Das S100A4-Protein ist für die Manifestierung eines metastatischen Phänotyps bei vielen Tumorarten von enormer Bedeutung. Die Aufklärung der zugrunde liegenden Mechanismen und der Interaktionspartner von S100A4 stellt daher einen vielsprechenden Forschungsansatz dar, um neue Erkenntnisse über das Verhalten von Tumorzellen während des Metastasierungsprozesses zu erhalten. Darauf aufbauend können neue Ansatzpunkte für die Therapie metastasierender Krebserkrankungen gewonnen werden. In dieser Hinsicht ist das bisher einer Behandlung kaum zugängliche maligne Melanom als besonders aggressiver und frühzeitig metastasierender Tumor ein ideales Modell zur Aufklärung der zellulären und molekularen Prozesse, über die S100A4 seine Metastasen-fördernden Wirkungen ausübt. Das Ziel der vorliegenden Arbeit war die biochemische und radiopharmakologische Charakterisierung der S100A4-RAGE-Interaktion sowie die Untersuchung der Beteiligung von S100A4 an Prozessen der Metastasierungskaskade in vitro und in vivo. Dies erforderte die Herstellung von rekombinantem S100A4-Protein und die Generierung von stabil mit S100A4-transfizierten Melanomzellen, die damit eine heraufregulierte S100A4-Proteinbiosynthese aufweisen. Die Gewinnung von rekombinantem S100A4 in biologisch funktioneller Form unter Verwendung eines prokaryotischen Expressionssystems erfolgte mit einem Reinheitsgrad von ca. 92%. Das rekombinante S100A4-Protein wurde mit dem Aktivester N-Succinimidyl-4-[18F]fluorbenzoat radioaktiv markiert und charakterisiert. Es wurde die Interaktion zwischen S100A4 bzw. 18F-markiertem S100A4 und der löslichen RAGE-Isoform sRAGE mit einer moderaten Bindungsaffinität im µM-Bereich nachgewiesen. Des Weiteren erfolgte erstmals die Analyse der radiopharmakologischen Eigenschaften von 18F-S100A4 mittels Untersuchungen zur zellulären Assoziation sowie zur metabolischen Stabilität, Bioverteilung und zu In-vivo-Interaktionen mittels Kleintier-Positronen-Emissions-Tomographie in der Ratte. Die In-vitro-Experimente wurden an Endothelzellen (HAEC) und an stabil mit RAGE-transfizierten A375-, A375-mock bzw. nicht transfizierten A375-Melanomzellen durchgeführt. Die A375-hRAGE-Zellen zeigten eine deutlich heraufregulierte RAGE-Proteinbiosynthese während die Endothelzellen eine vergleichsweise geringe intrazelluläre RAGE-Proteinkonzentration aufwiesen. Bei den Melanomzellen kann aufgrund der höheren Assoziation von 18F-S100A4 an A375-hRAGE-Zellen auf eine selektive Bindung von 18F S100A4 an RAGE-Rezeptoren auf der Zelloberfläche geschlossen werden. Die Assoziation von 18F S100A4 an Endothelzellen war bei 37°C in Gegenwart von nicht markiertem rekombinantem S100A4 signifikant vermindert, dementsprechend findet eine spezifische Interaktion von 18F-S100A4 mit Zelloberflächenrezeptoren der Endothelzellen statt. Dieses Ergebnis und die insgesamt höhere Bindung von 18F S100A4 an Endothelzellen im Vergleich zur Assoziation an Melanomzellen lassen neben RAGE noch andere Rezeptoren wie z. B. internalisierende Scavenger-Rezeptoren vermuten. Die In-vivo-Stabilitätsuntersuchungen verdeutlichen einen proteolytischen Abbau von 18F S100A4, allerdings belegen das Vorhandensein von 67% intaktem 18F-S100A4-Protein nach einer Stunde, die Stabilität von 18F-S100A4 in vivo. Die Bioverteilungs- bzw. PET-Untersuchungen zeigen eine schnelle, innerhalb weniger Minuten stattfindende hohe Akkumulation in den Nieren und verdeutlichen somit die renale Ausscheidung von 18F S100A4. Die maßgeblichen Anreicherungen in Milz, Leber, Blut, Lunge und Nebennieren lassen Interaktionen mit Oberflächenrezeptoren dieser Gewebe erkennen. Die temporäre Retention von 18F-S100A4 in der Lunge, dem Hauptsyntheseorgan von RAGE, und die verminderte 18F-S100A4-Akkumulation in Gegenwart des spezifischen RAGE-Liganden glykLDL ist ein Hinweis dafür, dass S100A4 in vivo in der Lunge an RAGE bindet. Die Aktivitätsanreicherungen in Milz, Leber und Nebenniere deuten aufgrund der geringeren RAGE-Synthese in diesen Organen auf die Interaktion von 18F-S100A4 mit anderen Zelloberflächenrezeptoren z. B. aus der Familie der Scavenger-Rezeptoren hin. Die Beteiligung von S100A4 an Metastasierungsprozessen des malignen Melanoms wurde an stabil mit S100A4-transfizierten A375-Melanomzellen, die eine Heraufregulierung der humanen bzw. murinen S100A4-Proteinbiosynthese im Vergleich zu A375-mock- (Vektor-Kontrolle) und nicht-transfizierten A375-Zellen zeigen, untersucht. Die A375-hS100A4-Zellen sezernierten zudem eine signifikant höhere S100A4-Proteinkonzentration in das umgebende Zellkulturmedium im Vergleich zu den Kontrollen. In dieser Hinsicht konnte bei den A375-hS100A4-Zellen, vermutlich aufgrund der höheren extrazellulären S100A4-Konzentration, eine gesteigerte Proliferations-, Motilitäts-, Migrations- und Invasionsrate gegenüber den A375-mock- und A375-Zellen nachgewiesen werden. In diesem Zusammenhang stehen ebenso die gesteigerte RAGE-Proteinbiosynthese und die signifikant höhere Aktivität des Transkriptionsfaktors NF-κB bei A375-Zellen nach 24-stündiger Inkubation mit Kulturmedium der A375-hS100A4-Zellen. Demnach wirkt vermutlich das extrazelluläre S100A4-Protein als autokriner bzw. parakriner Regulator von RAGE