Ten years of experience with MIBG applications and the potential of new radiolabeled peptides: a personal overview and concluding remarks.

The international workshop on metaiodobenzylguanidine (MIBG) and radiolabeled somatostatin analogs held in Rome in June, 1994 addressed a wide range of topics which might be classified into five broad general themes: Theme 1. The role of MIBG for the location of neuroendocrine tumors. A) The range of tumors in which MIBG scintigraphy is effective (pheochromocytomas, neuroblastoma, chemodectoma and other APUDomas). B) The increasing popularity of 123I as a radiolabel for MIBG (potential advantages in planar and SPECT imaging). C) MIBG as the prototype of a family of radiopharmaceuticals exploiting the biogenic amine uptake and storage mechanisms. (Other radiohalides 124I, 125I, 87Br, 211At, 18F; other PET radiopharmaceuticals such as 11C-epinephrine, 11C-hydroxyephedrine). Theme 2. The role of MIBG as an in vivo scintigraphic probe of the sympathetic nervous system. A) Cardiac sympathetic innervation (in cardiomyopathy, myocardial infarction, and as a prognostic index for cardiac transplantation). B) Pulmonary MIBG uptake as index of pulmonary endothelial/sympathetic function (MIBG by both the intravenous and inhaled routes of administration). Theme 3. MIBG for the radiopharmaceutical therapy of neuroendocrine tumors. A) Treatment of neuroblastoma early in the natural history of the disease (MIBG therapy as initial management, MIBG therapy combined with other modalities--e.g., chemotherapy and bone marrow transplantation). Theme 4. The role of radiolabeled somatostatin analogs for the location of neuroendocrine and other tumors. A) The range of tumors in which somatostatin receptor radiopharmaceutical scintigraphy is effective (pituitary tumors, central nervous system tumors, carcinoids, islet cell tumors, medullary thyroid carcinoma, small cell lung cancer, APUDomas). B) The superiority of 111In over 123I as a radiolabel (the future of potential 99mTc and other labels). C) Somatostatin receptor scintigraphy in autoimmune and other disorders. D) Pentetreotide as the prototype of a wide range of radiolabeled peptides as radiopharmaceuticals for the in vivo depiction of the receptors for peptide hormones, lymphokines, paracrine and other information transmitting molecules (the general concepts include the use of long-acting, slowly degraded analogs and the development of generally applicable labeling techniques. Examples include 123I-ANF, labeled interleukins and other lymphokines). Theme 5. Comparisons of MIBG and pentetreotide scintigraphy for the location of neuroendocrine tumors. A) The range of neuroendocrine and other tumors (e.g., pheochromocytomas, neuroblastomas, carcinoids, islet cell tumors and other APUDomas).