Background Although abdominal aortic aneurysm (AAA) growth is non-linear, serial measurements of aneurysm diameter are the mainstay of aneurysm surveillance and contribute to decisions on timing of intervention. Aneurysm biology plays a key part in disease evolution but is not currently routinely assessed in clinical practice. Magnetic Resonance Imaging (MRI) and Positron Emission Tomography-Computed Tomography (PET-CT) provide insight into disease processes on a cellular or molecular level, and represent exciting new imaging biomarkers of disease activity. Macrophage-mediated inflammation may be assessed using ultrasmall superparamagnetic particles of iron oxide (USPIO) MRI and the PET radiotracer 18FSodium Fluoride (18F-NaF) identifies microcalcification which is a response to underlying necrotic inflammation. The central aim of this thesis was to investigate these imaging modalities in patients with AAA. Methods and Results USPIO MRI: MULTI-CENTRE STUDY In a prospective multi-centre observational cohort study, 342 patients (85.4% male, mean age 73.1±7.2 years, mean AAA diameter 49.6±7.7mm) with asymptomatic AAA ≥4 cm anteroposterior diameter underwent MRI before and 24-36 hours after intravenous administration of USPIO. Colour maps (depicting the change in T2* caused by USPIO) were used to classify aneurysms on the basis of the presence of USPIO uptake in the aneurysm wall, representing mural inflammation. Intra- and inter-observer agreement were found to be very good, with proportional agreement of 0.91 (kappa 0.82) and 0.83 (kappa 0.66), respectively. At 1 year, there was 29.3% discordant classification of aneurysms on repeated USPIO MRI and at 2 years, discordance was 65%, suggesting that inflammation evolves over time. In the observational study, after a mean of 1005±280 days of follow up, there were 126 (36.8%) aneurysm repairs and 17 (5.0%) ruptures. Participants with USPIO enhancement (42.7%) had increased aneurysm expansion rates (3·1±2·5 versus 2·5±2·4 mm/year; difference 0·6 [95% confidence intervals (CI), 0·02 to 1·2] mm/year, p=0·0424) and had higher rates of aneurysm rupture or repair (69/146=47·3% versus 68/191=35·6%; difference 11·7%, 95% CI 1·1 to 22·2%, p=0·0308). USPIO MRI was therefore shown to predict AAA expansion and the composite of rupture or repair, however this was not independent of aneurysm diameter (c-statistic, 0·7924 to 0·7926; unconditional net reclassification -13·5%, 95% confidence intervals -36·4% to 9·3%). 18F-NaF PET-CT: SINGLE-CENTRE STUDY A sub-group of 76 patients also underwent 18F-NaF PET-CT, which was evaluated using the maximum tissue-to-background ratio (TBRmax) in the most diseased segment (MDS), a technique that showed very good intra- (ICC 0.70-0.89) and inter-observer (ICC 0.637-0.856) agreement. Aneurysm tracer uptake was compared firstly in a case-control study, with 20 patients matched to 20 control patients for age, sex and smoking status. 18F-NaF uptake was higher in aneurysm when compared to control aorta (log2TBRmax 1.712±0.560 vs. 1.314±0.489; difference 0.398 (95% CI 0.057, 0.739), p=0.023), or to non-aneurysmal aorta in patients with AAA (log2TBRmax 1.647±0.537 vs. 1.332±0.497; difference 0.314 (95% CI 0.0685, 0.560), p=0.004). An ex vivo study was performed on aneurysm and control tissue, which demonstrated that 18F-NaF uptake on microPET-CT was higher in the aneurysm hotspots and higher in aneurysm tissue compared to control tissue. Histological analysis suggested that 18F-NaF was highest in areas of focal calcification and necrosis. In an observational cohort study, aneurysms were stratified by tertiles of TBRmax in the MDS and followed up for 510±196 days, with 6 monthly serial ultrasound measurements of diameter. Those in the highest tertile of tracer uptake expanded more than 2.5 times more rapidly than those in the lowest tertile (3.10 [3.58] mm/year vs. 1.24 [2.41] mm/year, p=0.008) and were also more likely to experience repair or rupture (15.3% vs. 5.6%, log-rank p=0.043). In multivariable analyses, 18F-NaF uptake on PET-CT emerged as an independent predictor of AAA expansion (p=0.042) and rupture or repair (HR 2.49, 95% CI1.07, 5.78; p=0.034), even when adjusted for age, sex, body mass index, systolic blood pressure, current smoking and, crucially, aneurysm diameter. Conclusion These are the largest USPIO MRI and PET-CT studies in AAA disease to date and the first to investigate 18F-NaF. Both USPIO MRI and 18F-NaF PET-CT are able to predict AAA expansion and the composite of rupture and repair, with 18F-NaF PETCT emerging as the first imaging biomarker that independently predicts expansion and AAA events, even after adjustment for aneurysm diameter. This represents an exciting new predictor of disease progression that adds incremental value to standard clinical assessments. Feasibility and randomised clinical trials are now required to assess the potential of this technique to change the management and outcome of patients with AAA.