und NF κB. Die subkutane Injektion der A375- und stabil transfizierten A375-Melanomzellen in Nacktmäuse führte zur Entwicklung subkutaner Tumore an der Injektionsstelle. Bereits zwei Wochen nach der Injektion etablierten die A375-hS100A4-Zellen die signifikant größeren Tumore im Vergleich zu den A375-mS100A4-, A375-mock und A375-Zellen. Nach Injektion der Zellen in die Schwanzvene der Nacktmäuse konnte keine Entwicklung von Metastasen im Tierkörper festgestellt werden. IN DER VORLIEGENDEN ARBEIT WURDE NACHGEWIESEN: • RAGE ist ein Rezeptor für das S100A4-Protein. Allerdings gibt es eindeutige Hinweise für weitere S100A4-Zielproteine an der Zelloberfläche. • Die bedeutende Rolle von extrazellulärem S100A4 bei wichtigen zellulären Metastasierungsprozessen sowie bei der Aktivierung von Signalproteinen wie NF-κB und RAGE beim malignen Melanom. Die weitere Aufklärung der S100A4-spezifischen Signalkaskaden und Rezeptoren bei metastasierenden Tumorerkrankungen sowie die Charakterisierung von S100A4 als klinischen Parameter bei Patienten mit malignem Melanom stellen hoch interessante Aspekte in der Krebsforschung dar.

Positron emission tomography (PET) is a functional imaging method that allows studying physiological, biochemical or pharmacological processes in vivo. PET is being used in both research and clinical practice. In the brain, it has been used to investigate metabolism, receptor binding, and alterations in regional blood flow. This thesis involves both preclinical and clinical dual-tracer PET imaging studies of different neurological disorders. In this way, different radiotracers were used along the projects. The first project focused on the implementation and in vivo validation of the simultaneous dual-tracer PET imaging technique on the rat brain and its applications in the study of cerebral ischemia. In particular, in this project two biological processes were studied at the same time: cerebral blood flow and cerebral glucose metabolism. The second project consisted in a clinical correlation study of the GABAergic and serotonin systems in a population with Essential Tremor (ET), the most commonly movement disorders. / La tomografia per emissió de positrons (PET) és un mètode d'imatge funcional que permet l'estudi in vivo de processos fisiològics, bioquímics i farmacològics. La PET s'utilitza tant en la pràctica clínica com en la recerca. Al cervell, s'ha utilitzat per investigar el metabolisme, la neurotransmissió, i les alteracions en el flux sanguini regional. Aquesta tesi implica estudis preclínics i clínics de la tècnica PET en diversos trastorns neurològics. D'aquesta manera, es van utilitzar diferents radiotraçadors al llarg dels projectes. El primer projecte es va centrar en la implementació i validació in vivo de la tècnica PET del doble-marcador simultani en el cervell de rata i les seves aplicacions en l'estudi de la isquèmia cerebral. En particular, en aquest projecte es van estudiar en el mateix moment dos processos biològics: el flux sanguini cerebral i el metabolisme cerebral de la glucosa. El segon projecte va consistir en un estudi clínic de correlació dels sistemes GABAèrgic i serotoninèrgic en una població amb tremolor essencial (TE), el trastorn del moviment més comú

Background Novel theranostic options for high-risk non-muscle invasive bladder cancer are urgently needed. This requires a thorough evaluation of experimental approaches in animal models best possibly reflecting human disease before entering clinical studies. Although several bladder cancer xenograft models were used in the literature, the establishment of an orthotopic bladder cancer model in mice remains challenging. Methods Luciferase-transduced UM-UC-3LUCK1 bladder cancer cells were instilled transurethrally via 24G permanent venous catheters into athymic NMRI and BALB/c nude mice as well as into SCID-beige mice. Besides the mouse strain, the pretreatment of the bladder wall (trypsin or poly-L-lysine), tumor cell count (0.5 × 106–5.0 × 106) and tumor cell dwell time in the murine bladder (30 min – 2 h) were varied. Tumors were morphologically and functionally visualized using bioluminescence imaging (BLI), magnetic resonance imaging (MRI), and positron emission tomography (PET). Results Immunodeficiency of the mouse strains was the most important factor influencing cancer cell engraftment, whereas modifying cell count and instillation time allowed fine-tuning of the BLI signal start and duration – both representing the possible treatment period for the evaluation of new therapeutics. Best orthotopic tumor growth was achieved by transurethral instillation of 1.0 × 106 UM-UC-3LUCK1 bladder cancer cells into SCID-beige mice for 2 h after bladder pretreatment with poly-L-lysine. A pilot PET experiment using 68Ga-cetuximab as transurethrally administered radiotracer revealed functional expression of epidermal growth factor receptor as representative molecular characteristic of engrafted cancer cells in the bladder. Conclusions With the optimized protocol in SCID-beige mice an applicable and reliable model of high-risk non-muscle invasive bladder cancer for the development of novel theranostic approaches was established.

