Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
Nanoscale. 2019 Nov 21;11(43):20485-20496. doi: 10.1039/c9nr06512a. Epub 2019 Oct 25.
Monitoring malignant progression and disease recurrence post-therapy are central challenges to improving the outcomes of patients with multiple myeloma (MM). Whereas current detection methods that rely upon bone marrow examination allow for precise monitoring of minimal residual disease and can help to elucidate clonal evolution, they do not take into account the spatial heterogeneity of the tumor microenvironment. As such, they are uninformative as to the localization of malignant plasma cells and may lead to false negative results. With respect to the latter challenge, clinically-available imaging agents are neither sufficiently sensitive nor specific enough to detect minute plasma cell populations. Here, we sought to explore methods by which to improve detection of MM cells within their natural bone marrow environment, using whole-animal magnetic resonance imaging to longitudinally monitor early-stage disease as well as to enhance tumor detection after systemic therapy. We conducted a proof-of-concept study to demonstrate that ultra-small (<5 nm) gadolinium-containing nanoparticles bound to full-length antibodies against the B-cell maturation antigen (BCMA) exhibit rapid tumor uptake followed by renal clearance, improving the signal-to-noise ratio for MM detection beyond levels that are currently afforded by other FDA-approved clinical imaging modalities. We anticipate that when combined with bone marrow or blood biopsy, such imaging constructs could help to augment the effective management of patients with MM.
监测治疗后恶性进展和疾病复发是改善多发性骨髓瘤(MM)患者预后的核心挑战。目前依赖于骨髓检查的检测方法可以精确监测微小残留疾病,并有助于阐明克隆进化,但它们没有考虑到肿瘤微环境的空间异质性。因此,它们不能提供恶性浆细胞的定位信息,并且可能导致假阴性结果。就后者而言,临床可用的成像剂既不够敏感也不够特异,无法检测到微小的浆细胞群体。在这里,我们试图探索在天然骨髓环境中提高 MM 细胞检测的方法,使用全身磁共振成像(MRI)进行纵向监测早期疾病,并在全身治疗后增强肿瘤检测。我们进行了一项概念验证研究,证明了与全长针对 B 细胞成熟抗原(BCMA)的抗体结合的超小(<5nm)含钆纳米颗粒具有快速的肿瘤摄取,随后经肾脏清除,从而提高了 MM 检测的信噪比,超过了目前其他获得 FDA 批准的临床成像方式所能达到的水平。我们预计,当与骨髓或血液活检相结合时,这种成像结构可以帮助增强对 MM 患者的有效管理。
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