Thanks, Thanks, Debbie. Debbie. It's a great pleasure to be here, It's a great pleasure to be here.
and I appreciate your invitation and the organization's invitation. I appreciate your invitation. I'm actually relatively fresh off the plane from Seattle, We are from Seattle, just having moved here this summer. just had you moved here this summer. And, you know, And this is a really unique resource.
this is a really unique resource. I come from another world-class cancer center in Seattle, I come from another world-class cancer center in Seattle, the Fred Hutch Cancer Center. the Fred Hutch Cancer Center.
We didn't really have anything like this, We didn't really have anything like this and actually sent many of our NET patients out. and I've just sent many of our MDT patients out. So you may have gotten used to this and not quite understand how valuable and unique a resource having this big a program in a major cancer center is.
So you may have gotten used to this, and I quite understand how valuable it is. And so I've been very impressed and enjoyed being here. For those who are, For those that have been involved with nuclear medicine before, I feel like the entries you've seen in the name of the doctor were over.
I'm most for sure... Do we have another one on somewhere? No.
I feel like everybody's seen the scene in the naked gun. For those who have not, We want to avoid that kind of scene. Those that laugh probably remember that scene. we've seen our clinical director, You've probably seen our clinical director, Dan Crema, who's been taking charge.
Dan Prima, who's really taken charge of this program. And Dan thought it would be a good idea to have him on the show. good idea for his new chief to get a better idea of what the program's like. And so I've enjoyed getting to do that, and it's a pleasure for me to be here. I have a number of slides, as imagers always do.
I'm actually going to step through a few of them relatively quickly with the idea that I want to concentrate on a couple of areas. Nuclear medicine is this very strange interface between medicine and chemistry and nuclear physics. And I thought what I might do today is just explain some of those terms so when you walk into the department to get a scan or especially if you get therapy, So with the water and symbols and pieces of equipment, all these weird sort of numbers and symbols and big pieces of equipment that you see might make a little bit more sense.
you see money. And with the little of course, that's the mind of the point. They might not, but they might make a little bit more sense.
So I'm going to just very briefly talk about the importance of the nuclear medicine procedures for pheo-and pyrobic ganglioma patients. So I'm going to just share a little bit of information. So remember that you can see some of the things that are coming down. I'm going to concentrate almost the entirety on MIBG and some of the things that are coming down the pike in MIBG because I think that's going to be most of your interaction with nuclear medicine as a pheo and para patient. So without going through this in detail, and I'm going to skip this slide, there's a diverse group of patients with neuroendocrine tumors.
We actually have things in nuclear medicine for all of them. We're going to concentrate today on the pheochromocytomas and paragangliomas. I promise I won't go through quite this quickly. You'll get dizzy if I do. So, So why is it that you may have symptoms, why are radioisotope imaging and therapy important for patients who have this disorder?
So, you may have some masses or not have masses, number one is, this may be something that may be very helpful in early diagnosis. or an attitude like CT or MRI, When you have an early diagnosis, you have symptoms, you may have some masses or not have masses. you may have had a chemical accident, on an anatomic imaging like CT or MRI.
You may have biochemical abnormalities. What the nuclear medicine does is actually co-localizes the biochemical functionality with the anatomy. So if you have a mass in your adrenal, we can confirm, for example, that that is in fact a pheo based upon a cell. its functionality. This may be very important when the pheos or paras show up outside of the adrenal, The first, um, uh, repairs show up outside of the adrenal, which they do by definition for paras.
And in that case, which they do by definition. it can be very difficult to localize them by conventional technology. But because we're looking for regional function, And in that case, it can be very, we can identify those locations.
it escapes and becomes metastatic. And then as you heard earlier this morning, when this escapes and becomes metastatic, Um, the very few suspected therapies that work very well. there are very few systemic therapies that work very well. MIBG therapy is kind of like systemic radiation. radiation therapy, radiation therapy, and so it's actually a reasonably effective process.
and so it's actually a reasonably effective process. It's actually relatively rarely done in the U.S. This is one of the few centers that is doing it. It's actually relatively rarely best.
We certainly weren't doing that at my former center in Seattle. The therapy is good because it's highly targeted. This is a therapy that's highly targeted.
