Theranostics
| Theranostics | |
|---|---|
 A pictorial representation of a conventional nanotheranostic agent | |
| Other names | Theragnostics |
| Specialty | In Theranostics, therapeutic and diagnostic moieties are embedded in a single entity. |
The concept of theranostics or theragnostics broadly comes under personalized treatment method. The term theranostics represents the combination of therapeutic and diagnostic agents into a single entity.[1] Nowadays, cancer theranostics are getting attention, where targeted cancer therapy can be achieved and monitored efficiently by a diagnostic imaging tool. This cancer theranostics can also be considered as a novel subclass of image guided therapy.[2]
History
In 2002, J. Funkhouser coined the term theranostics. He defined theranostics as a material that combines modalities of therapy and diagnostic imaging.[1] In 1941 itself the concept of diagnostic imaging associated with treatment were started by using radioactive iodine. The Iodine-131 were used in the treatment of thyroid cancer and thyrotoxicosis.[3] Especially after World War II the radioactive iodine became familiar and cost-effective for diagnosis and treatment of thyroid cancer, so iodine-131 can be considered as the first theranostic agent.[4] In 1951, The American Journal of Medicine reported a clinical study of I131 in the treatment of thyroid carcinoma.[5]
Later fast emergence of nanotechnology in the medical field resulted Nanotheranostics. In conventional nanotheranostics, three different components: imaging, targeting and therapeutic agents were assembled as a single nanomaterial.[6] Utilization of these three in nanoform will result in non-invasive imaging and targeted therapy without affecting the surrounding healthy cells.[7] After successful acceptance of liposomal doxorubicin (Doxil) by USFDA in 1995, 99mTc-Labelled Liposomal doxorubicin were evaluated its theranostic ability and conducted phase I clinical study.[8]
A lot of researchers attracted to the field of theranostics and Ivyspring International Publisher started an independent journal named Theranostics. The current impact factor of the journal is 11.556[9] and later in 2017, they started a sister journal named Nanotheranostics,[10] this clearly indicates the huge research output generated in the field of theranostics research.
In December 2020, the USFDA approved Gallium 68Ga PSMA-11 as a targeted PET imaging and radiation therapy drug for Men with Prostate Cancer.[11][12]
Concepts
As we mentioned early in nanotheranostics, separate diagnostic and therapeutic agents are designed as a single nanoentity. To achieve the theranostic ability, currently using therapeutic and diagnostic approaches are,[6]
Diagnostic methods
- Positron emission tomography (PET): utilize radioisotopes such as 64Cu and 68Ga as visualizing tools.
- Magnetic resonance imaging (MRI): widely used Medical imaging technique, use Gd3+, Mn2+ and iron oxide nanoparticles as contrasting agents.
- Ultrasound imaging: Explore medical ultrasound as a diagnostic imaging tool, same time utilize its therapeutic benefits.
- Computed tomography: radiation assisted imaging, I and Au can be used as contrast agents.
- Medical optical imaging: visible light as an imaging tool, various quantum dots and NIR fluorophores can be used.
- Single-photon emission computed tomography (SPECT): gamma rays produced from nuclear medicine such as 99mTc and 123I, give tomographic imaging.
- Photoacoustic imaging: Non ionizing laser pulses and utilize the principle of Photoacoustic effect, different Au nanostructures and porphyrins can be used.
Therapeutic methods
- Chemotherapy: Various chemotherapeutic agents such as doxorubicin, paclitaxel etc.
- Radiation therapy: Ionizing radiations are used in treatment of cancer.
- Immunotherapy: cancer vaccines and Checkpoint inhibitors are used.
- Photodynamic therapy (PDT): utilizes 3 nontoxic components: light, Photosensitizer and tissue oxygen produce a toxic effect. Photosensitizer such as Temoporfin, Motexafin lutetium etc.
- Photothermal therapy (PTT): Photosensitizer such as Gold Nanoshells, excites by visible light and while relaxing it produces heat and that heat kills the targeted cells.