Ce mémoire est consacré à la compensation des effets de flous dans une image, communément appelés effets de volume partiel (EVP), avec comme objectif d’application l’amélioration qualitative et quantitative des images en médecine nucléaire. Ces effets sont la conséquence de la faible résolutions spatiale qui caractérise l’imagerie fonctionnelle par tomographie à émission mono-photonique (TEMP) ou tomographie à émission de positons (TEP) et peuvent être caractérisés par une perte de signal dans les tissus présentant une taille comparable à celle de la résolution spatiale du système d’imagerie, représentée par sa fonction de dispersion ponctuelle (FDP). Outre ce phénomène, les EVP peuvent également entrainer une contamination croisée des intensités entre structures adjacentes présentant des activités radioactives différentes. Cet effet peut conduire à une sur ou sous estimation des activités réellement présentes dans ces régions voisines. Différentes techniques existent actuellement pour atténuer voire corriger les EVP et peuvent être regroupées selon le fait qu’elles interviennent avant, durant ou après le processus de reconstruction des images et qu’elles nécessitent ou non la définition de régions d’intérêt provenant d’une imagerie anatomique de plus haute résolution(tomodensitométrie TDM ou imagerie par résonance magnétique IRM). L’approche post-reconstruction basée sur le voxel (ne nécessitant donc pas de définition de régions d’intérêt) a été ici privilégiée afin d’éviter la dépendance aux reconstructions propres à chaque constructeur, exploitée et améliorée afin de corriger au mieux des EVP. Deux axes distincts ont été étudiés. Le premier est basé sur une approche multi-résolution dans le domaine des ondelettes exploitant l’apport d’une image anatomique haute résolution associée à l’image fonctionnelle. Le deuxième axe concerne l’amélioration de processus de déconvolution itérative et ce par l’apport d’outils comme les ondelettes et leurs extensions que sont les curvelets apportant une dimension supplémentaire à l’analyse par la notion de direction. Ces différentes approches ont été mises en application et validées par des analyses sur images synthétiques, simulées et cliniques que ce soit dans le domaine de la neurologie ou dans celui de l’oncologie. Finalement, les caméras commerciales actuelles intégrant de plus en plus des corrections de résolution spatiale dans leurs algorithmes de reconstruction, nous avons choisi de comparer de telles approches en TEP et en TEMP avec une approche de déconvolution itérative proposée dans ce mémoire. / Partial Volume Effects (PVE) designates the blur commonly found in nuclear medicine images andthis PhD work is dedicated to their correction with the objectives of qualitative and quantitativeimprovement of such images. PVE arise from the limited spatial resolution of functional imaging witheither Positron Emission Tomography (PET) or Single Photon Emission Computed Tomography(SPECT). They can be defined as a signal loss in tissues of size similar to the Full Width at HalfMaximum (FWHM) of the PSF of the imaging device. In addition, PVE induce activity crosscontamination between adjacent structures with different tracer uptakes. This can lead to under or overestimation of the real activity of such analyzed regions. Various methodologies currently exist tocompensate or even correct for PVE and they may be classified depending on their place in theprocessing chain: either before, during or after the image reconstruction process, as well as theirdependency on co-registered anatomical images with higher spatial resolution, for instance ComputedTomography (CT) or Magnetic Resonance Imaging (MRI). The voxel-based and post-reconstructionapproach was chosen for this work to avoid regions of interest definition and dependency onproprietary reconstruction developed by each manufacturer, in order to improve the PVE correction.Two different contributions were carried out in this work: the first one is based on a multi-resolutionmethodology in the wavelet domain using the higher resolution details of a co-registered anatomicalimage associated to the functional dataset to correct. The second one is the improvement of iterativedeconvolution based methodologies by using tools such as directional wavelets and curveletsextensions. These various developed approaches were applied and validated using synthetic, simulatedand clinical images, for instance with neurology and oncology applications in mind. Finally, ascurrently available PET/CT scanners incorporate more and more spatial resolution corrections in theirimplemented reconstruction algorithms, we have compared such approaches in SPECT and PET to aniterative deconvolution methodology that was developed in this work.