Wherever this is taken up biochemically, We're going to see this a little bit later.... as you'll see a little bit later, the radiation we deposit is quite localized. And it can be quite effective in stemming tumor growth and even causing some tumor regression.
effective in stemming tumor growth and even causing some tumor to react to toxicity. with reasonable acceptable toxicity. And some new approaches that you heard about briefly in the overview this morning that I think are going to hold a lot of promise for actually going and doing a much better job of killing the tumor rather than just holding it at check are under evaluation, It's a new approach this morning that I think is going to hold. What is that energy and how does it work? in part from funding that have come from organizations that are affiliated with this group.
So I'll show some of that. So what is MIBG and how does it work? So I can barely pronounce it.
It's meta-iodobenzuanidine. I was a good physicist. I wasn't much of a chemist.
For those that are chemists and like chemical diagrams, you can see the structure over here. This was actually invented back in 1979 by Don Whelan, sort of one of the pioneers in nuclear medicine. And without dragging you through the chemistry, this acts like norepinephrine.
...like norepinephrine. So why do these things work? So why do these things work? We pick a chemical that is the same or almost like what the body uses, We pick a chemical that is the same or almost like what the body uses, and we basically use this radioactive version of this to trace through the pathways.
and we basically use this race through the path. So MIBG is a rather fancy name for something that looks a lot like epinephrine and norepinephrine. So NYBT is the right side.
All right, now we go to the nuclear side. So we go back to Physics 101 and atoms. Remember that there's a nucleus with protons and neutrons and a bunch of electrons whizzing around the outside.
The protons and neutrons are very heavy particles. The protons have a positive charge. And for stable elements, For stable elements, we tend to have about the same number of protons and neutrons as the we tend to have about the same number of protons.
elements get a little bit bigger, they like a little bit of excessive neutrons compared to protons. And for an atom, The electrons are light. They also have an electric charge.
it's far. If you didn't have an equal number, And for an atom, the protons are going to be equal to the electrons. You would spark if you didn't have an equal number of positives and negatives.
the nature of the atom is all of these types of interactions. And so nature likes to be balanced, at least except for relatively transient conditions. So that's what the atom is all about. the interactions that make the difference. Now, what determines chemical behavior is the number of electrons, Now, what determines chemical behavior is the number of electrons.
and therefore, by definition, the number of protons. What determines nuclear behavior is really the combination of the two, What determines nuclear behavior is the number of atoms in the cycle. as you'll see in a second. So what is a radioisotope?
Well, it's an element with a different atomic weight than the naturally occurring element that's radioactive. So, what is a isotope? Well, it's an element with a different atomic weight than the natural.
So, for example, fluorine, which is a compound commonly used in PET, or positron emission tomography, likes to exist as fluorine-19 in nature. So, if we were to take away one... When you take away one of its neutrons, it likes to get back to where it was and will actually emit a positron. I'll explain that in a second. And so these nuclei are usually imbalanced between their protons and neutrons.
And so these nuclei are usually in balance between the protons and neutrons. This may be much more than you wanted to learn on a Friday morning, but I hope to bear with me. So unstable isotopes have radioactive decay that include beta decay.
It's made much more than that. Let's see if the lysine starts to have radioactive decay. The reason that's important, that's how most of our therapy works at this point.
It includes beta decay, Gamma decay that yields a high-energy photon, and that's important. That's how most of our therapy works. a bit like an X-ray, X-ray, that's important because that's how we do our X-ray. that's important because that's how we do our imaging. And then positron decay, which is important for those that have ever had a PET scan because that's how a PET scanner works.
...the realest out of the best game that works. Positron, incidentally, is an anti-electron. How to turn incidentity into an anti-electron. It annihilates with... It annihilates with target electrons in the block.
target electrons in the body. And so it's a matter-antimatter interaction. And so as a matter of anti-Star Trek fans, So for this is actually the way Star Trek ships are supposed to work.
Star Trek fans, this is actually the way Star Trek ships were supposed to work. We just don't want to see you playing that. We just don't go at warp speed quite yet. So, let's go through an example of... So let's go through an example.
Iodine is a rather important compound. I think I may have got the numbers cut off a little bit. The naturally occurring iodine has 53 protons and 74 neutrons.
It likes a little excess of neutrons. And it's stable and it kind of hangs out and it's an important part of your body composition. ...stable in the 90s, I don't know if this is especially important, It's especially important for thyroid type processes. but I signed with Trump to cancel our island in the 30s because we couldn't get the regional distribution of air, Now I-123 has too few neutrons and it has to be made by a cyclotron because it doesn't naturally exist. It has about a 12-hour half-life, so it needs a pretty impressive production network.
which is the way we get it. During the hurricane, we had to cancel our I-123 procedures because we couldn't get the original distribution by air, What it does is it captures the light. which is the way we get it.
