A radiomarcação de biomoléculas específicas com o tecnécio-99m 99mTc utilizando agentes quelantes bifuncionais é um campo em crescimento na Medicina Nuclear. Em especial, a classe de peptídeos regulatórios, como a Neurotensina, participa de processos fisiológicos essenciais no organismo, como o crescimento tumoral. O objetivo do presente trabalho foi o estudo comparativo da influência dos agentes quelantes bifuncionais 6-hidrazinonicotinamida (HYNIC) e S-acetil-mercaptoacetiltriglicina (MAG3), no comportamento in vitro e in vivo do análogo duplamente estabilizado da Neurotensina(8-13) radiomarcado com 99mTc, em células tumorais de mama da linhagem MDA-MB-231. Um elevado rendimento radioquímico (> 97%) e estabilidade frente aos agentes transquelantes foi observado para ambos análogos radiomarcados. Foram também obtidos comportamentos similares in vitro, no que diz respeito à porcentagem de ligação às proteinas plasmáticas (aproximadamente 22%), estabilidade metabólica, ligação aos receptores celulares (intervalo nM) e taxas de internalização/externalização para ambos radiocomplexos. A maior lipofilicidade encontrada para o análogo radiomarcado via MAG3 refletiu nas principais diferenças nos estudos de biodistribuição. A degradação do análogo radiomarcado via HYNIC nos estudos de estabilidade metabólica in vivo aos 90 min levou a menor retenção tumoral (0,44±0,02% DI/g), e consequentemente, às menores razões tumor/órgãos não-alvos (< 5%). Embora a superioridade do traçador marcado via MAG3 tenha sido comprovada no presente estudo, um redesenho estrutural objetivando contornar a alta captação no trato gastrointestinal deve ser realizada a fim de que sua potencial aplicabilidade não seja comprometida. / The radiolabeling of receptor specific biomolecules with 99mTc using bifunctional chelator agents represents a growing field in Nuclear Medicine, specially, regarding regulatory peptides, such as Neurotensin, which are important in several essential physiological functions, particularly in tumor growth. The aim of the study was the comparative radiolabeling evaluation of the double-stabilized NT(8-13) analog with 99mTc, via the bifunctional chelating agents 6- hydrazinonicotinamide (HYNIC) and S-acetyl-mercaptoacetyltriglycine (MAG3) in MDA-MB-231 breast cancer cell line. High radiochemical yields (> 97%) and stability toward transchelant agents was observed for both radiolabeled analogs. Also, comparable in vitro behaviour regarding the percentage of plasma protein binding (nearby 22%), metabolic stability, receptor binding affinity (nM range), and internalization/externalization rates were obtained. The greater lipophilicity found for the analog radiolabeled via MAG3, reflected in the major differences in biodistribution studies. The in vivo metabolic stability studies suggested that the degradation observed in the later time point (90 min) for the conjugate radiolabeled via HYNIC, leads not only to lower tumor uptake accumulation (0,44±0,02% ID/g), but also to lower tumor-to-non-tumor ratios (< 5%). Although the superiority of the tracer radiolabeled via MAG3 had been confirmed in the present study, a strucutural re-design aiming the reduction of the high gastrointestinal uptake must be done in order to guarantee the potential applicability of MAG3-radiocomplex.