La radiothérapie est une des méthodes principales utilisée dans le traitement thérapeutique des tumeurs malignes. Pour améliorer son efficacité, deux problèmes essentiels doivent être soigneusement traités : la prédication fiable des résultats thérapeutiques et la segmentation précise des volumes tumoraux. La tomographie d’émission de positrons au traceur Fluoro- 18-déoxy-glucose (FDG-TEP) peut fournir de manière non invasive des informations significatives sur les activités fonctionnelles des cellules tumorales. Les objectifs de cette thèse sont de proposer: 1) des systèmes fiables pour prédire les résultats du traitement contre le cancer en utilisant principalement des caractéristiques extraites des images FDG-TEP; 2) des algorithmes automatiques pour la segmentation de tumeurs de manière précise en TEP et TEP-TDM. La théorie des fonctions de croyance est choisie dans notre étude pour modéliser et raisonner des connaissances incertaines et imprécises pour des images TEP qui sont bruitées et floues. Dans le cadre des fonctions de croyance, nous proposons une méthode de sélection de caractéristiques de manière parcimonieuse et une méthode d’apprentissage de métriques permettant de rendre les classes bien séparées dans l’espace caractéristique afin d’améliorer la précision de classification du classificateur EK-NN. Basées sur ces deux études théoriques, un système robuste de prédiction est proposé, dans lequel le problème d’apprentissage pour des données de petite taille et déséquilibrées est traité de manière efficace. Pour segmenter automatiquement les tumeurs en TEP, une méthode 3-D non supervisée basée sur le regroupement évidentiel (evidential clustering) et l’information spatiale est proposée. Cette méthode de segmentation mono-modalité est ensuite étendue à la co-segmentation dans des images TEP-TDM, en considérant que ces deux modalités distinctes contiennent des informations complémentaires pour améliorer la précision. Toutes les méthodes proposées ont été testées sur des données cliniques, montrant leurs meilleures performances par rapport aux méthodes de l’état de l’art. / Radiation therapy is one of the most principal options used in the treatment of malignant tumors. To enhance its effectiveness, two critical issues should be carefully dealt with, i.e., reliably predicting therapy outcomes to adapt undergoing treatment planning for individual patients, and accurately segmenting tumor volumes to maximize radiation delivery in tumor tissues while minimize side effects in adjacent organs at risk. Positron emission tomography with radioactive tracer fluorine-18 fluorodeoxyglucose (FDG-PET) can noninvasively provide significant information of the functional activities of tumor cells. In this thesis, the goal of our study consists of two parts: 1) to propose reliable therapy outcome prediction system using primarily features extracted from FDG-PET images; 2) to propose automatic and accurate algorithms for tumor segmentation in PET and PET-CT images. The theory of belief functions is adopted in our study to model and reason with uncertain and imprecise knowledge quantified from noisy and blurring PET images. In the framework of belief functions, a sparse feature selection method and a low-rank metric learning method are proposed to improve the classification accuracy of the evidential K-nearest neighbor classifier learnt by high-dimensional data that contain unreliable features. Based on the above two theoretical studies, a robust prediction system is then proposed, in which the small-sized and imbalanced nature of clinical data is effectively tackled. To automatically delineate tumors in PET images, an unsupervised 3-D segmentation based on evidential clustering using the theory of belief functions and spatial information is proposed. This mono-modality segmentation method is then extended to co-segment tumor in PET-CT images, considering that these two distinct modalities contain complementary information to further improve the accuracy. All proposed methods have been performed on clinical data, giving better results comparing to the state of the art ones.

Introdução: Hiperplasia Macronodular Adrenal Primária (PMAH) é uma causa rara de Síndrome de Cushing (SC), caracterizada por macronódulos funcionantes geralmente acometendo ambas as glândulas adrenais. Recentemente, o exame 18F-FDG PET/CT detectou três pacientes com PMAH apresentando captação aumentada de 18F-FDG. No entanto, ainda não foi elucidado o mecanismo pelo qual a PMAH apresentaria uma alta captação de 18F-FDG. Objetivos: Os objetivos deste estudo foram investigar se a expressão de GLUT1, HK1, HK2 e/ou HK3 estão relacionados à alta captação de 18F-FDG na PMAH e comparar estas expressões com tecidos adrenais provenientes de pacientes com AAC e CAA. Métodos: 12 pacientes com PMAH que realizaram 18F-FDG-PET/CT, previamente à adrenalectomia. A captação de 18F-FDG foi quantificada como maximum standardized uptake value (SUVmax). Expressão do RNAm foi investigada através de RT-PCR e a expressão proteica através de técnicas de imunoistoquímica. Expressão gênica e proteica dos pacientes com PMAH foi comparada com 15 pacientes com AAC e 10 pacientes com CAA. As correlações foram realizadas através do teste de coeficiente de correlação de Pearson e as comparações, através do teste Kruskal-Wallis, seguido do ajuste de Dunn. Significância estatística foi considerada quando p < 0.05. Resultados: Todos os pacientes com PMAH apresentaram