And what it does is it captures an electron. So it pulls an electron into the nucleus, and one way of thinking about it is it turns one of the protons into the neutron, And one way of thinking about it is it turns one of the protons into the neutrons, so it gets back to where the natural isotope is. so it gets back to where the natural isotope is. And this will produce a gamma, And this will produce a gamma, and we use that for imaging.
and we use that for imaging. I131, which is the isotope that we use for therapy, I-131 isotope that we use for therapy has too many neutrons. has too many neutrons.
It's made by a nuclear reactor, It's made by yourself. You go down to your local power plant. so if you go down to your local power plant, dip your hand in the bucket, you can get something a little bit more complicated than that.
It's an 8-day epileptic. You can get some I131. It has an eight-day half-life, so it hangs around for a while.
is part of the way it works. The decay is by beta decay, It decays by beta decay, which you will see in a second, which in a second you'll see is a particle that's very helpful for therapy, is a particle that is very helpful for therapy. and it also produces a gamma so we can do some imaging of the I-131, And it is also used in some imaging with the I131.
But now it's actually used in the I133. but not as nicely as we can of I-123. So here's the picture.
So here's the picture. We have beta decay, We have beta decay, which yields a fast electron or a beta particle, which yields a fast electron. as well as an antineutrino. We don't hear a whole lot about antineutrinos or neutrinos. They tend to pass through large objects.
They tend to pass through large objects that pass through the earth on a regular basis when they come from the sun. They pass through the Earth on a regular basis. regular basis when they come from the sun.
So they don't interact much with neutrinos in our daily life. So we don't interact much with neutrinos in our daily life. The beta particle, The beta particle, on the other hand, on the other hand, is a fast electron that will dump all of its energy into a relatively small place. is a fast electron that will dump its energy into a relatively small place. And if you do that in the right location, And if you do that in the right location, you can cause some significant tissue damage and damage to DNA.
you can cause some significant tissue damage and damage to DNA. And that's, And that's, in essence, in essence, how we kill tumors when we use something like I-131. how we kill tumors when we use it.
I-124, you're going to see, I-124, you're going to see at the very end of my talk, is a positron. And so, is a positron emitter. when it releases one of these... And so when it releases one of these anti-electrons, it actually goes on to generate some other downstream.
Some other downstream nuclear effects, downstream nuclear effects that we can actually image and gives us a rather extraordinary way to image patients. we can actually image and use a rather extraordinary way to image patients. And I'll show you how that works in a second. And I'll show you how that works in a second.
And then some... And then some, Isotopes will give us a gamma decay or a high-energy photon that will escape the body but interact with our detectors, as you touched on, we'll escape the body and interact with our detectors, and that's how we do imaging. and that's how we do imaging.
For any nuclear physicist in the crowd, For any new systems, they're probably more complex, you'll realize that pure gamma decay with no change is actually not one of these two isotopes. I suppose. But these two compounds do deal with cameras, But these two compounds do yield gammas, which are fairly... which are fairly important in the process. Okay, so let's go back now to chemistry.
Okay, let's go back now to chemistry. You can see people who live in nuclear medicine have to kind of be able to go back and forth between disciplines. Let's see, people with an infirmary medicine have time to deal with the graphic.
So how does this MIBG stuff work? Here's norepinephrine. Here's MIBG. Here's the neuro-epidemic.
With a little bit of imagination, Here's MIBG. you can begin to see that those look somewhat similar. You can begin to see that those look somewhat similar.
So what happens? In nerve terminals in the sympathetic and parasympathetic system, So what happens, in nerve terminals in the sympathetic and parasympathetic systems, especially the sympathetic system, they're built to kind of handle these kind of molecules. especially the sympathetic system, they're built.
And in general, And in general, what happens is when they release norepinephrine, what happens is, when they release norepinephrine, they like not to waste that, they like not to waste that, and so they actually reabsorb a fair amount of that when they're done using it in the nerve terminal and in that junction. and so they actually reabsorb a fair amount of that using it in the nerve. And so there is uptake called uptake 1. And so there is an uptake called uptake 1. that will come into the nerve and get stored in little vesicles in the nerve terminal. It's stored in little vesicles in the nerve terminal, and so basically, And so basically, the MIPG fades out of the system and will come in through that mechanism and get stored there. MIBG fakes out the system and will come in through that mechanism and get stored there.
