Current Radiopharmaceuticals - Volume 6, Issue 4, 2013

The pathology of Alzheimer’s disease (AD) is characterized by the extracellular and intracellular accumulation of amyloid-β (Aβ) fibrillar plaques formed by the Aβ1-42 peptide, neurofibrillary tangles (NFTs) consisting of hyperphosphorylated tau, extensive neuritic and synaptic degradation, and neuron loss. One of the priorities for the treatment of AD is both the early detection and accurate chart progression of the accumulation of Aβ plaques in human brains. Molecular imaging tools can provide an in vivo visualization of Aβ plaques. Specific identification of amyloid plaques would allow a more accurate prognosis and ensure more effective clinical trials of anti-amyloid agents at earlier disease stage. The emphasis of this review is on the development of Aβ peptide radiopharmaceuticals or the ones combined with nanocarrierbased such as Molecular Trojan horses or nanoparticles for applications in in vivo amyloid imaging in AD.

Over the last decade the interest towards functional neuroimaging has gradually increased, especially in the field of neurodegenerative diseases. At present, diagnosis of dementia is mostly clinical. Numerous modalities of neuroimaging are today available, each of them allowing a different aspect of neurodegeneration to be investigated. Although during the last period many have predicted a forthcoming disappearance of SPECT imaging in favour of the PET imaging, many new radiotracers SPECT, dual-SPECT tracers techniques and receptor targeting designed radiopharmaceuticals are currently at study. Besides, last decade has also assisted to the development of new SPECT imaging systems, most of them integrated with other imaging modalities (MRI, CT, ultrasound techniques), granting improved imaging capabilities. All these improved conditions, especially appealing for the neuroimaging, together with the new radiopharmaceuticals in development may renovate the interest for SPECT clinical applications.

An assessment of the new monograph chapter Compounding of Radiopharmaceuticals has been conducted on the basis of the first period of implementation of Italian legislation on Good Radiopharmaceuticals Practice (NBP) in the preparation of radiopharmaceuticals, in keeping with Decree by the Italian Ministry of Health dated March 30, 2005. This approach is well grounded in the several points of similarity between the two sets of regulations. The impact on patient risk, on staff risk, and on healthcare organization risk, has been assessed. At the same time, the actual costs of coming into compliance with regulations have been estimated. A change risk analysis has been performed through the identification of healthcare-associated risks, the analysis and measurement of the likelihood of occurrence and of the potential impact in terms of patient harm and staff harm, and the determination of the healthcare organization's controlling capability. In order to evaluate the economic impact, the expenses directly related to the implementation of the activities as per ministerial decree have been estimated after calculating the overall costs unrelated to NBP implementation. The resulting costs have then been averaged over the total number of patient services delivered. NBP implementation shows an extremely positive impact on risk management for both patients receiving Nuclear Medicine services and the healthcare organization. With regard to healthcare workers, instead, the implementation of these regulations has a negative effect on the risk for greater exposure and a positive effect on the defense against litigation. The economic impact analysis of NBP implementation shows a 34% increase in the costs for a single patient service. The implementation of the ministerial decree allows for greater detectability of and control over a number of critical elements, paving the way for risk management and minimization. We, therefore, believe that the proposed tool can provide basic criteria for analysis that could be used by other organizations setting about completing the same process.

Molecular imaging with various biomarkers plays a significant role in the diagnostic assessment of patients with dementing disorders, by detecting functional and pathophysiologic changes in the brain. PET imaging, in particular, allows the measurements of different molecular targets, such as functional markers of neurodegeneration (glucose metabolism), markers for pathological aggregates (such as amyloid, tau and synuclein aggregates) and neuroinflammation, and also markers of several neurotransmission systems. In the current view, neurodegenerative diseases are associated with the development of pathologic changes that play a different role in disease onset and evolution, often starting long before the onset of clinically detectable impairment. Molecular imaging represents thus a unique tool to collect relevant information contributing to accurate diagnosis, treatment and response monitoring. In this article, we review the current literature focusing on the PET radiotracers used for molecular imaging in dementia.

In this study was carried on a systematic review of the data was carried out in the topic of monoclonal antibodies in the last 40 years. All the data collected and summarized revealed that this new class of medicine may bring great advance in the field of radiopharmacy, oncology and imaging.

Incidence of thyroid cancer (TC) has increased over the last decade, in most parts of the world, possibly because of increased ionizing radiations. We therefore analyzed records of patients with TC who were treated at our hospital (Prof. Dr. Ion Chiricuta, Institute of Oncology Cluj-Napoca, Romania) since the nuclear accident at Chernobyl in 1986. We performed a comparative analysis of the database for 10, 20 and 25 years after the Chernobyl accident. Changes in histological profiles and tumor sizes imply that, in addition to nuclear fallout, highly sensitive thyroid diagnostic procedures are responsible for this increase in reported incidence, which appears to be driven by improved discovery of small (< 1 cm) preclinical tumors. This invites a real public health question.