alta captação de 18F-FDG, cujo SUVmáx variou de 3.3 a 8.9 e o tamanho do maior nódulo variou de 3.5 a 15cm. Foi observada forte correlação positiva entre o tamanho do maior nódulo e o SUVmáx nos pacientes com PMAH. No entanto, não foi estabelecida correlação entre a expressão de GLUT1, HK1, HK2 e HK3 e o SUVmáx nos pacientes com PMAH. A expressão do SLC2A1 e HK2 foi significativamente maior nos pacientes com CAA do que nos pacientes com AAC e PMAH. Conclusões: A captação aumentada de 18F-FDG na PMAH não está relacionada ao aumento da expressão de GLUT1, HK1, HK2 e HK3. Estudos futuros serão necessários para elucidar a via glicolítica que é responsável pelo metabolismo da glicose na PMAH / Introduction: Primary macronodular adrenal hyperplasia (PMAH) is a rare cause of Cushing\'s syndrome, characterized by functioning adrenal macronodules and increased cortisol production. Recently, integrated 18F-FDG-PET/CT examination revealed an increased 18F-FDG uptake in patients with PMAH. However, it is still unclear the mechanism by which PMAH would present with a high 18F-FDG uptake in PET/CT. Objectives: The aim of this study was to investigate whether GLUT1, HK1, HK2 and/or HK3 expression would account for the high18F-FDG uptake in PMAH and compare these expressions with ACA and ACC adrenal tisuue. Methods: 12 patients undergoing adrenalectomy for PMAH with previous 18F-FDG-PET/CT. 18F-FDG uptake was quantified as the maximum standardized uptake value (maxSUV). mRNA expression was investigated through quantitative RT-PCR and protein expression was investigated using immunohistochemical studies. PMAH gene and protein expression were compared to 15 patients with ACA and 10 with ACC. Correlations were performed through Pearson\'s correlation coefficient test and comparisons through Kruskal-Wallis test, followed by Dunn adjust. Statistical significance was considered when p < 0.05. Results: All patients with PMAH presented with high 18F-FDG uptake, the range of SUVmax in these patients varied from 3.3 to 8.9 and the nodule sizes varied from 3.5 to 15 cm. There was a strong positive correlation between the nodule size and 18F-FDG uptake. However, no correlation could be established between gene and protein expression of GLUT1, HK1, HK2 and HK3 and 18F-FDG uptake. SLC2A1 and HK2 expression was significantly higher in patients with CCA than in patients with AAC and PMAH. Conclusions: Increased 18F-FDG uptake in PMAH does not arise from the overexpression of GLUT1, HK1, HK2 or HK3. Further investigation is required to elucidate the glycolytic pathway involved in glucose metabolism in PMAH

Argentina e Brasil apresentam, cada um com suas particularidades, situações deficitárias no que diz respeito à base produtiva de alta intensidadetecnológica. Nesse amplo contexto, mostram-se de forte relevância políticas públicas de ciência, tecnologia e inovação voltadas para o fortalecimento e aprimoramento das áreas de produção e pesquisa nacionais em campos estratégicos. Por conformar um ramo fortemente demandante e dependente de produtos e serviços com intenso conteúdo tecnológico e ser um dos pilares do sistema de proteção social, o campo da saúde ganha destaque. Com isso, aparece como central para as políticas públicas nacionais dos países subdesenvolvidos, tendo em vista a importância de alcançarem maiores graus de autonomia frente aos oligopólios mundiais que dominam a produção de medicamentos e equipamentos para a saúde. É nesse conjunto de circunstâncias que se insere a proposta do presente trabalho, cujo objetivo é analisar umcircuito espacial produtivo e seus respectivos círculos de cooperação (SANTOS, 1986) que envolvem um serviço de alta densidade tecnológica na área da saúde. O recorte mais específico é a circularidade produtiva do radiofármaco fluordesoxiglucose (FDG-18F) para estudos em equipamento de tomografia por emissão de pósitrons (PET-CT) na Argentina e no Brasil. Para alcançar esse objetivo, além de pesquisa bibliográfica sobre o tema, empreendeu-se uma análise das políticas de ciência, tecnologia e inovação em saúde nos dois países. Destaca-se a realização de entrevistas com atores-chaves de várias instituições argentinas e brasileiras, abarcando representantes dos mais diversos segmentos envolvidos no circuito espacial produtivo estudado. O conjunto analítico explorado possibilitou o encontro de relevantes similitudes entre o funcionamento sistêmico dos elementos em questão nos dois países analisados, fundamentalmente no que concerne à lógica de atuação de setores privados na oferta e disponibilização de equipamentos e na prestação de serviços sofisticados de diagnóstico por imagem, como o caso do PET-CT. As estratégias de incorporação da tomografia computadorizada por emissão de pósitrons nos sistemas de saúde brasileiro e argentino são exemplos significativos, na área da saúde, de como as políticas do Estado e das empresas têm articulado os lugares para promover circuitos espaciais produtivos e círculos de cooperação que, todavia, nem sempre respondem aos princípios de universalização da saúde / Argentina and Brazil are found to be lacking in terms of a production base of high intensity technology.In this broad context, public policies on science, technology and innovation aimed at strengthening and improving national production and research in strategic fields are highly significant.Constituting a segment that is both heavily demanding and dependent on high technological content products