Now, Now, if it has an imaging compound associated with it, if it has an imaging compound that came from it, we can tell where that came from and take a picture of where we have these nerve terminals in excess, say, to take a picture of where we have these nerves in excess, taking up too much of this kind of material. taking up too much of this kind of material. And if we put a therapeutic payload on this, And if we put a therapeutic payload on this, we can actually use it to kill the cell that took that up, we can actually use it to kill the cell and pick that up, which we want to do if we're trying to take care of tumors. which we want to do. Now one of the important things is there's two types of uptake.
There's a type 1 uptake and a type 2 uptake. There are two types of uptake. When we can make relatively pure stuff that has relatively little chemical and a lot of radionuclide, There's a type 1 uptake that we make.
The type 1 uptake is specific and very localized. we get type 1 uptake, which is the way we want to be. It's very specific.
As we start getting to the point of having a type 2 uptake, It's very localized. If we start getting to the point of having type 2 uptake, it's much less concentrated, it's much less concentrated. It's much more distributed over the body rather than in the tumors per se. it's much more distributed over the body. ...say, And so this is one of the impetus is to try to get as good and so this is one of the purposes to try to get as good MIBG and as good synthesis as we can.
MIBG and as good synthesis. as we can. I'll explain that in just a second. So, I won't go into these types of mechanisms of uptake, I'll explain that in just a second.
So, I won't go into it, but again, but again, we want to get the really sort of high affinity, we want to get really sort of high affinity. very localized uptake as part of our approach. So what are the indications for MIBG?
So what are the indications for MIBG? And again, the most common indication is going to be theochromoparal ganglioma. If you're a children's hospital, you'll be using this for related tumors, neuroblastomas. And then we do use this somewhat for other neuroendocrine tumors, although if you come to my session there later, if you're interested, you'll see we use a few other compounds as well.
...as well. I know you can't possibly read this slide, Anybody who can't possibly read the slide, if you come to nuclear medicine, but if you come to Nuclear Medicine, talk to Katie, our nurse who's over there, talk to she'll go through a long list of medications that potentially interfere with us. Katie or a neurodivergent, there are a number of medications that are in the sympathetic chain, There are a number of medications that work by interfering with the sympathetic chain, and you have to be on certain specific classes of drugs not to interfere with MIBG.
and you have to be on certain specific classes of drugs not to interfere with MIPG. Because if you don't do that, Because if you don't do that, and we have a net and we have a negative MIBG scan, G scan, we don't know whether it's because you didn't go off the right medications, we don't know whether it's because you didn't go off the right medications. or we just don't have the tumor that takes up MIPG. or whether you just don't have a tumor that takes up MIBG. So the medications are actually a really critical component of what we do, So the medications are actually a really critical component of what we do.
and it's an actually fairly picky list, as you can see. So here's a normal MIBG scan. So here's a normal MIBG scan. Somebody that has a normal uptake in the heart and the liver, Somebody that has a normal heart excretion into the bladder.
some excretion into the bladder. In our scans, Our scans in black means that we've collected more photons. a black means that we've collected more photons, so it's hotter if you want to think about it that way. We have normal uptake in the salivary glands, a little bit of uptake in the thyroid that can happen for a variety of mechanisms, including iodine that goes off the molecule. So this is a relatively normal scan.
This is a relatively normal scan. Sometimes we'll even see a little bit of... Sometimes you can see a little bit of normal difference back here. normal adrenal, which we can see back here. Now here's somebody who has a metastatic paraganglioma, Here's somebody who has a medicine that's numbered.
and there's a number of things that are not normal. There's this large There's a large MIMG added tissue mass there. MIBG-avid tissue mass there, and if you look from the back, And if you look from the back, there's a couple of other sites which are likely to be metastases in other locations, there's a couple of other sites which are likely to be metastases in other locations, including what looks like metastases in the spine. including what looks like metastases in the spine. Now these are relatively clear pictures, Now these are relatively clear.
and they're not always like this, and this is part of our job security is to be able to read these. And this is part of our job security is to be able to read these. One of the big advantages recently is we're now combining One of the big advantages recently is we're now combining our new medicine cameras with CT cameras so we can bring the anatomy and the function together.
our nuclear medicine cameras with CT cameras so we can bring the anatomy and the function together. That's been a very powerful tool. That's the places in the country that are well set up for what we call spec CT or PET CT. Not many places in the country are well set up for what we call SPECT CT or PET CT.
