND METHODS: This is a retrospective review of 48 adult diabetic patients with refractory gastroparesis who had a GES system implanted surgically and had follow-up evaluations at 6 and 12 months. The outcome measures were total symptom score (TSS), derived from six upper gastrointestinal (GI) symptom subscores; health-related quality of life (HQOL), including physical composite score (PCS) and mental composite score (MCS) assessed by SF-36 questionnaire, radionuclide gastric emptying test, nutritional status, HbA1c, and adverse events. RESULTS: In comparison with baseline, TSS, all six upper GI symptom subscores, PCS, and MCS were significantly improved at 6 months, with the improvement sustained at 12 months. Of 13 patients receiving nutritional support at baseline by tube feeding, only 5 required supplemental enteral feeding at 12 months, and none of the 9 on total parenteral nutrition continued this support. The mean number of hospitalization days during the year after GES was significantly reduced by 52 days compared with the prior year. HbA1c levels were significantly reduced at 12 months. Gastric emptying was only minimally and not significantly faster. Because of infections at the pulse generator pocket site, four patients had their GES systems removed 3-17 months postsurgery. CONCLUSIONS: In diabetic patients with refractory gastroparesis, high-frequency GES by a permanently implanted system significantly improved upper GI symptoms, HQOL, nutritional status, glucose control, and hospitalizations with an acceptably low complication rate.

Adult↗

Methods for detection of left ventricular edges.

The ability to accurately and reproducibly measure left ventricular performance offers significant clinical advantages in patient management. Specifically, data on wall motion of the left ventricle, the characteristics and shape of the left ventricular volume curve, and measurement of ejection fraction are the general parameters of interest evaluated. These parameters may be measured with either first-pass studies or gated equilibrium blood pool images. Either method is relatively simple, economical, and presents little risk to the patient. Over the last several years both methods have undergone considerable study, and relatively standardized techniques for the two methods exist at present. Both techniques require moderate to extensive data processing. In general, a region of interest (ROI) must be defined before further quantitative analysis is possible. There are at present multiple approaches to the establishment of an ROI for the left ventricle. The major differences between these approaches is in the algorithms used to generate the boundary of the ROI or "the edge". In order for the computer to recognize the edge of the left ventricle, objective and reproducible edge-detection processes are needed. It is the purpose of this paper to review computerized edge-detection algorithms as they apply particularly to the noisy and blurry images obtained in nuclear medicine studies.

Heart Ventricles↗

Particle sizing and biokinetics of interstitial lymphoscintigraphic agents.

The biokinetics of inert lymphoscintigraphic agents strongly depends on their particle size. Different techniques for characterization of colloids are discussed. Experiments have been performed on eight different colloids. The particle size has been investigated with scanning electron microscopy. Activity distributions have been obtained with ultrafiltration and gel-column scanning technique. The colloids suggested for lymphoscintigraphy were found to have a median size of about 40-50 nm except one minimicro-aggregated human serum albumin colloid which has a median particle size around 10 nm. The biokinetics were studied with a scintillation camera in rabbits after a subcutaneous injection. Time-activity curves were generated. After 5 hr the rabbits were dissected and the activity content in different tissues measured. A compartment model for the biokinetics was designed and rate constants evaluated. The total and specific activity uptake in parasternal lymph nodes was highest for the small-particle colloids. The compartment model showed a good fitting to the experimental data.

Absorption↗