and services and as one of the pillars of the social protection system, the field of health care is of particular importance.Thus it appears as central to the national public policies of developing countries, bearing in mind the importance of achieving greater degrees of autonomy from the global oligopolies that dominate the production of drugs and health care equipment.It is within this set of circumstances that the proposal for this study is placed, with the aim of analysing a productive spatial circuit and its respective circles of cooperation (Milton Santos, 1986) involved in the service of technological high density in the area of health.The most specific example is the productive circularity of the radiopharmaceutical fluorodeoxyglucose (FDG-18F) for studies in positron emission tomography equipment (PET-CT) in Argentina and Brazil.To achieve this aim, as well as a bibliographic study on the topic, a review was conducted into the science, technology and innovation policies in health in both countries.This featured interviews with key players from several Argentinian and Brazilian institutions, encompassing representatives from the most diverse segments involved in the productive spatial circuit under investigation. The analytical set explored enabled the finding of significant similarities between the systemic functioning of the elements in question in both countries, fundamentally as regards the role played by the private sector in the supply of equipment and the provision of sophisticated diagnostic imaging services, such as PET-CT.Strategies to incorporate PETCT scans into the Brazilian and Argentinian health systems is a significant example of how the policies of the State and of private companies have underpinned the places to promote productive spatial circuits and circles of cooperation that do not always answer to the principles of universalized health care

A baixa oxigenação (hipóxia) altera drasticamente o metabolismo celular e a forma de produção de ATP, que em tumores pode estimular e permitir que as células desenvolvam mecanismos de escape, adaptação e resistência, contribuindo não só para um comportamento maligno e agressivo, mas também lhes conferindo resistência a tratamentos quimioterapêuticos e radioterapêuticos. A detecção de regiões de hipóxia em tumores pode ser realizada com diferentes radiofármacos. Neste trabalho preparamos e avaliamos o comportamento dos radiofármacos (18F)FAZA e [[99mTc]glucarato]- em células de melanoma murino B16F10, correlacionando dados bioquímicos e histopatológicos com a captação celular dos radiofármacos in vitro e com imagens em equipamento PET/SPECT/CT obtidas de camundongos C57Bl6 implantados com tumores. O (18F)FAZA foi obtido em rendimento de 17,9 % e pureza radioquímica de 86,72 %, enquanto que o rendimento e pureza radioquímica do [[99mTc]glucarato]- foi superior a 95 %, sendo que este complexo se liga à proteínas plasmáticas com taxa de aproximadamente 40 % e o complexo é desestabilizados pela mesmas, após 4 horas de incubação a 37 oC. O complexo também não é estável na presença de cisteína e histidina. A captação in vitro do [[99mTc]glucarato]- nas células foi da ordem de 0,1 % independente da condição e do tempo, enquanto que a captação de (18F)FAZA atingiu 0,9 % sob hipóxia e 0,2 % sob normóxia, nos primeiros 15 minutos de estudo. A biodistribuição ex vivo em camundongos apresentou taxa de captação por grama de tumor e razão tumor/sangue da ordem de 0,04 % e 1,49 para o [[99mTc]glucarato]- e de 0,34 % e 1,39 para o (18F)FAZA, em tempo de 1 hora. Imagem obtidas de camundongos, mostraram intensa captação da (18F)FDG no tumor, e tanto (18F)FAZA quanto [[99mTc]glucarato]- foram capazes de evidenciar regiões de hipóxia ou necrose, respectivamente, nos tumores, ainda que com baixa taxa de captação. Imagens autorradiográficas do [[99mTc]glucarato]- nos tumores excisados dos animais apresentaram distribuição homogênea no tumor, com algumas áreas de captação sugeridas como necróticas; tomando a autorradiografia como referência, o [[99mTc]glucarato]- não se concentrou na córtex renal, região reconhecidamente hipóxica. Assim, (18F)FAZA e [[99mTc]glucarato]- puderam ser preparados em nosso laboratório com qualidade suficiente para uso em pesquisa e demonstram potencial para utilização em novos estudos visando a detecção de regiões de hipóxia ou necrose, respectivamente / The low oxygen concentration, also named hypoxia, drastically alters cellular metabolism and the production form of ATP which, in tumors, can stimulate and allow cells to develop mechanisms for escape, adaptation and resistance, contributing not only to malignant and aggressive behavior, but also their conferring resistance to chemotherapeutic and radiotherapeutic treatments. The detection of regions of hypoxia in tumors can be performed using different radiopharmaceuticals. In this work we prepared and evaluated the behavior of radiopharmaceuticals (18F)FAZA and [[99mTc]glucarate]- in B16F10 murine melanoma cells, biochemical and histopathological data correlating it with the radiopharmaceutical cellular uptake, both in vitro or by PET/SPECT/CT imaging obtained from C57Bl6 mice implanted with tumors. The (18F)FAZA was obtained in radiochemical yield of 17.8 % and radiochemical purity of 86.72 %, while the radiochemical yield and purity for [[99mTc]glucarate] - was higher to 95 %, and this complex binds to the plasma proteins at concentration of 40 %, however a the