- Gene therapy: utilize small interfering RNA, plasmids and CRISPR
Radiotheranostics
Radiopharmaceuticals gained considerable attention as a diagnostic and therapeutic aid.[13] In past decades these radiopharmaceuticals gained attention as radiotheranostics, few of the formulations were already approved by FDA.[14]
| Ingredient (trade name) | Ligand | Therapeutic Isotope | Imaging Isotope | Target | Disease | FDA Approval date / Ref |
|---|---|---|---|---|---|---|
| Dotatate (Lutathera) | Peptide | 177Lu | 68Ga, 111In | SSTR2 | Neuroendocrine tumor | Approved, 2018[15] |
| Lexidronam (Quadramet) | EDTMP | 153Sm | 99Tc, Na18F | New bone formation | Bone metastasis, Osteosarcoma | Approved, 1997[16] |
| Radium-223(Xofigo) | dichloride | 223Ra | 99Tc, Na18F | Calcimimetic | Prostate cancer and bone metastasis | Approved, 2013[17] |
| Strontium-89 (Metastron) | None | 89Sr | Na18F | New bone formation | Bone pain | Approved, 1993[18] |
| Tositumomab (Bexxar) | Monoclonal antibody | 131I | 124I, 131I | CD20 | follicular large-cell lymphoma | Approved, 2003 withdrawn, 2014[19] |
| Iobenguane (Azedra) | None | 131I | 123I, 124I | Norepinephrine transporter | Pheochromocytoma and paraganglioma | Approved, 2018[15] |
| Gallium 68 PSMA-11 (68Ga PSMA-11) | PSMA | 68Ga | 68Ga | Prostate-specific antigen | prostate cancer | Approved, 2020[12] |
Nanotheranostics
Nanotheranostics are one of the greatest outcomes of nanomedicine, still the research outputs are in infancy, so far there is no clinically approved nanotheranostics.[6][20] Various nanotheranostics developed for Triple-negative breast cancer (TNBC) and few are in clinical trial.[21]
Imaging-guided focal therapy
Various nanoparticles designed as photodynamic therapy (PDT) and photothermal therapy (PTT) probes, these designed photosensitizers have reduced systemic toxicity, cannot form induced resistance and have high targeting efficiency.[22][23][24]
Future and outlook
- Major scope of theranostics is cost-effective treatment along with early cancer diagnosis.
- Theranostics may help in achieving high efficacy and low toxicity of medicines[6]
- Reports shows the global market for theranostics will make a big impact in upcoming years.[25]
References
- ↑ 1.0 1.1 Kelkar, Sneha S.; Reineke, Theresa M. (29 August 2011). "Theranostics: Combining Imaging and Therapy". Bioconjugate Chemistry. 22 (10): 1879–1903. doi:10.1021/bc200151q. ISSN 1043-1802. PMID 21830812.
- ↑ Hapuarachchige, Sudath; Artemov, Dmitri (2020). "Theranostic Pretargeting Drug Delivery and Imaging Platforms in Cancer Precision Medicine". Frontiers in Oncology. 10: 1131. doi:10.3389/fonc.2020.01131. ISSN 2234-943X. PMC 7387661 Check
|pmc=value (help). PMID 32793481 Check|pmid=value (help). - ↑ Cassen, B.; Curtis, L. (22 July 1949). "Measurement of Ionizing Radiations in Vivo". Science. 110 (2847): 94–95. doi:10.1126/science.110.2847.94. PMID 17837667.
- ↑ Silberstein, Edward B. (1 May 2012). "Radioiodine: The Classic Theranostic Agent". Seminars in Nuclear Medicine. 42 (3): 164–170. doi:10.1053/j.semnuclmed.2011.12.002. ISSN 0001-2998. PMID 22475425.
- ↑ Freedberg, A. Stone; Ureles, Alvin L.; Lesses, Mark F.; Gargill, Samuel L. (1 July 1951). "Treatment of thyroid carcinoma with radioactive iodine (I131)". The American Journal of Medicine. 11 (1): 44–54. doi:10.1016/0002-9343(51)90007-1. ISSN 0002-9343. PMID 14837925.
- ↑ 6.0 6.1 6.2 6.3 Chen, Hongmin; Zhang, Weizhong; Zhu, Guizhi; Xie, Jin; Chen, Xiaoyuan (July 2017). "Rethinking cancer nanotheranostics". Nature Reviews Materials. 2 (7): 17024. doi:10.1038/natrevmats.2017.24. PMC 5654564. PMID 29075517.
- ↑ Wong, Xin Yi; Sena-Torralba, Amadeo; Álvarez-Diduk, Ruslan; Muthoosamy, Kasturi; Merkoçi, Arben (7 February 2020). "Nanomaterials for Nanotheranostics: Tuning Their Properties According to Disease Needs". ACS Nano. 14 (3): 2585–2627. doi:10.1021/acsnano.9b08133. ISSN 1936-0851. PMID 32031781 Check
|pmid=value (help). Unknown parameter|s2cid=ignored (help) - ↑ Koukourakis, M. I.; Koukouraki, S.; Giatromanolaki, A.; Archimandritis, S. C.; Skarlatos, J.; Beroukas, K.; Bizakis, J. G.; Retalis, G.; Karkavitsas, N.; Helidonis, E. S. (November 1999). "Liposomal Doxorubicin and Conventionally Fractionated Radiotherapy in the Treatment of Locally Advanced Non–Small-Cell Lung Cancer and Head and Neck Cancer". Journal of Clinical Oncology. 17 (11): 3512–3521. doi:10.1200/JCO.1999.17.11.3512. PMID 10550149.