Understanding the mnemonic functions of the brain has been extensively facilitated by the development of functional neuroimaging techniques such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). The present thesis aims at investigating the neural mechanisms underlying memory for personally experienced events (episodic memory), using PET. In paper I, similarities between encoding and retrieval of enacted (motor) information were explored. We observed increased retrieval activation in right premotor areas in the brain when sentences encoded by motor enactment and sentences encoded by maintenance rehearsal were contrasted. In paper II, overlap between encoding and retrieval was explicitly tested for three types of event information: spatial, item, and temporal. Using conjunction analyses, we found that encoding and retrieval of spatial information was associated with increased brain activity in bilateral inferior parietal regions. Encoding and retrieval of item information were related to increased activation in right inferior temporal cortex, and encoding and retrieval of temporal information were associated with increased activation in left inferior temporal and left inferior frontal cortex. In paper III, brain activity associated with retrieval success was examined. Conditions included three levels of retrieval success (high, medium, and low level), for two types of information (pictures and sentences). The results showed a pattern of activation that distinguished between brain regions involved in processing of sentences vs. processing of pictures. A second pattern that distinguished between brain regions involved in encoding vs. retrieval processes, irrespectively of material (sentences and pictures) and retrieval success, was also found. The manipulation of retrieval success was associated with systematic changes in the correlation between material specific regions and other areas of the brain. In study IV, changes in activation related to successful retrieval of pictures were investigated. More specifically, we expected to find decreases in infero-temporal (IT) regions of the brain that were associated with successful recognition memory. As expected, we found a region in left IT cortex that showed decreased activation related to memory for event information. This decrease in activation could be dissociated from responses related to novelty detection, and perceptual priming. The results from study I and II are discussed in relation to findings and theories regarding similarities between encoding and retrieval processes, and reactivation of modality-specific brain areas important for memory storage. The results from studies III and IV are discussed in relation to differences between encoding and retrieval processes, e.g. asymmetric frontal activation and sub-processes of episodic memory, such as retrieval mode, retrieval success, and novelty detection. Taken together, the studies show that different episodic memory processes are correlated with distinct brain areas, hence supporting the view that remembering is based on multiple component processes. / digitalisering@umu.se

No description available.

O melanoma maligno é um tipo de câncer com grande risco de produzir metástases e com altas taxas de mortalidade resultantes de diagnósticos tardios e falta de tratamentos eficazes. Ao longo dos últimos anos, a terapia gênica voltada para o câncer e o desenvolvimento de métodos capazes de visualizar processos moleculares e celulares ao longo da terapia, tem recebido especial atenção. Diante deste quadro, nossos objetivos foram utilizar o sistema de Tomografia por Emissão de Pósitrons (PET) para diagnosticar precocemente tumores e investigar a eficácia terapêutica de uma nova imunoterapia em um modelo animal de melanoma metastático. Visando atingir esses objetivos, padronizou-se a síntese e realizou-se o controle de qualidade do 9- [4-18F-fluoro-3-hidroximetil-butil) guanina, [18F] FHBG, considerado o padrão-ouro em estudos clínicos, para acompanhamento de terapia gênica por PET. Métodos: Sintetizou-se o [18F] FHBG, por substituição nucleofílica tipo 2 do precursor tosilato com [18F-] fluoreto de potássio /Kryptofix 2.2.2, seguido de desproteção com HCl 1 M e purificação por HPLC. A identidade química, pureza radioquímica e atividade específica do [18F] FHBG foram determinadas por Cromatografia Líquida de Alta Eficiência (CLAE). Introduziu-se o gene de timidina quinase (TK) com o vetor retroviral pCL-TK nas linhagens B16F10 (melanoma murino) e LLC (carcinoma de pulmão murino). Os estudos de captação in vitro dos radiotraçadores [18F] FHBG e [18F] FDG foram realizados nas linhagens celulares tumorais murinas transduzidas ou não com a proteína TK. Para os estudos in vivo, camundongos C57BL6 previamente inoculados intravenosamente com células de melanoma expressando a enzima TK, foram imageados subsequentemente utilizando os radiotraçadores [18F] FDG e [18F] FHBG. A eficácia da imunoterapia foi testada em modelo profilático e terapêutico animal de melanoma metastático. Resultados: O tempo de síntese total do [18F] FHBG variou entre 80-150 minutos. O rendimento radioquímico variou entre 1-4%, (n = 19) decaimento corrigido. A pureza radioquímica foi superior a 99% e a atividade específica variou entre 0,14GBq/μmoL-0,21GBq/μmoL. Com a introdução do gene timidina quinase (TK), obtiveram-se as linhagens repórter B16F10-TK e LLC-TK, para os estudos in vitro. As células B16F10 e LLC, expressando GFP foram utilizadas como linhagens controles. Estudos in vitro com o [18F] FHBG revelaram uma captação cerca de 4 vezes maior em células que expressam TK (B16-TK e LLC-TK) em comparação com as células controle GFP. O [18F] FDG apenas captou cerca de duas vezes mais em células TK do que em células que expressam GFP. A detecção de tumores em modelo animal de metástase pulmonar com o [18F] FDG