complex is unstable in presence of albumine after 4 hours, at 37 oC. The complex is unstable in the presence of cysteine and histidine, at 37 oC. The in vitro uptake of [[99mTc]glucarate]- in B16F10 cells was approximately 0.1% independently of experimental conditions, while (18F)FAZA reached 0.9%, under hypoxia, and 0.2%, under normoxia, the first 15 minutes of the study. The ex vivo biodistribution in mice showed uptake in tumor and tumor/blood ratio of the 0.04 % and 1.49 for [[99mTc]glucarate]- and 0.34 % and 1.39 for (18F)FAZA. Imaging obtained from mice showed intense uptake of (18F)FDG in the tumor, and both (18F)FAZA and [[99mTc]glucarate]- were able to show hypoxia or necrotic regions in the tumor. Autoradiographic imaging showed homogeneous distribution of [[99mTc]glucarate]- in the slices of tumor excised from animals; taking kidney autoradiography as a reference, the [[99mTc]glucarate]- was not concentrated in renal cortex, a region admittedly hypoxic. In conclusion (18F)FAZA and [[99mTc]glucarate]- could be prepared in our laboratory with sufficient quality for use in research and demonstrate potential for use in future studies aiming to detect regions of hypoxia and necrosis, respectively

Hipóxia é definida como a baixa teor de oxigênio. Nos tumores a principal causa da hipóxia é a isquemia, que ocorre em função do rápido crescimento da massa tumoral e diminuição ou obstrução dos vasos sanguíneos que irrigam o interior dos tumores. Como a hipóxia é uma das causas do aumento da resistência à radioterapia de radiação e algumas formas de quimioterapia, a identificação de tumores com regiões de hipóxia é de elevada relevância e a utilização de radiofármacos tem sido muito promissora, por ser um método não invasivo e que podem mapear diferentes alterações fisiológicas associadas à hipóxia. Neste trabalho sintetizamos o ligante [[99mTc](O)2HL91], com rendimento final de síntese de 82,6% e preparamos o respectivo complexo de tecnécio, com eficiência de marcação maior que 97 %; também foi preparado o radiofármaco (18F)FAZA, com eficiência de marcação de 17,9% e pureza radioquímica, após purificação, maior que 86 %. Estudos de captação em células de melanoma murino B16F10, apresentaram taxa de captação de 0,73%, em condições de normóxia e de 8,5 % em condições de hipóxia para o [[99mTc](O)2HL91] , sobe as mesmas condições, de 0,73% e 0,98%, para o (18F)FAZA, respectivamente. Estudos de biodistribuição ex vivo mostraram taxa de captação em tumores da ordem de 4,3% para o [[99mTc](O)2HL91] e de 0,56% para o (18F)FAZA, a relação tumor/sangue foi de 2,6% e 2,5%, respectivamente. Para ambos os rins são a principal via de excreção. Análise, por autorradiografia, de cortes dos tumores mostraram claramente a concentração do [[99mTc](O)2HL91] em regiões de hipóxia/necrose. Imagem da distribuição dos radiofármacos em camundongos C57/Bl6, com tumores de células B16F10, utilizando sistema hibrido PET/SPECT/CT dedicado a pequenos animais, mostraram que a concentração do [[99mTc](O)2HL91] permitiu visualizar captação difusa em regiões do tumor, o mesmo foi observado para o (18F)FAZA, mas em uma taxa menor. Em conclusão, os resultados obtidos apresentam as possibilidades de preparação e utilização de dois radiofármacos, o [[99mTc](O)2HL91] e o (18F)FAZA, como agentes marcadores para hipóxia, utilizando as técnicas de SPECT e PET para imagem. Todavia, novos estudos deverão ser realizados para determinação da especificidade desses radiofármacos em diferentes linhagens tumorais / Hypoxia is a deficiency of oxygen in the cell. In tumors the primary cause of hypoxia is ischemia, which occurs due to the rapid growth of the tumor mass and reduction or blockage of the blood vessels decreasing nutrients and oxygen supply in more internal regions of the tumors. Once hypoxia is one cause of the increased resistance to radiation therapy and some forms of chemotherapy, their identification in tumors is highly relevant and use of radiopharmaceuticals has been very promising, because it is a noninvasive and can map different physiological changes associated with hypoxia. In this work, we synthesized the ligand [[99mTc](O)2HL91] given a final synthesis yield of 82.6% and prepared their technetium complex with the labeling efficiency greater than 97%, the (18F)FAZA radiopharmaceutical was also prepared with labeling yield of 17.9% and marking radiochemical purity higher of 86 %, after purification. Uptake studies in murine B16F10 melanoma cells showed uptake rate of 0.73% in normoxic conditions and 8.5% in hypoxic conditions, for [[99mTc](O)2HL91], and, under same conditions, 0.73% and 0.98%, for (18F)FAZA. Ex vivo biodistribution study showed uptake rate in tumors of approximately 4.3% for [[99mTc](O)2HL91] and 0.56% for (18F)FAZA, the tumor/blood ratio was 2.6% and 2.5% respectively. For both products the main route 16 of excretion was by the kidneys. Analysis by autoradiography of tumors sections clearly showed the concentration of [[99mTc](O)2HL91] in hypoxia/necrosis regions. The distribution of radiopharmaceuticals in C57/Bl6 mice implanted with tumor B16F10 cells, using dedicated small animals hybrid system PET/SPECT/C, permitted to observe the uptake of the [[99mTc](O)2HL91] in diffuses points in the tumor regions, the same was observed for the (18F)FAZA, but with lower intensity. In conclusion, the results obtained show possibilities for preparation and use of both radiopharmaceuticals, the [[99mTc](O)2HL91] and (18F)FAZA as agents for hypoxia marker, using the SPECT and PET image techniques. However, further studies should be conducted to determine the specificity of these radiopharmaceuticals in different tumor cell lines