Ours is one of the institutions that's there. Ours is one of the institutions that's there. We're actually about to make an investment in about four or five new SPECT CT cameras specifically for these kind of indications.
We're actually about to make an investment to not fortify new spec CT cameras, specifically for these kind of indications. All right, All right, so let's talk a little bit about the treatment, so let's talk a little bit about the treatment. and then again, And again, I'll try to move... I'll try to move this along and show you a little bit of the advance that we're doing.
This along with a little bit of the advanced that we're doing. I know those of you that came to talk to Katie this morning had a chance to talk a little bit about this as well. So what are the principles for I-131-MIBG?
I know a lot of those of you that came to us. Well, the... And I131, as you saw, So what are the principles for tissue damage? is a good isotope if you're trying to do tissue damage.
And in this case, And in this case, you're carrying this nuclear payload on top of a chemical that will localize with fair specificity into the tumor sites. you're carrying this nuclear payload of specificity into the tumor cells. Oops, Oops, sorry.
sorry. I131 is going to be the isotope of choice. because of its therapeutic benefit. And the efficacy comes because the beta particle stops within about a millimeter or so of where it's emitted. The C comes because the beta particle stops within about a millimeter, And so the chemical carries this payload to the place you want it, and so the chemical is able to process all its energy exactly where you want it.
and then it deposits all its energy exactly where you want to get rid of it, which is right in the middle of the tumor, so you can kill the tumor cell. Because of that, Because of that, the radiation is much more localized than we could possibly do if we had to do it in radiation from an accelerator. the radiation is much more localized than we could possibly get radiation from the accelerator. So some of these tumors are actually not that radiation sensitive, So some of these tumors are actually not that radiation sensitive, but because we can dump lots of radiation into a very small place, but with lots of radiation to a very small place, without further ado, let's go ahead and see what we can do.
without hurting the rest of the body, That's underlying. that's the underlying efficacy for this type of approach. ...to see for this type of approach. But there is toxicity, But there is toxicity, and the toxicity comes from the localization of the radiopharmaceutical that is present in tumors other than tissue, and the toxicity comes from the localization of radiopharmaceuticals that is present in tumors other than tissue. and the rate-limiting toxicity, And the rate limiting toxicity, which limits our ability to do this, which limits our ability to do this, is going to be in those very sensitive tissues to radiation, is going to be in those very sensitive tissues to radiation, like the blood and especially the bone marrow.
like the blood and especially the bone. So the dose-limiting toxicity is hematologic. The toxicity is hematologic, meaning it's nadir, With its nadir, that means your trunks tend to drop out about four to six weeks.
that means your counts tend to drop out at about four to six weeks. The relatively low-dose approach to this, The relatively low-dose approach to this, and I'll define what a mimicry is in a second, and I'll define what a millicurie is in a second, is well-tolerated, is well-tolerated. and can actually be done as an outpatient. and can actually be done as an outpatient. This is all off-label.
This is all off, so it's not covered by insurance at this point, It's not covered by insurance at this point, so that's one of the limitations that we have in this treatment. so that's one of the limitations that we have in this treatment, That's why relatively few places do it. so I relatively few places do it. There have been some studies doing high-dose treatment. doing kindness treatment.
In some cases, In some cases, for example, for example, example at UCSF that was done with backup for a bone marrow transplant. at UCSF that was done with backup for bone marrow. So if you give too much, So if you do too much, you got to be sure, you've got to be careful to be able to replenish the marrow.
be careful to be able to replenish the marrow. You can actually do that as a clinic strategy. You can actually do that as a therapeutic strategy.
My former institution, My former institution, the Hutch Center, the Hutch Center, is famous for doing that, is famous for doing that, where you actually give a lot to wipe out the tumor, where you actually give a lot to write about these days. knowing you're going to have to replenish the bone marrow. And these days, replenishing the bone marrow is not as horrible a process as it used to be.
However, in general, this approach has been done without the need for what we call marrow ablation. This approach has been done without the need for what we call narrowing. We don't need to think about it.