ocorreu a partir de 15 dias do estabelecimento das lesões. No entanto, nos estudos in vivo com [18F] FHBG, houve captação apenas na região intestinal, durante as três semanas em que os animais foram acompanhados. A imunoterapia com células tratadas pela combinação de p19Arf e IFNβ, em camundongos C57BL6 com metástase pulmonar, conferiu redução do tamanho dos focos metastáticos aos animais tratados. Conclusões: Neste trabalho padronizou-se a síntese manual do [18F] FHBG, o qual foi avaliado em estudos in vitro e in vivo. Os estudos in vitro confirmaram a especificidade do [18F] FHBG no monitoramento da expressão de HSV1-tk em linhagens celulares. No entanto, o [18F] FHBG não se acumulou nas lesões metastáticas in vivo e estudos posteriores serão necessários para uma melhor caracterização utilizando o [18F] FHBG. O resultado do tratamento combinado de p19Arf e IFNβ foi promissor para o tratamento de lesões metastáticas. / Malignant melanoma is a type of cancer with a great risk of producing metastases and with high mortality rates resulting from late diagnosis and lack of effective treatments. Over the past few years, directed gene therapy for cancer and the development of methods to visualize molecular and cellular processes throughout therapy, have received special attention. In this context, our aim was to use the Positron Emission Tomography (PET) system, as a tool, for early detection of tumors and investigate the therapeutic efficacy of a new immunotherapy in an animal model of metastatic melanoma. To achieving these goals, the synthesis of [18F] FHBG, the gold standard in clinical studies for monitoring gene therapy by PET, was standardized and the quality control was performed. We also present the results of in vitro uptake and in vivo evaluation of [18F] FHBG, compared to [18F] FDG, the most commonly used radiopharmaceutical for diagnosis in oncology by PET. The vaccine was derived from transduced B16F10-TK cells with the adenoviral vectors AdRGDPGp19Arf and AdRGDPGIFNβ. Methods: [18F] FHBG was synthesized by type 2 nucleophilic radiofluorination of a tosylate precursor with [18F-] potassium fluoride / Kryptofix 2.2.2, followed by deprotection with 1N HCl and purification by HPLC. The chemical identity, radiochemical purity and specific activity of [18F] FHBG were determined by High Performance Liquid Chromatography (HPLC). The thymidine kinase (TK) gene was introduced with the pCL-TK retroviral vector into the B16F10 (murine melanoma) and LLC (murine lung carcinoma) lines. In vitro uptake studies of [18F] FHBG and [18F] FDG were performed on cell lines transduced or not with TK protein. For in vivo studies, C57BL6 mice, previously injected with HSV1tk expressing tumors, were subsequently imaged using the [18F] FDG and [18F] FHBG radiotracers. The efficacy of immunotherapy was tested in a prophylactic and therapeutic animal model of metastatic melanoma. Results: The total synthesis time of [18F] FHBG ranged from 80-150 min. The radiochemical yield ranged from 1-4%, (n = 19) corrected decay. Radiochemical purity was greater than 99% and the specific activity ranged from 0.14GBq / μmoL- 0.21GBq / μmoL. With the introduction of the thymidine kinase (TK) gene, the B16F10-TK and LLC-TK reporter lines were obtained for in vitro studies, B16F10 cells and LLC, expressing GFP, were used as controls. In vitro studies with [18F] FHBG revealed about 4-fold uptake in TK-expressing cells (B16-TK and LLC-TK) compared to GFP control cells. [18F] FDG binds only about twice as much in TK cells as in cells expressing GFP. The detection of tumors in an animal model of pulmonary metastasis with [18F] FDG occurred 15 days after lesion establishment. However, the in vivo studies with [18F] FHBG, the uptake was only found in the intestinal region, over the 3 weeks in which the mice were followed. Immunotherapy with cells treated by the combination of p19Arf and IFNβ, in C57BL6 mice with pulmonary metastasis, reduced the size of the metastatic foci in treated animals. Conclusions: In this study we demonstrate the standardization of [18F] FHBG synthesis and its use in in vitro and in vivo. The in vitro studies have confirmed the specificity of [18F] FHBG to monitor HSV1-tk expression in cell lines. However, [18F] FHBG did not accumulate in the metastatic lesions in vivo and further studies will be required for a better characterization using [18F] FHBG. The outcome of the combined treatment of p19Arf and IFNβ was promising for the treatment of metastatic lesions.

O melanoma maligno é um tipo de câncer com grande risco de produzir metástases e com altas taxas de mortalidade resultantes de diagnósticos tardios e falta de tratamentos eficazes. Ao longo dos últimos anos, a terapia gênica voltada para o câncer e o desenvolvimento de métodos capazes de visualizar processos moleculares e celulares ao longo da terapia, tem recebido especial atenção. Diante deste quadro, nossos objetivos foram utilizar o sistema de Tomografia por Emissão de Pósitrons (PET) para diagnosticar precocemente tumores e investigar a eficácia terapêutica de uma nova imunoterapia em um modelo animal de melanoma metastático. Visando atingir esses objetivos, padronizou-se a síntese e realizou-se o controle de qualidade do 9- [4-18F-fluoro-3-hidroximetil-butil) guanina, [18F] FHBG, considerado o padrão-ouro em estudos clínicos, para acompanhamento de terapia gênica por PET. Métodos: Sintetizou-se o [18F] FHBG, por substituição nucleofílica tipo 2 do precursor tosilato com [18F-] fluoreto de potássio /Kryptofix 2.2.2, seguido de desproteção com HCl 1 M e purificação por HPLC. A identidade química, pureza radioquímica e atividade específica do [18F] FHBG foram determinadas por Cromatografia Líquida de Alta Eficiência (CLAE). Introduziu-se o gene de timidina quinase (TK) com o vetor retroviral pCL-TK nas linhagens B16F10 (melanoma murino) e