- ↑ "Theranostics". thno.org.
- ↑ "Nanotheranostics". ntno.org.
- ↑ Commissioner, Office of the (2 December 2020). "FDA Approves First PSMA-Targeted PET Imaging Drug for Men with Prostate Cancer". FDA.
- ↑ 12.0 12.1 "Drug Approval Package: GALLIUM GA 68 PSMA-11". accessdata.fda.gov. US FDA.
- ↑ Brugarolas, Pedro; Comstock, Jessica; Dick, David W.; Ellmer, Teresa; Engle, Jonathan W.; Lapi, Suzanne E.; Liang, Steven H.; Parent, Ephraim E.; Pillarsetty, Naga Vara Kishore; Selivanova, Svetlana; Sun, Xiankai; Vavere, Amy; Scott, Peter J. H. (1 June 2020). "Fifty Years of Radiopharmaceuticals". Journal of Nuclear Medicine Technology. 48 (Supplement 1): 34S–39S. ISSN 0091-4916. PMID 32605944 Check
|pmid=value (help). - ↑ Herrmann, Ken; Schwaiger, Markus; Lewis, Jason S; Solomon, Stephen B; McNeil, Barbara J; Baumann, Michael; Gambhir, Sanjiv S; Hricak, Hedvig; Weissleder, Ralph (1 March 2020). "Radiotheranostics: a roadmap for future development". The Lancet Oncology. 21 (3): e146–e156. doi:10.1016/S1470-2045(19)30821-6. ISSN 1470-2045. PMC 7367151 Check
|pmc=value (help). PMID 32135118 Check|pmid=value (help). - ↑ 15.0 15.1 "ADVANCING HEALTH THROUGH INNOVATION 2018 NEW DRUG THERAPY APPROVALS". fda.gov. US Food & Drug Administration (FDA).
- ↑ "Drugs@FDA: FDA-Approved Drugs". accessdata.fda.gov. FDA.
- ↑ "Drugs@FDA: FDA-Approved Drugs". accessdata.fda.gov.
- ↑ "Drugs@FDA: FDA-Approved Drugs". accessdata.fda.gov.
- ↑ "Drug Approval Package: Brand Name (Generic Name) NDA #". accessdata.fda.gov.
- ↑ Wong, Xin Yi; Sena-Torralba, Amadeo; Álvarez-Diduk, Ruslan; Muthoosamy, Kasturi; Merkoçi, Arben (24 March 2020). "Nanomaterials for Nanotheranostics: Tuning Their Properties According to Disease Needs". ACS Nano. 14 (3): 2585–2627. doi:10.1021/acsnano.9b08133. PMID 32031781 Check
|pmid=value (help). Unknown parameter|s2cid=ignored (help) - ↑ Kim, TH; Lee, S; Chen, X (April 2013). "Nanotheranostics for personalized medicine". Expert Review of Molecular Diagnostics. 13 (3): 257–69. doi:10.1586/erm.13.15. PMC 3696508. PMID 23570404.
- ↑ Idris, NM; Gnanasammandhan, MK; Zhang, J; Ho, PC; Mahendran, R; Zhang, Y (October 2012). "In vivo photodynamic therapy using upconversion nanoparticles as remote-controlled nanotransducers". Nature Medicine. 18 (10): 1580–5. doi:10.1038/nm.2933. PMID 22983397. Unknown parameter
|s2cid=ignored (help) - ↑ "A Study of MRI/US Fusion Imaging and Biopsy in Combination With Nanoparticle Directed Focal Therapy for Ablation of Prostate Tissue". clinicaltrials.gov. 1 March 2021.
- ↑ Jin, CS; Overchuk, M; Cui, L; Wilson, BC; Bristow, RG; Chen, J; Zheng, G (September 2016). "Nanoparticle-Enabled Selective Destruction of Prostate Tumor Using MRI-Guided Focal Photothermal Therapy". The Prostate. 76 (13): 1169–81. doi:10.1002/pros.23203. PMID 27198587. Unknown parameter
|s2cid=ignored (help) - ↑ "Theranostics Market Size, Share, Trends & Industry Report". bccresearch.com.
Category:Medical diagnosis Category:Nanomedicine Category:Medical tests Category:Radiology Category:Therapy Category:Nanomedicine Category:Medicine]
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