So you really don't need to think about having a... There may be something there. transplant when you do this, but it may be something that one could come back to one day. Okay, Okay, so what's a millicurie?
so what's a millicurve? You've heard about this. You've heard about this. Well, a millicurie is a disintegration per second. Well, a millicurve is a disintegration per second.
It's a unit of radioactive decay. It's a unit of radioactive decay. That's the way we measure how many radioactive nuclei we have is how often we see a decay.
That's the way we measure how many radioactive nutrients we have when we see a decay. And the millicurie is just the number of And the millicurve is just the number of disintegrations per second converted to a vector. of disintegrations per second converted to a becquerel or a millicury, and one millicury is 37 million disintegrations per second.
37 million disintegrations per second, So there's a lot of nuclei in this world, and we get a fair amount of disintegrations when we give our activity. so there's a lot of new guy disintegrations when we get it. So the amount of radiation delivered is going to be proportional to the number of millicuries we give, So the amount of radiation delivered, which are typically for this kind of drug going to be in the sort of area somewhere around 100, which are typically for this kind of, you know, somewhere around 100 days, sometimes a little bit higher, maybe sometimes a little bit higher depending upon your specific dosimetry, for symmetry, and the amount of radioactivity that we're going to get. and that's what we call the dose, so it's the amount of radioactivity that we're giving you. So what happens?
So what happens? Well, Well, these are generally slow-growing tumors, these are generally slow growing tumors, and so we're mostly trying to stem their growth with radioactivity, and so we're mostly trying to stand in their up-do with the activity. and we're trying to get them to be more sensitive to radiation.
And we often do this with serial loader dose therapy, we often do this with serial low-dose therapy, knowing that we can give this to stop the tumor without causing much additional toxicity, knowing that we can give this to stop the tumor without causing much additional toxicity and without having to worry about wiping out the bone marrow. and without having to worry about the difference in studies in higher dose therapy, There have been some studies in higher-dose therapy, but again, but again, many of those were done with backup for the bone marrow, many of those are done with back-up with the donor, just in case you ran into one. just in case we ran into unexpected toxicity.
That's not necessarily been the approach that's been taken so far, ...the approach has been taken so far in the discipline of hand-to-hand. but it is an approach that can be taken. I'm going to kind of skip through some of these other processes and go on and talk a little bit about the Let's skip through some of these other processes and go on and talk a little bit about toxicity. little bit about toxicity. Again, Again, grade four hematologic toxicity, grade 4 hematologic toxicity, so a drop in white count platelets on white counts is the most common.
so drop in white count platelets on white counts, is the most common. And it happens in some of the higher dose trials, And it happens... Anytime you give this amount of radiation, but will recover in almost all folks. Anytime you give this amount of radiation, you will get some acute effects like nausea and vomiting. you will get some acute effects like nausea, vomiting...
And one of the things that patients need to be prepared with is no matter how much we try to block the thyroid by giving them a cold, And one of the things that patients need to be prepared with is no matter how much we try to block the thyroid by giving cold iodine, I don't know, a Lugol solution or SSKI solution, solution. There's a lot of people who get loose. there's I-131. one that gets loose.
When it gets loose, When it gets loose, it goes to the thyroid and it will destroy some of the thyroid tissue. it goes to the thyroid and will destroy some of the thyroid tissue. So some patients may need to go on thyroid hormone supplement when they get this treatment. So some patients may need to go on thyroid hormone supplement when they get this treatment.
I'm going to skip through some of the rest of this and I'll come back to it and just show you, Let's get through some of the rest of this and I'll come back to it. And just share with you the first. for example, here is the impact that we can get in many of the patients where you see some significant debulking of many of these masses before and after treatment. So this can be a very successful treatment. You see how that has actually now changed and decreased over time.
Let me skip through this in the interest of time. Talk to you a little bit about some exciting future directions, especially since much of this research has been supported by many of the patient advocate organizations. So one of the things we want to do is be able to get a much better idea of how much radiation we're delivering to the tumor. Right now we base our ...and base our treatment is based upon how much the patient can tolerate, our treatments based upon how much a patient can tolerate, we'd actually like to know how much radiation the tumor is getting.
we'd actually like to know how much radiation the tumor is getting. And this is where positron emission tomography comes into play. And this is where positron emission...