LLC (carcinoma de pulmão murino). Os estudos de captação in vitro dos radiotraçadores [18F] FHBG e [18F] FDG foram realizados nas linhagens celulares tumorais murinas transduzidas ou não com a proteína TK. Para os estudos in vivo, camundongos C57BL6 previamente inoculados intravenosamente com células de melanoma expressando a enzima TK, foram imageados subsequentemente utilizando os radiotraçadores [18F] FDG e [18F] FHBG. A eficácia da imunoterapia foi testada em modelo profilático e terapêutico animal de melanoma metastático. Resultados: O tempo de síntese total do [18F] FHBG variou entre 80-150 minutos. O rendimento radioquímico variou entre 1-4%, (n = 19) decaimento corrigido. A pureza radioquímica foi superior a 99% e a atividade específica variou entre 0,14GBq/μmoL-0,21GBq/μmoL. Com a introdução do gene timidina quinase (TK), obtiveram-se as linhagens repórter B16F10-TK e LLC-TK, para os estudos in vitro. As células B16F10 e LLC, expressando GFP foram utilizadas como linhagens controles. Estudos in vitro com o [18F] FHBG revelaram uma captação cerca de 4 vezes maior em células que expressam TK (B16-TK e LLC-TK) em comparação com as células controle GFP. O [18F] FDG apenas captou cerca de duas vezes mais em células TK do que em células que expressam GFP. A detecção de tumores em modelo animal de metástase pulmonar com o [18F] FDG ocorreu a partir de 15 dias do estabelecimento das lesões. No entanto, nos estudos in vivo com [18F] FHBG, houve captação apenas na região intestinal, durante as três semanas em que os animais foram acompanhados. A imunoterapia com células tratadas pela combinação de p19Arf e IFNβ, em camundongos C57BL6 com metástase pulmonar, conferiu redução do tamanho dos focos metastáticos aos animais tratados. Conclusões: Neste trabalho padronizou-se a síntese manual do [18F] FHBG, o qual foi avaliado em estudos in vitro e in vivo. Os estudos in vitro confirmaram a especificidade do [18F] FHBG no monitoramento da expressão de HSV1-tk em linhagens celulares. No entanto, o [18F] FHBG não se acumulou nas lesões metastáticas in vivo e estudos posteriores serão necessários para uma melhor caracterização utilizando o [18F] FHBG. O resultado do tratamento combinado de p19Arf e IFNβ foi promissor para o tratamento de lesões metastáticas. / Malignant melanoma is a type of cancer with a great risk of producing metastases and with high mortality rates resulting from late diagnosis and lack of effective treatments. Over the past few years, directed gene therapy for cancer and the development of methods to visualize molecular and cellular processes throughout therapy, have received special attention. In this context, our aim was to use the Positron Emission Tomography (PET) system, as a tool, for early detection of tumors and investigate the therapeutic efficacy of a new immunotherapy in an animal model of metastatic melanoma. To achieving these goals, the synthesis of [18F] FHBG, the gold standard in clinical studies for monitoring gene therapy by PET, was standardized and the quality control was performed. We also present the results of in vitro uptake and in vivo evaluation of [18F] FHBG, compared to [18F] FDG, the most commonly used radiopharmaceutical for diagnosis in oncology by PET. The vaccine was derived from transduced B16F10-TK cells with the adenoviral vectors AdRGDPGp19Arf and AdRGDPGIFNβ. Methods: [18F] FHBG was synthesized by type 2 nucleophilic radiofluorination of a tosylate precursor with [18F-] potassium fluoride / Kryptofix 2.2.2, followed by deprotection with 1N HCl and purification by HPLC. The chemical identity, radiochemical purity and specific activity of [18F] FHBG were determined by High Performance Liquid Chromatography (HPLC). The thymidine kinase (TK) gene was introduced with the pCL-TK retroviral vector into the B16F10 (murine melanoma) and LLC (murine lung carcinoma) lines. In vitro uptake studies of [18F] FHBG and [18F] FDG were performed on cell lines transduced or not with TK protein. For in vivo studies, C57BL6 mice, previously injected with HSV1tk expressing tumors, were subsequently imaged using the [18F] FDG and [18F] FHBG radiotracers. The efficacy of immunotherapy was tested in a prophylactic and therapeutic animal model of metastatic melanoma. Results: The total synthesis time of [18F] FHBG ranged from 80-150 min. The radiochemical yield ranged from 1-4%, (n = 19) corrected decay. Radiochemical purity was greater than 99% and the specific activity ranged from 0.14GBq / μmoL- 0.21GBq / μmoL. With the introduction of the thymidine kinase (TK) gene, the B16F10-TK and LLC-TK reporter lines were obtained for in vitro studies, B16F10 cells and LLC, expressing GFP, were used as controls. In vitro studies with [18F] FHBG revealed about 4-fold uptake in TK-expressing cells (B16-TK and LLC-TK) compared to GFP control cells. [18F] FDG binds only about twice as much in TK cells as in cells expressing GFP. The detection of tumors in an animal model of pulmonary metastasis with [18F] FDG occurred 15 days after lesion establishment. However, the in vivo studies with [18F] FHBG, the uptake was only found in the intestinal region, over the 3 weeks in which the mice were followed. Immunotherapy with cells treated by the combination of p19Arf and IFNβ, in C57BL6 mice with pulmonary metastasis, reduced the size of the metastatic foci in treated animals. Conclusions: In this study we demonstrate the standardization of [18F] FHBG synthesis and its use in in vitro and in vivo. The in vitro studies have confirmed the specificity of [18F] FHBG to monitor HSV1-tk expression in cell lines. However, [18F] FHBG did not accumulate in the metastatic lesions in vivo and further studies will be required for a better characterization using [18F] FHBG. The outcome of the combined treatment of p19Arf and IFNβ was promising for the treatment of metastatic lesions.

