Radiotheranostics - Precision Medicine in Nuclear Medicine and Molecular Imaging.
Radiotheranostics - Precision Medicine in Nuclear Medicine and Molecular Imaging.
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DOI：
10.7150/ntno.64141
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Aparici CM
中科院分区：
文献类型：
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作者：
Duan H;Iagaru A;Aparici CM
“在分子水平上看你治疗什么，治疗你所看到的”，可能是治疗诊断学的座右铭。该概念意味着使用相同的分子诊断（成像）和治疗细胞（通常是癌症），从而保证成像的肿瘤细胞的靶向细胞毒性方法，同时保留健康组织。正如已故的山姆·甘比尔所说，成像剂就像一个“分子间谍”，揭示了肿瘤细胞的位置和疾病负担的程度（诊断）。对于治疗，相同的“分子间谍”停靠在相同的肿瘤细胞上，这次提供细胞毒性剂量的辐射（治疗）。这种双重性代表了“治疗诊断对”的概念，它遵循了目标精确和个性化医疗的范围和基本原则。虽然在21世纪初的医学文献中提到了治疗诊断学一词，但这一原理对核医学来说并不新鲜。治疗诊断学的第一个例子可以追溯到1941年，当时扫罗·赫兹（Saul Hertz）博士首次应用放射性碘对甲状腺功能亢进症患者的甲状腺细胞进行放射性核素治疗。从那时起，治疗诊断学就一直是核医学和分子成像的一个组成部分。我们越了解肿瘤生物学和致癌的分子病理学，包括特异性突变和受体表达谱，就越能开发出特异性更高的“分子间谍”，用于诊断性分子成像和随后的放射性核素靶向治疗（放射治疗诊断学）。为“治疗诊断对”适当选择诊断和治疗放射性核素至关重要，不仅要考虑细胞毒性辐射发射的类型，还要考虑线性能量转移（LET）和物理半衰期。放射化学和放射性药物学的进展与新的放射性标记技术和螯合剂正在彻底改变该领域。由于所有这些进步，细胞毒性全身放射性核素治疗的前景在过去几十年中急剧扩大。本文讨论了目前和未来有前途的治疗诊断应用的各种类型的疾病，如甲状腺疾病，神经内分泌肿瘤（NET），儿科恶性肿瘤，前列腺癌（PC），并提供了一个展望未来的前景。
'See what you treat and treat what you see, at a molecular level', could be the motto of theranostics. The concept implies diagnosis (imaging) and treatment of cells (usually cancer) using the same molecule, thus guaranteeing a targeted cytotoxic approach of the imaged tumor cells while sparing healthy tissues. As the brilliant late Sam Gambhir would say, the imaging agent acts like a 'molecular spy' and reveals where the tumoral cells are located and the extent of disease burden (diagnosis). For treatment, the same 'molecular spy' docks to the same tumor cells, this time delivering cytotoxic doses of radiation (treatment). This duality represents the concept of a 'theranostic pair', which follows the scope and fundamental principles of targeted precision and personalized medicine. Although the term theranostic was noted in medical literature in the early 2000s, the principle is not at all new to nuclear medicine. The first example of theranostic dates back to 1941 when Dr. Saul Hertz first applied radioiodine for radionuclide treatment of thyroid cells in patients with hyperthyroidism. Ever since, theranostics has been an integral element of nuclear medicine and molecular imaging. The more we understand tumor biology and molecular pathology of carcinogenesis, including specific mutations and receptor expression profiles, the more specific these 'molecular spies' can be developed for diagnostic molecular imaging and subsequent radionuclide targeted therapy (radiotheranostics). The appropriate selection of the diagnostic and therapeutic radionuclide for the 'theranostic pair' is critical and takes into account not only the type of cytotoxic radiation emission, but also the linear energy transfer (LET), and the physical half-lives. Advances in radiochemistry and radiopharmacy with new radiolabeling techniques and chelators are revolutionizing the field. The landscape of cytotoxic systemic radionuclide treatments has dramatically expanded through the past decades thanks to all these advancements. This article discusses present and promising future theranostic applications for various types of diseases such as thyroid disorders, neuroendocrine tumors (NET), pediatric malignancies, and prostate cancer (PC), and provides an outlook for future perspectives.