A radiomarcação de biomoléculas específicas com o tecnécio-99m 99mTc utilizando agentes quelantes bifuncionais é um campo em crescimento na Medicina Nuclear. Em especial, a classe de peptídeos regulatórios, como a Neurotensina, participa de processos fisiológicos essenciais no organismo, como o crescimento tumoral. O objetivo do presente trabalho foi o estudo comparativo da influência dos agentes quelantes bifuncionais 6-hidrazinonicotinamida (HYNIC) e S-acetil-mercaptoacetiltriglicina (MAG3), no comportamento in vitro e in vivo do análogo duplamente estabilizado da Neurotensina(8-13) radiomarcado com 99mTc, em células tumorais de mama da linhagem MDA-MB-231. Um elevado rendimento radioquímico (> 97%) e estabilidade frente aos agentes transquelantes foi observado para ambos análogos radiomarcados. Foram também obtidos comportamentos similares in vitro, no que diz respeito à porcentagem de ligação às proteinas plasmáticas (aproximadamente 22%), estabilidade metabólica, ligação aos receptores celulares (intervalo nM) e taxas de internalização/externalização para ambos radiocomplexos. A maior lipofilicidade encontrada para o análogo radiomarcado via MAG3 refletiu nas principais diferenças nos estudos de biodistribuição. A degradação do análogo radiomarcado via HYNIC nos estudos de estabilidade metabólica in vivo aos 90 min levou a menor retenção tumoral (0,44±0,02% DI/g), e consequentemente, às menores razões tumor/órgãos não-alvos (< 5%). Embora a superioridade do traçador marcado via MAG3 tenha sido comprovada no presente estudo, um redesenho estrutural objetivando contornar a alta captação no trato gastrointestinal deve ser realizada a fim de que sua potencial aplicabilidade não seja comprometida. / The radiolabeling of receptor specific biomolecules with 99mTc using bifunctional chelator agents represents a growing field in Nuclear Medicine, specially, regarding regulatory peptides, such as Neurotensin, which are important in several essential physiological functions, particularly in tumor growth. The aim of the study was the comparative radiolabeling evaluation of the double-stabilized NT(8-13) analog with 99mTc, via the bifunctional chelating agents 6- hydrazinonicotinamide (HYNIC) and S-acetyl-mercaptoacetyltriglycine (MAG3) in MDA-MB-231 breast cancer cell line. High radiochemical yields (> 97%) and stability toward transchelant agents was observed for both radiolabeled analogs. Also, comparable in vitro behaviour regarding the percentage of plasma protein binding (nearby 22%), metabolic stability, receptor binding affinity (nM range), and internalization/externalization rates were obtained. The greater lipophilicity found for the analog radiolabeled via MAG3, reflected in the major differences in biodistribution studies. The in vivo metabolic stability studies suggested that the degradation observed in the later time point (90 min) for the conjugate radiolabeled via HYNIC, leads not only to lower tumor uptake accumulation (0,44±0,02% ID/g), but also to lower tumor-to-non-tumor ratios (< 5%). Although the superiority of the tracer radiolabeled via MAG3 had been confirmed in the present study, a strucutural re-design aiming the reduction of the high gastrointestinal uptake must be done in order to guarantee the potential applicability of MAG3-radiocomplex.

Hintergrund: Ein sehr häufig in der nuklearmedizinischen Diagnostik genutztes Radionuklid ist 99mTc. Es emittiert Gammastrahlung mit einer relativ niedrigen Energie (140 keV) und hat eine kurze Halbwertszeit von 6 h. Zusätzlich zur Gammastrahlung entstehen bei jedem Zerfall von 99mTc Auger-Elektronen. Diese niederenergetischen Elektronen, sehr kurzer Reichweite verfügen über einen hohen LET und erzeugen somit eine ausreichende Energiedeposition, um direkte DSB zu erzeugen. Bei Untersuchungen zu Chemotoxizität und Radiotoxizität mit Zellexperimenten gilt es eine Vielzahl an verschiedenen Schutzmechanismen, Reparaturmechanismen und Signalkaskaden in Zellen zu beachten, welche häufig noch nicht vollständig erforscht sind. Um das schädigende Potential von unterschiedlichen Substanzen und Strahlenqualitäten auf die DNA zu untersuchen, wurde ein zellfreies System gewählt. Ziel dieser Arbeit war es, neben den Strahlenqualitäten der Alpha-, Beta, Gamma- und Röntgenstrahlung die Auger-Elektronen des 99mTc auf ihr Potential zur Induktion von DNA-Strangbrüchen zu untersuchen. Hierfür stand die Substanz 99mTc-HYNIC-DAPI zur Verfügung, welche 99mTc an