O sistema microPET/CT é um importante equipamento utilizado nas pesquisas de imagem diagnóstica em pequenos animais. O radiofármaco mais usado nesta tecnologia é o fluordeoxiglicose marcado com flúor-18. Este estudo tem como objetivo efetuar o controle radiológico no laboratório de pesquisa microPET/CT do Centro de Radiofarmácia do IPEN-CNEN/SP, de forma a satisfazer tanto as normas nacionais como as recomendações internacionais. O laboratório está classificado pela equipe de radioproteção da instalação como área supervisionada, nas quais embora não seja obrigatória a adoção de medidas específicas de proteção e segurança, devem ser submetidas reavaliações regulares das condições do ambiente de trabalho. Visando assegurar a proteção radiológica dos trabalhadores diretamente envolvidos no manuseio do equipamento, realizou-se o monitoramento do local de trabalho e a avaliação do controle de dose individual. Inicialmente foi feito o monitoramento pré-operacional, isto é, o levantamento radiométrico no laboratório. Além disso, mediu-se nível de radiação externa nas instalações do laboratório e suas adjacências, por meio da colocação de nove dosímetros termoluminescentes (TL) de CaSO4:Dy, em locais previamente selecionados. Os indivíduos ocupacionalmente expostos foram avaliados mensalmente por meio do uso de dosímetros TL posicionados no tórax e por medidas de corpo inteiro, tomadas a cada seis meses. O período do estudo foi de dois anos, com início em abril de 2014. Para o controle do microPET/CT realizou-se testes de desempenho de acordo com o protocolo padrão do equipamento e em conformidade com a norma desenvolvida pela força tarefa para estudos com PET em animais Animal PET Standard Task Force. O presente estudo permitiu demonstrar que os níveis de radiação das áreas (estimativas de dose ambiente e dose efetiva), assim como a blindagem do equipamento estão adequados de acordo com os limites da exposição ocupacional. Ressalta-se a importância de se seguir rigorosamente os princípios de radioproteção, já que se trata de pesquisas com fontes radioativas não seladas. / Micro PET/CT scanner is an essential tool generally used for small animal molecular imaging. Fluorine-18-labeled fluorodeoxyglucose is the most widely used radioisotope in this technique. The present study aimed to evaluate the radiation levels in a micro PET/CT research laboratory of the Radiopharmacy Center at IPEN-CNEN / SP, in order to accomplish both national standards and international recommendations. The radioprotection team has classified the laboratory as supervised area; even this laboratory does not require the adoption of specific measures for protection and safety, should be done regular re-evaluation of the conditions of occupational exposures. Workplace monitoring and individual control assessment were carried out to ensure the radiological protection of all workers directly involved in handling the scanner. Initially, there was conducted a radiometric survey, as well as measurements of the external radiation level in the workplace and its surroundings. To achieve this goal, there were placed nine thermoluminescent dosimeters of CaSO4:Dy in preselected locations. Monthly evaluations of the occupationally exposed individuals were carried out through the use of TL dosimeters, ported in the workers´ chest. Moreover, whole body measurements were performed every six months. The study period was about two-years which started in April 2014. All tests to evaluate micro PET/CT performance were based on the standard protocol of the equipment in accordance with the standard developed by the Animal PET Standard Task Force. Present study\'s results demonstrated that the ambient radiation levels (ambient and effective estimated radiation dose), as well as the effective shielding equipment are both adequate. This study emphasizes that it is essential to strictly follow the principles of radioprotection in workplace, whenever researches involve radioactive unsealed sources.

L’un des aspects les plus critiques dans les planifications dosimétriques des traitements par radiothérapie est la délinéation des limites de la tumeur. Cette délinéation se fait généralement sur les images anatomiques de tomodensitométrie (TDM). Mais récemment, il est recommandé de faire cette délinéation pour les cancers broncho-pulmonaires non à petites cellules (CBNPC) sur les images fonctionnelles de Tomographie par Émission de Positon (TEP) pour prendre en compte les caractéristiques biologiques de la cible. Jusqu’à ce jour, aucune technique de segmentation ne s’est révélée satisfaisante pour les images TEP en application clinique. Une solution pour ce problème est proposée dans cette étude. Méthodes : Les optimisations de notre méthode ont consisté principalement à faire l’ajustement des seuils directement à partir des corps des patients au lieu de le faire à partir du fantôme. Résultats : Pour les lésions de grands axes supérieurs à 20 mm, notre technique de segmentation a montré une bonne estimation des mesures histologiques (la moyenne de différence de diamètre entre données mesurées et déterminées avec notre technique = +1,5 ± 8,4 %) et une estimation acceptable des mesures TDM. Pour les lésions de grands axes inférieurs ou égaux à 20 mm, cette méthode a montré un écart avec les mesures dérivées des données histologiques ou bien des données TDM. Conclusion : Cette nouvelle méthode d’ajustement montre une bonne précision pour la délimitation des lésions de grands axes compris entre 2 et 4,5 cm. Néanmoins, elle n’évalue pas correctement les lésions les plus