Page 10 - ITPS-6-2

INNOSC Theranostics and
Pharmacological Sciences Theranostics in neurosurgery

Alzheimer’s disease (AD), are characterized by a decreased
expression of SVA2 with a decreased synaptic density [42,43] .
Various therapeutic modalities can be used to slow the
progression of neurodegenerative disorders, such as
electrical neural stimulation, and these forms of treatment
can be paired with [ C]UCB-J to provide active feedback
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while implementing therapeutic measures . The measure
[44]
of SVA2 by [ C]UCB-J has a remarkable diagnostic
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capability in neurodegenerative diseases. It has long been
and continues to be the standard radiotracer to diagnose
different forms of dementia, as well as their severity and
[42]
varying cognitive manifestations . For instance, in one
preclinical study by Bertoglio et al. using an animal model,
PET scans were conducted for two groups of mice: One
Figure 2. Targeted radionuclide therapy possesses both therapeutic wild-type group and one group with AD . Mice with AD
[45]
and diagnostic capabilities in the form of size reduction and tumor showed a significantly lower uptake in the hippocampus.
demarcation, respectively. The incorporation of radiolabeled molecules
safely allows for several routes of action as demonstrated. Similar studies were done in mouse models with PD and
Huntington’s disease, which showed diminished SV2A
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oncology. A study by Palmisciano et al. found that [ Ga] quantity on PET imaging, emphasizing that [ C]UCB-J
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Ga-DOTA-SSTR PET tracers can provide accurate images can be used to diagnose brain activity in different forms
[45]
for the clinical management of meningiomas and pituitary of dementia .
adenomas due to their strong binding to a pathological Decreased concentrations of the [ C]UCB-J in mice
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overexpression of somatostatin subtype receptors 2 with AD were recently corroborated in clinical trials,
(SSTR2) . Accordingly, this tracer is employed in surgical which further emphasized the diagnostic potential of [ C]
[32]
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resections to clearly demarcate tumor involvement and UCB-J. For instance, one study by Wilson et al. compared a
minimize damage to the surrounding tissue. Numerous group of 12 patients with PD to 16 control patients . The
[46]
studies have been conducted to assess the clinical study found significantly lower [ C]UCB-J uptake volume
11
applications of [ Ga]Ga-DOTATOC-PET, which are on PET scans in various brain regions in patients with
68
outlined in Table 1. In one case report of a 68-year-old PD, but it also found correlations between SVA2 and the
man with pituitary carcinoma, [ Ga]Ga-DOTA-SSTR was severity of patient symptoms. In doing so, it highlighted
68
combined with [ Lu]Lu-DOTATATE and contributed to the correlation between synaptic density and subsequent
177
a decline in tumor progression over four years . As [ Ga] brain and cognitive damage . In another comparative
68
[33]
[46]
Ga-DOTA-SSTR imaged the tumor through its affinity study by Chen et al., ten patients with AD were compared
for SSTR2, which was overexpressed in the pituitary to 11 control patients. The study found a 41% reduction
gland by the tumor, [ Lu]Lu-DOTATATE was able to in hippocampal [ C]UCB-J in patients with AD, and it
177
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exert its radioactive effects at binding sites to slow tumor expanded on this finding by linking [ C]UCB-J to cognitive
11
progression . Hence, diagnostic radiotracers, such as ability . Hence, in neurosurgical procedures, [ C]UCB-J
[33]
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[47]
[ Lu]Lu-DOTATATE, can be used to have a therapeutic can be used as a form of biofeedback for cognitive ability
177
effect on tumor progression, granting them excellent when paired with therapeutic modalities, including but not
theranostic capabilities. Other forms of radionuclide limited to electrical stimulation.
therapy can be also used for the treatment of meningioma,
such as Y-DOTATOC. Studies evaluating the utility of In addition, 18F-FDG is a glucose analog that can
90
this isotope are outlined in Table 2. be utilized to monitor cerebral glucose metabolism. It
has similar implications to [ C]UCB-J in classifying
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3.2. Radiotracers in neurodegenerative disorders neurodegenerative diseases by severity or cognitive
Radiopharmaceuticals can also be utilized to provide real- impacts. Because patients with dementia have decreased
time feedback during neurosurgical interventions. For cerebral glucose metabolism, 18F-FDG with PET scanning
instance, [ C]UCB-J in PET scans can be used to target allows for the differentiation of AD from the other
11
synaptic vesicle protein A2 (SVA2) and subsequently classifications of dementia by highlighting specific brain
measure synaptic density. SVA2 is a synaptic vesicle regions . In recent years, 18F-FDG is being increasingly
[48]
membrane protein involved in neurotransmitter release investigated to replace [ C]UCB-J in imaging for patients
11
from neurons. Neurodegenerative disorders, such as PD or with AD due to its longer half-life advantage .
[47]
Volume 6 Issue 2 (2023) 4 https://doi.org/10.36922/itps.417