das Plasmid binden und somit in direkte DNA-Nähe bringen kann. Material und Methode: Alle Versuche wurden mit dem Plasmid pUC 19, einem künstlich hergestellten, bakteriellen Plasmid mit 2686 Basenpaaren, welches als nackte DNA ohne Proteine vorliegt, durchgeführt. Der Vergleich zwischen bestrahltem Plasmid in Ab- und Anwesenheit des Radikalfängers DMSO gibt Hinweise darauf, ob Strangbrüche direkt induziert oder nach Radikalbildung indirekt erzeugt werden. Bei radikalvermittelter Wirkung verhindert DMSO DNA-Strangbrüche und die ungeschädigte Supercoiled-Plasmid-Konformation bleibt erhalten. Nach Bestrahlung des Plasmids erfolgte der Nachweis von Strangbrüchen mittels Agarose-Gelelektrophorese. Bekommt ein Plasmid Einzel- oder Doppelstrangbrüche, so verändert sich seine Konformation zu einem ringförmigen/open circle (ESB) oder einem linearen Plasmid (DSB). Durch veränderte Laufeigenschaften im Agarosegel sind die verschiedenen Konformationen voneinander trennbar. Nach Anfärben der DNA mit dem Fluoreszenzfarbstoff Ethidiumbromid konnte das fluoreszierende Plasmid fotografiert und die Intensität der Konformationsbanden quantifiziert werden. Ergebnisse: Zuerst wurde die Reproduzierbarkeit der Methodik überprüft und festgestellt, dass eine Korrelation zwischen Plasmidmasse und Fluoreszenzintensität besteht. Anschließend wurde in Vorversuchen gezeigt, dass die Inkubationstemperaturen, pH-Werte und der Radikalfänger DMSO keinen Einfluss auf die Plasmidintegrität haben. Bei Bestrahlung mit Röntgenstrahlung, dem Beta-Strahler 188Re und dem nicht DNA-gebundenen Gamma-Strahler und Auger-Emitter 99mTc konnte mit steigender Dosis eine Zunahme an ESB festgestellt werden. Vergleichsproben mit DMSO zeigten keinen Anstieg von ESB, was auf eine radikalvermittelte 67 DNA-Schädigung mittels Reaktiver Sauerstoffspezies (ROS) hinweist. Ab einer Energiedosis von ca. 80 Gy konnten nach Bestrahlung mit 188Re und 99mTc zusätzlich zu den ESB auch DSB nachgewiesen werden. DMSO konnte in den Vergleichsproben sowohl die ESB als auch die DSB erfolgreich verhindern. Bei einer sehr hohen Dosis ≥ 600 Gy zeigte DMSO Kapazitätsgrenzen und es konnten nicht mehr alle Strangbrüche verhindert werden. Die Bestrahlung mit dem Alpha-Strahler (hoher LET) 223Ra fügte, im Vergleich zu Strahlung mit niedrigem LET, dem Plasmid überproportional viele DSB zu. Einige dieser DSB konnten nicht durch DMSO verhindert werden, was auf einen direkten DNA-Schaden bzw. eine zu hohe Radikaldichte hinweist. Ein noch stärkerer direkter Effekt konnte beobachtet werden, wenn 99mTc über die Substanz 99mTc-HYNIC-DAPI an DNA gebunden wurde. Dabei konnten schon ab einer Energiedosis von 4 Gy DSB erzeugt werden, welche trotz Radikalfänger nicht verhindert werden konnten. Schlussfolgerung: Dieser bei 99mTc-HYNIC-DAPI beobachtete Effekt wird den Auger-Elektronen zugeschrieben. Aufgrund ihrer kurzen Reichweite und ihres hohen LET sind sie in der Lage direkte DSB zu erzeugen, wenn sie DNA-gebunden sind oder sich in geringem Abstand zur DNA befinden. Die Ergebnisse der Experimente weisen auf ein therapeutisches Potential von 99mTc hin. Weitere Untersuchungen müssen zeigen, ob eine Adressierung von 99mTc an die DNA im Zellkern einer intakten Zelle zu verwirklichen ist und ob DNA-gebundenes 99mTc durch die Energie der Auger-Elektronen den Zelltod herbeiführen kann. Im nächsten Schritt sollte die Erforschung von Trägersubstanzen erfolgen, welche es ermöglichen Auger-Emitter spezifisch an die DNA von Tumorzellen zu koppeln. / Introduction and aim of the study: A radionuclide commonly used in diagnostic nuclear medicine is 99mTc. It emits gamma rays with a relatively low energy (140 keV) and has a short half-time (6h). In addition to gamma rays, 99mTc radiates so called Auger-electrons with low energy, low range and high linear energy transfer. Due to the high-LET Auger-electrons have a sufficient energy deposition to induce direct double-strand breaks to the DNA. In these experiments we used plasmid DNA to evaluate damage induced to biological systems by different chemotoxical substances and radionuclides as well as external radiation. By using plasmids instead of cell cultures we avoid lots of unexplored signal pathways in cells and it is possible to quantify chemotoxical and radiation damage to the DNA. Materials and methods: The double-stranded plasmid pUC 19 with 2686 bp is used in all experiments. It is a synthetically produced bacterial plasmid without any proteins. To