petites, cela peut être dû à l’effet du volume partiel / Tumor delineation is a critical aspect in radiotherapy planning treatment and is usually performed on the anatomical images of a computed tomography (CT) scan. Recently, for non-small cell lung cancer, it has been recommended to use functional Positron Emission Tomography (PET) images to take into account the target biological characteristics. However, today, there is no satisfactory segmentation technique for PET images in clinical applications. In the present study, a solution of this problem is proposed. Methods: The optimizations of tumor delineation consisted primarily on the thresholds adjustment directly from patients, rather than phantoms. The development and the validation of this adjustment were done by comparing segmented lesions on PET images with two different gold standards: measurements performed on CT images of the selected lesions and histological measurements of surgically removed tumors. Results: For lesions greater than 20 mm, our segmentation technique showed very good estimation of histological measurements (mean difference diameter between measured and calculated data equal to +1.5 ± 8.4 %) and an acceptable estimation of CT measurements. For lesions smaller or equal to 20 mm, the method showed a large gap with the measurements derived from histological or CT data. Conclusion: This novel segmentation technique shows very high accuracy for the lesions of large axes between 2 and 4.5 cm. Nevertheless, it does not correctly evaluate smaller lesions probably because of the partial volume effect

O sistema microPET/CT é um importante equipamento utilizado nas pesquisas de imagem diagnóstica em pequenos animais. O radiofármaco mais usado nesta tecnologia é o fluordeoxiglicose marcado com flúor-18. Este estudo tem como objetivo efetuar o controle radiológico no laboratório de pesquisa microPET/CT do Centro de Radiofarmácia do IPEN-CNEN/SP, de forma a satisfazer tanto as normas nacionais como as recomendações internacionais. O laboratório está classificado pela equipe de radioproteção da instalação como área supervisionada, nas quais embora não seja obrigatória a adoção de medidas específicas de proteção e segurança, devem ser submetidas reavaliações regulares das condições do ambiente de trabalho. Visando assegurar a proteção radiológica dos trabalhadores diretamente envolvidos no manuseio do equipamento, realizou-se o monitoramento do local de trabalho e a avaliação do controle de dose individual. Inicialmente foi feito o monitoramento pré-operacional, isto é, o levantamento radiométrico no laboratório. Além disso, mediu-se nível de radiação externa nas instalações do laboratório e suas adjacências, por meio da colocação de nove dosímetros termoluminescentes (TL) de CaSO4:Dy, em locais previamente selecionados. Os indivíduos ocupacionalmente expostos foram avaliados mensalmente por meio do uso de dosímetros TL posicionados no tórax e por medidas de corpo inteiro, tomadas a cada seis meses. O período do estudo foi de dois anos, com início em abril de 2014. Para o controle do microPET/CT realizou-se testes de desempenho de acordo com o protocolo padrão do equipamento e em conformidade com a norma desenvolvida pela força tarefa para estudos com PET em animais Animal PET Standard Task Force. O presente estudo permitiu demonstrar que os níveis de radiação das áreas (estimativas de dose ambiente e dose efetiva), assim como a blindagem do equipamento estão adequados de acordo com os limites da exposição ocupacional. Ressalta-se a importância de se seguir rigorosamente os princípios de radioproteção, já que se trata de pesquisas com fontes radioativas não seladas. / Micro PET/CT scanner is an essential tool generally used for small animal molecular imaging. Fluorine-18-labeled fluorodeoxyglucose is the most widely used radioisotope in this technique. The present study aimed to evaluate the radiation levels in a micro PET/CT research laboratory of the Radiopharmacy Center at IPEN-CNEN / SP, in order to accomplish both national standards and international recommendations. The radioprotection team has classified the laboratory as supervised area; even this laboratory does not require the adoption of specific measures for protection and safety, should be done regular re-evaluation of the conditions of occupational exposures. Workplace monitoring and individual control assessment were carried out to ensure the radiological protection of all workers directly involved in handling the scanner. Initially, there was conducted a radiometric survey, as well as measurements of the external radiation level in the workplace and its surroundings. To achieve this goal, there were placed nine thermoluminescent dosimeters of CaSO4:Dy in preselected locations. Monthly evaluations of the occupationally exposed individuals were carried out through the use of TL dosimeters, ported in the workers´ chest. Moreover, whole body measurements were performed every six months. The study period was about two-years which started in April 2014. All tests to evaluate micro PET/CT performance were based on the standard protocol of the equipment in accordance with the standard developed by the Animal PET Standard Task Force. Present study\'s results demonstrated that the ambient radiation levels (ambient and effective estimated radiation dose), as well as the effective shielding equipment are both adequate. This study emphasizes that it is essential to strictly follow the principles of radioprotection in workplace, whenever researches involve radioactive unsealed sources.

