Molecular imaging of tumor-specific markers and their expression in other organs
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Cardio-Oncology Service, Nuclear Cardiovascular Imaging Laboratory, Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY
Received Jun 2, 2020; accepted Jun 2, 2020 doi:10.1007/s12350-020-02310-1
See related article, https://doi.org/10.10 07/s12350-020-02307-w. Nuclear imaging provides us with a unique ability to study various biochemical, metabolic and molecular processes, expression of cell membrane proteins and receptors, matrix composition, and gene expression, at a cellular, tissue and organ level in intact animals and humans under various physiological conditions.1–6 This involves an identification of a target inside the body, which is highly specific for a particular disease process and is abundantly expressed and is amenable to an exogenously administered probe. The next step requires an identification or development of new ligand(s) specific for that particular target and its radiolabeling with a suitable radiotracer to image the target. These techniques allow us to study the metabolism of glucose, free fatty acids and various amino acids; nucleic acid synthesis as a marker of cell proliferation; activity of membrane transporters; expression of cell membrane associated and matrix-associated proteins and receptors and delivery of therapeutic interventions to these targets. These imaging techniques have greatly enhanced our understanding of tumor biology and pathophysiology and have also played a significant role in developing several highly effective novel cancer therapies.7 Fluorine-18 labeled deoxyglucose (18FDG) imaging has been the backbone of molecular imaging and is in extensive clinical use for diagnosing and staging of solid cancers
Reprint requests: Diwakar Jain, MD, FACC, MASNC, Cardio-Oncology Service, Nuclear Cardiovascular Imaging Laboratory, Department of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
and in evaluating response to therapy in patients with various malignancies.8 18FDG imaging has also provided an interesting insight into the tumor microenvironment: a highly hypoxic and acidic milieu, primarily dependent upon anerobic glycolysis for meeting its energy demand. This requires a profound increase in glucose uptake, facilitated by an upregulation of cell membrane GLUT transporters and an upgraded system for clearance of lactic acid and other waste metabolites in the cancer cells. Although, 18FDG remains the key radiotracer used in oncology, a number of other radiotracers such as 18F-FLT (fluorothymidine), 18 F-Methionine, 18F-fluoroestrodiol have been developed and are undergoing evaluation for studying various aspects of tumor biology.9–11 In this issue of the journal Siebermair et al present cardiac findings in 32 patients with cancers (pancreatic cancer in 18 and malignancies of other organ systems in 14), who underwent whole body PET-CT or PET-MR imaging with 68Ga-FAPI (fibroblas
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