distinguish between directly and indirectly (radical induced) induced damage we used the radical scavenger DMSO. Indirectly induced damage via reactive oxygen species (ROS) can be prevented by DMSO. The quantification of supercoiled forms, single strand breaks (SSB) and double strand breaks (DSB) was measured by the method of agarose gel electrophoresis. After the electrophoresis, agarose gels are dyed in ethidium bromide and imaged with a ccd-camera using ultraviolet transillumination. The bands of the different plasmid forms were quantified through the FIJI computer program. Results: First of all a correlation between plasmid mass and fluorescence intensity was shown. In a pretrial no damaging effect to the plasmid from incubation temperature, pH-value and radical scavenger DMSO appeared. Afterwards we examined chemotoxical SnCl2, external x-rays, the alpha emitter 223Ra, the beta emitter 188Re, gamma- and Auger-emitter 99mTc and the DNA-bound 99mTc-HYNIC-DAPI. The radical scavenger DMSO was used to differentiate between indirect (radical induced) and direct DNA-damage. All different radiation qualities showed an increasing DNA-damage with increasing energy dose. For the low-LET radiation qualities like chemotoxical SnCl2, external x-rays, the beta emitter 188Re and not DNA-bound 99mTc, DMSO showed the quality to prevent the damage. After the deposition of an energy dose ≥ 600 Gy DMSO showed a limitation in his scavenger capacity. During radiation with high-LET beams like 223Ra or DNA-bound 99mTc-HYNIC-DAPI DMSO showed less or nearly no ability to prevent DNA-damage. A 4 Gy dose of 99mTc-HYNIC-DAPI was able to induce DSB into the plasmid. These DSB could not be prevented by DMSO. The lower ESB:DSB ratio for high-LET beams also displays that direct damage is more likely to create DSB than indirect damage. Conclusion: In conclusion we can say that DNA-bound 99mTc-HYNIC-DAPI was most appropriate to induce DSB via a direct effect. It was impossible to prevent this damage due to adding the 69 radical scavenger DMSO. We attribute this to low range, low-LET Auger-electrons and suppose that it may be possible to use DNA-bound 99mTc for therapeutic purpose. Further research has to show if 99mTc can be targeted to the DNA of intact cells and if suitable tracers can be found to safely target and kill tumor cells.

Orientador: Cesar Cabello dos Santos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T08:45:28Z (GMT). No. of bitstreams: 1 Duarte_GiulianoMendes_D.pdf: 5275602 bytes, checksum: 5180518eed1c8045749e430f93e8b706 (MD5) Previous issue date: 2007 / Resumo: Objetivos: Estudar a utilização de cirurgia radioguiada com 99mTc-sestamibi associada à ressonância nuclear magnética (RNM) no câncer de mama. Para isso, foram desenvolvidas duas novas técnicas: uma intitulada Avaliação Intra-peratória Radioguiada das Margens (Radioguided Intraoperative Margins Evaluation -RIME) que usa um radiofármaco intravenoso para auxiliar, através de uma sonda detectora de radiação (probe), a ressecção tumoral; a outra intitulada Fusão da Ressonância Nuclear Magnética e Cintilografia Mamária (Magnetic Resonance Imaging/ Scintimammography fusion ¿ MRI/SM) que procura determinar a extensão tumoral. Dessa forma, esta tese visa avaliar a factibilidade das técnicas, o valor da RIME em obter margens livres e o valor da MRI/SM em determinar o tamanho real do tumor comparando com outros exames. Sujeitos e métodos: Foi realizado um estudo experimental descritivo em 23 mulheres com carcinoma ductal invasivo de mama estádios IIA a IIIA, agendadas para mastectomia. Dois a dez dias antes da cirurgia, as pacientes foram submetidas à cintilografia mamária com 99mTc-sestamibi, na qual foi localizado o tumor e estimado o tempo ideal para iniciar a cirurgia radioguiada através de uma curva de contagem de radiação por tempo. No mesmo dia, 20 pacientes realizaram uma ressonância nuclear agnética com gadolíneo. No momento da cirurgia, a mesma dose de 99mTc-sestamibi foi injetada intravenosamente. Esperou-se o tempo ideal estimado previamente e então foi realizada uma segmentectomia com auxílio do probe, que determinou as margens de ressecção. A ressonância foi usada para avaliar comprometimento da pele, fáscia profunda a outros focos de tumor que foram incluídos na segmentectomia. Isso caracterizou a RIME. Após, todas as pacientes foram submetidas à mastectomia. A egmentectomia e a mama residual foram examinadas histologicamente. Paralelamente, foi