Im Kontext komplexer zellulärer Prozesse stellen Phosphopeptide essentielle bioaktive Verbindungen dar, die mit Phosphorylierungs- und Dephosphorylierungsreaktionen eng verbunden sind. Diese Prozesse sind in die Regulation nahezu jeder zellulären Funktion involviert und spielen damit ebenso im Falle von Erkrankungen eine tragende Rolle. Synthetische Phosphopeptide könnten in Form molekularer Sonden zur Charakterisierung dieser physiologisch fundamentalen Prozesse beitragen. Die radiopharmazeutische Forschung brachte in den letzten zwei Jahrzehnten zahlreiche radiomarkierte Peptide für das Peptidrezeportargeting im Rahmen der Tumordiagnose und -therapie hervor. Unter diesen regulatorischen Peptiden mit vorwiegend neuroendokrinem Ursprung sind bisher keine radiomarkierten Phosphopeptide für die Anwendung in der molekularen Bildgebung bekannt. Das Anliegen dieser Arbeit ist es, grundlegende Erkenntnisse zur Synthese und Markierung von Phosphopeptiden zu erlangen. Neben der Etablierung der Radiomarkierung von Phosphopeptiden mit dem kurzlebigen Positronenstrahler Fluor-18 und deren radiopharmakologischen Charakterisierung steht auch die Fluoreszenzmarkierung mit dem Fluorophor 5(6)-Carboxyfluorescein (CF) im Fokus. Phosphopeptidliganden der kürzlich identifizierten Polo-Box-Domäne (PBD) als Phosphopeptid-bindende Proteindomäne der Zellzykluskinase Plk1, die ebenso ein interessantes onkologisches Target darstellt, wurden für diese Arbeit als Model ausgewählt. Es stand ein Repertoire verschiedenster Methoden zur Verfügung, welche molekulare Bildgebung mittels Kleintier-PET, wie auch optische Bildgebung und die Radiomarkierung mittels klassischer und Mikrofluidik-Technik beinhalten. Im ersten Abschnitt der Promotion wurden kürzlich vorgestellte Plk1-PBD-gerichtete Phosphopeptide mit einer Ser-pThr-Kernsequenz ausgewählt und deren Darstellung mit der Fmoc-gestützten orthogonalen Festphasenpeptidsynthese (SPPS) vollzogen. Dabei erfolgt die Umsetzung nach dem Prinzip des Synthon-basierten Ansatzes, der den Einsatz des monobenzylierten Phosphothreonin-Bausteines involviert. Das Uronium-basierte Kupplungs- und Aktivierungsreagenz HBTU/HOBt/DIPEA, sowie das Abspaltreagenz TFA/Wasser/Thioanisol/EDT als eine modifizierte Variante des Reagenz K garantiert die zuverlässige Synthese von Phosphopeptiden unter Erhalt der Phosphatfunktion. Zur Charakterisierung der Peptide wurden HPLC und Massenspektrometrie als geeignete Methoden herangezogen. An die erfolgreiche Darstellung von Phosphopeptiden schloss sich im Weiteren die Ausarbeitung einer zuverlässigen Radiomarkierungsstrategie mit dem kurzlebigen Positronenstrahler Fluor-18 an. Das bifunktionelle, aminogruppenselektive Agenz N-Succinimidyl-4-[18F]fluorbenzoat ([18F]SFB) ist für eine indirekte und milde Markierung von Peptiden geeignet. Durch Optimierung der N-terminalen 18F-Fluorbenzoylierung des Phosphopeptides MQSpTPL 2 hinsichtlich der Verwendung eines 0,05 M Na2HPO4-Puffers (pH 9) als Reaktionsmedium bei geringer Peptidmenge (0,5 mg), sowie 40°C Reaktionstemperatur und 30 min Reaktionszeit kann das 18F-markierte Phosphopeptid [18F]FBz-MQSpTPL [18F]4 in guten radiochemischen Ausbeuten von 25-28%, mit entsprechender radiochemischer Reinheit >95% mittels HPLC-Reinigung und guter spezifischer Aktivität (20-40 GBq/µmol) hergestellt werden. Der Einsatz von Peptiden ist für die molekulare Bildgebung besonders attraktiv, jedoch oftmals durch ihre Instabilität in vivo, ausgelöst durch ubiquitär vorhandene endogene Peptidasen, limitiert. Beispielsweise besitzt ein N-terminal 18F-fluorbenzoyliertes Neurotensin(8-13) eine biologische Halbwertszeit von weniger als 5 min in vivo. Mit dem neuartigen 18F-markierten Phosphopeptid [18F]FBz-MQSpTPL [18F]4 wurde ein Peptid geschaffen, das in vitro und besonders in vivo außerordentlich hohe Stabilität von > 50% nach 60 min aufweist und damit wegweisende Eigenschaften für die Entwicklung neuer stabiler Radiopeptide für die molekulare Bildgebung aufzeigt. Da Phosphopeptiden aufgrund ihrer negativgeladenen Phosphatfunktionalität ein intrazellulärer Zugang verwehrt bleibt, wie auch in dieser Arbeit an den Tumorzelllinien HT-29 und FaDu nachgewiesen wurde, steht die Realisierung einer verbesserten intrazellulären Internalisierung von Phosphopeptiden im Blickfeld des zweiten Teils der Promotion. Der Versuch einer gezielten Zellaufnahme über rezeptorinternalisierende Peptide wurde mit dem Neuropeptidhormon Neurotensin(8-13) (NT(8-13)), welches über einen G-Protein-gekoppelten Mechanismus in die Zelle gelangt, beschritten. Jedoch zeigte ein Triazol-verbrücktes Konjugat 8 aus NT(8-13) als molekularer Transporter und dem Phosphopeptid MQSpTPL 2, welches auf Basis der Azid-Alkin-Click-Chemie synthetisiert wurde, anhand seiner niedrigen Bindungsaffinität (IC50 = 8,33 µM) kein Potential zu einer erfolgreichen Zellinternalisierung des Phosphopeptides. Vermittler eines rezeptorunabhängigen molekularen Zelltransportes stellen zellpenetrierende Peptide (CPP) dar. Versuche mit den derzeit kürzesten CPPs, den zellpenetrierenden Pentapeptiden (CPP5) oder auch Bax-Inhibitoren genannt, waren nicht erfolgreich. Zwei