And when you get a PET scan, And when you get a PET scan, you usually think of an FDG PET scan. you usually think of an FDG We're actually looking at something different, at glucose metabolism. PET scan, But we can actually label the MIBG with I124 instead of I123 or I131, we're actually looking at something different.
We can actually labor a sort of I-123, and then take actually a rather nice-looking picture in a mouse, I-131, and then take actually a rather... Nice little picture of a mouse, if you happen to be a mouse, or more relevantly, if you happen to be a mouse, sorry. Must have the human or more relevant, MIBG here, human, uh, or PET scan in a patient.
uh, um, that's the indication, So compared to the other information you're seeing, so compared to the other definition... We have sort of an exquisite amount of detailed spatial information and anatomic information that tells us exactly where the localization is. We have detailed spatial information and atomic information that tells us exactly where the localization is. More importantly, More importantly, it's quantitatively very accurate, it's quantitatively very accurate to exactly how much of the molecule got to each part of the body.
so we can tell exactly how much of the molecule got to each part of the body, and we can use that to do much more sophisticated calculations of how much radiation we're getting to the patient. And we can use that to do much more sophisticated calculations of how much radiation. One of the most exciting areas that I think is coming out of the plant is this compound called acetine.
Now, one of the most exciting areas that I think is coming down the pike is this compound called astatine, this element called astatine-211. It's something we call acetine-211-mg. You're going, I don't think I heard about that in my chemistry class. Actually a very heavy element. It's actually a very heavy element, And in 211, and at 211 it becomes an alpha emitter, we use an alpha emitter.
I'll show you in a second. and I'll show you what that is in a second. Alpha emitters are very effective at causing tissue damage in the face.
Alpha emitters are very effective at causing tissue damage, and they can therefore be very effective therapeutic agents. I liken this to a beta emitter trying to knock down a building with a bowling ball. I liken this to a beta emitter trying to knock down a building with a...
bowling ball, I mean, I mean with a golf ball, with a golf ball. rather than using a big wrecking ball, which is what astatine is like when we have these nuclear emissions. And so this is actually very complicated, And so this is actually very complicated in psychotropic physics as well as chemistry.
psychotron physics as well as chemistry, but if it can be worked out and the studies can be done to show this can be done safely without too much normal tissue toxicity as we think we can, But if it can be more delved in, studies can be done to show this can be done safely without too much hormonal tissue toxicity, which we think we can, we really think that this is going to be a much more efficacious therapy, we really think that this is going to be a much more efficacious therapy, especially for patients with more challenging tumors. especially for patients with more challenging tumors. We're already seeing this with alpha emitters that are being used in certain other diseases, We're already seeing this with being used in certain other diseases like, like, for example, for example, prostate cancer, prostate cancer bone metastases. bone metastases.. but it looked very promising in the early studies that have been looked at in a number of places.
...seeing the early studies that we've looked at at a number of places, This institution is probably leading the way as much as anybody for this individual application. this institution is probably leaving away as much as anybody from this individual application. So what's an alpha emitter? So what's an alpha? An alpha emitter is when the nucleus actually spits off a piece of itself in an alpha particle, It actually spits off the pieces of itself in an alpha particle, which is two protons, which is two protons, two neutrons, two neutrons, more or less a helium particle.
more or less a helium particle. And again, And again, alpha particles do a whole lot of damage in a very close space, alpha particles do a whole lot of damage in a very low space. so they don't go very far. They don't go very far, so they deposit all of their energy in one spot, So they deposit all of their energy in one spot, which is good. which is good, and importantly, they deposit all their energy exactly where you want it to go, which is where the chemical landed.
So we think in the long run, Although this is a very difficult, although this is a very difficult compound to work with, if we can get it to work, it's going to be very efficacious. And there are some preliminary studies going on that make this look very good. So I want to stop by thanking a number of folks that are involved in this. As I mentioned, his own lab.
this is really mostly Dan Prima's work. He's worked with the Psychotron Group, a small animal imaging facility, his own lab, and has developed quite a bit of collaborations with other labs. and, as I mentioned, has had funding from the Fiat-Pera alliance, As I mentioned, has had funding from the theater very long. which has been very important.
So with that, and I apologize for running through the slides relatively quickly, So we're going to do a slideshow to quickly, hopefully you understand some of the nuclear physics and chemistry a little bit more. hopefully, And if we have time, understand some of the new purposes in chemistry. I'd be happy to answer questions, and if not, I'd be happy to talk to folks during the break. Thanks.