desenvolvido um programa de computador em linguagem visual que realizou, de forma semi-automática, a fusão das imagens de ressonância e cintilografia em 20 pacientes (MRI/SM). Foi determinado como tumor na MRI/SM a área de intersecção das imagens, o tumor foi medido e comparado com a medida no exame histológico, ressonância nuclear magnética, mamografia e exame clínico. Para análise estatística foram utilizados os testes exato de Fisher, t de Student, Wilcoxon e regressão linear. Resultados: Em todas as pacientes foi possível realizar as técnicas de RIME e MRI/SM (factibilidade de 100%). A RIME permitiu a ressecção do tumor com margens livres em 19 pacientes, com média de margem de 4,8mm. Em 11 casos não havia doença residual na mama após a segmentectomia. A média do tamanho da doença residual na mama foi 3,6mm e geralmente estava localizado próximo ao leito tumoral (<1,5cm em 10 pacientes). Não houve associação entre presença de doença residual e o tamanho do tumor ou estado das margens. A medida do tumor na MRI/SM teve uma correlação com o exame histológico melhor que a ressonância, a mamografia e exame clínico em todos os diâmetros estudados. Conclusões: As técnicas de RIME e MRI/SM são factíveis. A RIME permitiu auxiliar a ressecção tumoral com margens livres na maioria das vezes. A MRI/SM parece ser melhor que ressonância, mamografia e exame clínico para determinar a extensão tumoral / Abstract: Aims: To study the use of radioguided surgery with 99mTc-sestamibi, associated with magnetic resonance imaging (MRI), for breast cancer evaluation. For this, we developed two techniques: the first was dominated Radioguided Intraoperative Margins Evaluation (RIME), a technique that uses a radiopharmaceutical agent to distinguish normal and cancer tissue with a probe; the second was termed Magnetic Resonance Imaging and Scintimammography fusion (MRI/SM) to determine the extension of cancer. Thus, this study aims to assess the feasibility of techniques, the ability of RIME to obtain free margins and the ability of MRI/SM to determine the real tumor extension, in comparison to other examinations. Subjects and methods: A descriptive experimental study was carried out on 23 women with invasive ductal breast carcinoma, stages IIA to IIIA, programmed for mastectomy. Two to 10 days before the surgery, the patients were submitted to a scintimammography with 99mTc-sestamibi to localize the tumor and to estimate the optimal time to begin radioguided surgery, through a curve of radiation count per time. On the same day, 20 patients realized a MRI with gadolinium. At the moment of the surgery, the same dose of 99mTc-sestamibi was injected intravenously, after a previously-estimated optimal time a segmentectomy was performed with a probe that determined the resection margins. MRI was used to evaluate the compromising of the skin, deep fascia and the other tumor foci that were included in the segmentectomy, characterizing the RIME. All the patients were then submitted to mastectomy. The segmentectomy and residual breast were histopathologically examined. In parallel, software was developed in visual language to perform the MRI/SM fusion in 20 patients. The intersection area between the MRI and scintimammography was determined as tumor in MRI/SM and the tumor was measured and compared with the measurement in the pathological, MRI, mammography and clinical examination. The Fisher¿s exact test, Student¿s t-test, Wilcoxon¿s test and linear regression were used for statistical analysis. Results: The RIME and MRI/SM techniques were successfully performed in all patients (feasibility of 100%). The principal tumor was removed by RIME and provided histologically-free margins in 19 patients (mean margins, 4.8mm). Additionally, 11 patients were without residual disease after segmentectomy. The mean size of residual carcinoma was 3.6mm and generally located near the tumor bed (< 1.5cm in 10 patients). There was no significant association between presence of residual disease and tumor size or margin status. The MRI/SM cancer measurements correlated better with pathology than MRI, mammography and clinical examination in all diameters analyzed. Conclusions: The RIME and MRI/SM techniques are feasible. In general, RIME aids in tumor resection with free margins. MRI/SM seems to be better than MRI, mammography and clinical examination to determine the tumoral extension / Doutorado / Tocoginecologia / Doutor em Tocoginecologia