weitere, in dieser Arbeit verwendete, potente CPPs sind sC18, abgeleitet aus dem antimikrobiellen Peptid Cathelicidin, sowie hCT(18-32)-k7, einem verzweigten Calcitonin-Derivat. Mit den Phosphopeptid-CPP-konjugierten Verbindungen MQSpTPL-sC18 2-CPP1 und MQSpTPL-hCT(18-32)-k7 2-CPP2 wurden nicht-toxische Konstrukte geschaffen, die eine definierte Aufnahme in HeLa, MCF-7 und HT-29 Zellen aufweisen, wie nach Markierung mit dem Fluoreszenzfarbstoff 5(6)-Carboxfluorescein (CF) mittels optischer Bildgebung nachgewiesen werden konnte. Die Integration und Anwendung der Mikrofluidik-Technik im Rahmen der Darstellung der N-terminal 18F-fluorbenzoylierten Phosphopeptid-CPP-Konjugate [18F]FBz-MQSpTPL-sC18 [18F]2-CPP3 und [18F]FBz-MQSpTPL-hCT(18-32)-k7 [18F]2-CPP4 weist im Vergleich zur konventionellen Radiomarkierung entscheidende Vorteile auf. In Anwesenheit der für die [18F]SFB-Markierung reaktiven ε-NH2-Gruppen in den CPP-Fragmenten zeichnet sich im Rahmen der mikrofluiden Markierung entscheidende Selektivität für den N-Terminus der Peptide ab. Die radiochemischen Markierungsausbeuten betragen 21% für [18F]2-CPP3 und 26% für [18F]2-CPP4, im Vergleich zu 2-4% für [18F]2-CPP3 und [18F]2-CPP4 bei klassischer Markierung. In Zellaufnahmestudien wurde ebenfalls eine Internalisierung der 18F-markierten Konjugate in FaDu, HT-29 und MCF-7 Zellen bestätigt, die in allen drei Zelllinien vergleichbar ist und um 40% ID/mg Protein liegt. Wie auch das 18F-markierte Hexaphosphopeptid selbst in Wistar-Unilever-Ratten, zeigten die 18F-markierten Phosphopeptid-CPP-Konjugate in Kleintier-PET-Untersuchungen in Balb/C-Mäusen (Normaltiere) die für ein radiomarkiertes Peptid typische Bioverteilung. Hierbei ist eine renale Exkretion eingeschlossen. Im Rahmen dieser Arbeit ist es gelungen, erstmals 18F-markierte Phosphopeptide mit zellpenetrierenden Eigenschaften für die molekulare Bildgebung zu entwickeln. Diese neuen zellpenetrierenden Phosphopeptide stehen für die Untersuchung intrazellulärer Prozesse, die auf Phosphorylierungs-/Dephosphorylierungsprozessen basieren, zur Verfügung.

La prise en charge des cancers bronchiques localisés et localement avancés reste un challenge thérapeutique en cas de traitement par radiothérapie ou radio-chimiothérapie avec des taux d’échec importants. Il a été démontré que la Tomographie par Emission de Positons (TEP) au FDG était indispensable dans la stadification et la planification de la radiothérapie des cancers bronchiques non à petites cellules. De nombreux travaux ont proposé d’adapter le traitement de radiothérapie aux données de la TEP du métabolisme (FDG) mais également à partir de la TEP de l’hypoxie. Nous avons au cours des dernières années essayé de définir les différentes stratégies d’adaptation de la radiothérapie à partie des données de l’imagerie fonctionnelle. Dans le premier travail (travail 1), nous avons analysé les différentes méthodes de segmentation de traceurs à faible contraste pour obtenir des méthodes reproductibles et utilisables au cours d’essais thérapeutiques multicentriques. Ce travail a permis de définir une méthode de segmentation pour le FMISO (traceur de l’hypoxie) mais également pour la FLT qui permet de définir la prolifération. Le second travail (travail 2a et 2b) est le résultat de l’étude multicentrique d’augmentation de dose de radiothérapie à partir des données de la TEP FMISO. Dans ce travail, nous avons proposé de réaliser un boost de radiothérapie chez les patients présentant des tumeurs hypoxiques. Il a été démontré qu’une augmentation modérée de la dose de radiothérapie permettait d’obtenir le même contrôle local à 3 mois pour des tumeurs pourtant plus volumineuses et une tendance à un contrôle supérieur à 3 ans chez les patients ayant pu bénéficié d’un boost par rapport à ceux traités à 66Gy (26.5 mois versus 15.3 mois). Les travaux suivants (travaux 3 et 4) s’intéressent à l’hétérogénéité de fixation de la TEP-FDG et aux méthodes de segmentation de ce traceur en per-radiothérapie. Ces données permettent d’envisager des doses de radiothérapie hétérogènes avec des augmentations ciblées sur les volumes les plus hypermétaboliques en pré-traitement ou sur les volumes pour lesquels il persiste une fixation pathologique en cours de traitement. Les travaux 5 et 6 s’intéressent aux corrélations entre les zones les plus hypermétaboliques (FDG) et les zones hypoxiques (FMISO). Dans un premier temps, nous mettons en évidence le manque de corrélation entre ces 2 traceurs puis dans un second temps l’impact dosimétrique des différentes stratégies de radiothérapie adaptative basée sur la TEP du métabolisme ou de l’hypoxie. Dans le dernier travail (travail 7), nous avons comparé les résultats de deux traceurs de l’hypoxie chez des patients traités par chirurgie pour un cancer bronchique ; ces données ont été comparées aux données d’immunohistochimie pour permettre une meilleure connaissance des traceurs de l’hypoxie. L’ensemble de ces travaux doit permettre une meilleure identification des stratégies de radiothérapie adaptative basée sur l’imagerie fonctionnelle par TEP du métabolisme ou de l’hypoxie. / Résumé en anglais non disponible