La tomographie par émission de positons (TEP) est une méthode d’imagerie clinique en forte expansion dans le domaine de l’oncologie. De nombreuses études cliniques montrent que la TEP permet, d’une part de diagnostiquer et caractériser les lésions cancéreuses à des stades plus précoces que l’imagerie anatomique conventionnelle, et d’autre part d’évaluer plus rapidement la réponse au traitement. Le raccourcissement du cycle comprenant le diagnostic, la thérapie, le suivi et la réorientation thérapeutiques contribue à augmenter le pronostic vital du patient et maîtriser les coûts de santé. La durée d’un examen TEP ne permet pas de réaliser une acquisition sous apnée. La qualité des images TEP est par conséquent affectée par les mouvements respiratoires du patient qui induisent un flou dans les images. Les effets du mouvement respiratoire sont particulièrement marqués au niveau du thorax et de l’abdomen. Plusieurs types de méthode ont été proposés pour corriger les données de ce phénomène, mais elles demeurent lourdes à mettre en place en routine clinique. Des travaux récemment publiés proposent une évaluation de ces méthodes basée sur des critères de qualité tels que le rapport signal sur bruit ou le biais. Aucune étude à ce jour n’a évalué l’impact de ces corrections sur la qualité du diagnostic clinique. Nous nous sommes focalisés sur la problématique de la détection des lésions du thorax et de l'abdomen de petit diamètre et faible contraste, qui sont les plus susceptibles de bénéficier de la correction du mouvement respiratoire en routine clinique. Nos travaux ont consisté dans un premier temps à construire une base d’images TEP qui modélisent un mouvement respiratoire non-uniforme, une variabilité inter-individuelle et contiennent un échantillonnage de lésions de taille et de contraste variable. Ce cahier des charges nous a orientés vers les méthodes de simulation Monte Carlo qui permettent de contrôler l’ensemble des paramètres influençant la formation et la qualité de l’image. Une base de 15 modèles de patient a été créée en adaptant le modèle anthropomorphique XCAT sur des images tomodensitométriques (TDM) de patients. Nous avons en parallèle développé une stratégie originale d’évaluation des performances de détection. Cette méthode comprend un système de détection des lésions automatisé basé sur l'utilisation de machines à vecteurs de support. Les performances sont mesurées par l’analyse des courbes free-receiver operating characteristics (FROC) que nous avons adaptée aux spécificités de l’imagerie TEP. L’évaluation des performances est réalisée sur deux techniques de correction du mouvement respiratoire, en les comparant avec les performances obtenues sur des images non corrigées ainsi que sur des images sans mouvement respiratoire. Les résultats obtenus sont prometteurs et montrent une réelle amélioration de la détection des lésions après correction, qui approche les performances obtenues sur les images statiques. / Positron emission tomography (PET) is nuclear medicine imaging technique that produces a three-dimensional image of functional processes in the body. The system detects pairs of gamma rays emitted by a tracer, which is introduced into the body. Three-dimensional images of tracer concentration within the body are then constructed by computer analysis. Respiratory motion in emission tomography leads to image blurring especially in the lower thorax and the upper abdomen, influencing this way the quantitative accuracy of PET measurements as well a leading to a loss of sensitivity in lesion detection. Although PET exams are getting shorter thanks to the improvement of scanner sensitivity, the current 2-3 minutes acquisitions per bed position are not yet compatible with patient breath-holding. Performing accurate respiratory motion correction without impairing the standard clinical protocol, ie without increasing the acquisition time, thus remains challenging. Different types of respiratory motion correction approaches have been proposed, mostly based on the use of non-rigid deformation fields either applied to the gated PET images or integrated during an iterative reconstruction algorithm. Evaluation of theses methods has been mainly focusing on the quantification and localization accuracy of small lesions, but their impact on the clinician detection performance during the diagnostic task has not been fully investigated yet. The purpose of this study is to address this question based on a computer assisted detection study. We evaluate the influence of two motion correction methods on the detection of small lesions in human oncology FDG PET images. This study is based on a series of realistic simulated whole-body FDG images based on the XCAT model. Detection performance is evaluated with a computer-aided detection system that we are developing for whole-body PET/CT images. Detection performances achieved with these two correction methods are compared with those achieved without correction, ie. with respiration average PET images as well as with reference images that do not model respiration effects. The use of simulated data makes possible the creation of theses perfectly corrected images and the definition of known lesions locations that serve as a reference.