Search

PurposeSince the introduction of PSMA PET/CT with 68Ga-PSMA-11, this modality for imaging prostate cancer (PC) has spread worldwide. Preclinical studies have demonstrated that short-term androgen deprivation therapy (ADT) can significantly increase PSMA expression on PC cells. Additionally, retrospective clinical data in large patient cohorts suggest a positive association between ongoing ADT and a pathological PSMA PET/CT scan. The present evaluation was conducted to further analyse the influence of long-term ADT on PSMA PET/CT findings.MethodsA retrospective analysis was performed of all 1,704 patients who underwent a 68Ga-PSMA-11 PET/CT scan at our institution from 2011 to 2017 to detect PC. Of 306 patients scanned at least twice, 10 had started and continued ADT with a continuous clinical response between the two PSMA PET/CT scans. These ten patients were included in the current analysis which compared the tracer uptake intensity and volume of PC lesions on PSMA PET/CT before and during ongoing ADT.ResultsOverall, 31 PC lesions were visible in all ten patients before initiation of ADT. However, during ongoing ADT (duration 42-369 days, median 230 days), only 14 lesions were visible in eight of the ten patients. The average tracer uptake values decreased in 71% and increased in 12.9% of the PC lesions. Of all lesions, 33.3% were still visible in six patients with a complete PSA response (≤0.1 ng/ml).ConclusionContinuous long-term ADT significantly reduces the visibility of castration-sensitive PC on PSMA PET/CT. If the objective is visualization of the maximum possible extent of disease, we recommend referring patients for PSMA PET/CT before starting ADT.

Here, DNA damage is shown to occur as a direct consequence of inducing haematopoietic stem cells to exit quiescence in response to conditions of stress; in mice with mutations modelling those seen in Fanconi anaemia, this leads to a complete collapse of the haematopoietic system. Stress-linked HSC DNA damage The accumulation of DNA damage as haematopoietic stem cells (HSCs) age is thought to contribute to age-related degeneration, an idea that is supported by the fact that accelerated ageing syndrome caused by defects in DNA repair, such as Fanconi anaemia syndrome, is associated with bone marrow failure. Michael Milsom and colleagues show here that DNA damage is a direct outcome of forcing HSCs to exit quiescence in response to a wide range of stimuli that mimic conditions of stress. In mice with mutations modelling those seen in Fanconi anaemia, this leads to a complete collapse of the haematopoietic system. These findings highlight the possible role of stress-induced HSC DNA damage in diseases that that have a pro-inflammatory component, as well as in normal ageing. Haematopoietic stem cells (HSCs) are responsible for the lifelong production of blood cells. The accumulation of DNA damage in HSCs is a hallmark of ageing and is probably a major contributing factor in age-related tissue degeneration and malignant transformation.sup.1. A number of accelerated ageing syndromes are associated with defective DNA repair and genomic instability, including the most common inherited bone marrow failure syndrome, Fanconi anaemia.sup.2,3. However, the physiological source of DNA damage in HSCs from both normal and diseased individuals remains unclear. Here we show in mice that DNA damage is a direct consequence of inducing HSCs to exit their homeostatic quiescent state in response to conditions that model physiological stress, such as infection or chronic blood loss. Repeated activation of HSCs out of their dormant state provoked the attrition of normal HSCs and, in the case of mice with a non-functional Fanconi anaemia DNA repair pathway, led to a complete collapse of the haematopoietic system, which phenocopied the highly penetrant bone marrow failure seen in Fanconi anaemia patients. Our findings establish a novel link between physiological stress and DNA damage in normal HSCs and provide a mechanistic explanation for the universal accumulation of DNA damage in HSCs during ageing and the accelerated failure of the haematopoietic system in Fanconi anaemia patients., Author(s): Dagmar Walter [sup.1] , Amelie Lier [sup.1] , Anja Geiselhart [sup.2] , Frederic B. Thalheimer [sup.3] , Sina Huntscha [sup.1] , Mirko C. Sobotta [sup.4] , Bettina Moehrle [sup.5] [...]

Inducible genetic labelling of haematopoietic stem cells (HSCs) and linked mathematical modelling show that at least 30% of all HSCs are productive, and that adult haematopoiesis is largely sustained by 'short-term' downstream stem cells that operate near self-renewal in the steady state; HSC fate mapping provides a quantitative model for better understanding of HSC functions in health and disease. Following haematopoiesis in vivo Most of what we know of the properties of haematopoietic stem cells (HSCs) is derived from transplantation and reconstitution of an emptied blood and immune system. Relatively little is known about how HSCs behave under physiological conditions. It was reported recently that normal haematopoeisis in adults is driven by thousands of long-lived progenitors rather than classic HSCs. Hans-Reimer Rodewald and colleagues have used inducible genetic labelling of primitive HSCs in a mouse model, combined with mathematical modelling, to show that although HSCs participate in establishment of the blood system in early life, steady-state haematopoiesis depends mainly on progenitors that are able to self-renew but also receive rare input from long-term HSCs. This input is increased following physiological challenges. Haematopoietic stem cells (HSCs) are widely studied by HSC transplantation into immune- and blood-cell-depleted recipients. Single HSCs can rebuild the system after transplantation.sup.1,2,3,4,5. Chromosomal marking.sup.6, viral integration.sup.7,8,9 and barcoding.sup.10,11,12 of transplanted HSCs suggest that very low numbers of HSCs perpetuate a continuous stream of differentiating cells. However, the numbers of productive HSCs during normal haematopoiesis, and the flux of differentiating progeny remain unknown. Here we devise a mouse model allowing inducible genetic labelling of the most primitive Tie2.sup.+ HSCs in bone marrow, and quantify label progression along haematopoietic development by limiting dilution analysis and data-driven modelling. During maintenance of the haematopoietic system, at least 30% or ~5,000 HSCs are productive in the adult mouse after label induction. However, the time to approach equilibrium between labelled HSCs and their progeny is surprisingly long, a time scale that would exceed the mouse's life. Indeed, we find that adult haematopoiesis is largely sustained by previously designated 'short-term' stem cells downstream of HSCs that nearly fully self-renew, and receive rare but polyclonal HSC input. By contrast, in fetal and early postnatal life, HSCs are rapidly used to establish the immune and blood system. In the adult mouse, 5-fluoruracil-induced leukopenia enhances the output of HSCs and of downstream compartments, thus accelerating haematopoietic flux. Label tracing also identifies a strong lineage bias in adult mice, with several-hundred-fold larger myeloid than lymphoid output, which is only marginally accentuated with age. Finally, we show that transplantation imposes severe constraints on HSC engraftment, consistent with the previously observed oligoclonal HSC activity under these conditions. Thus, we uncover fundamental differences between the normal maintenance of the haematopoietic system, its regulation by challenge, and its re-establishment after transplantation. HSC fate mapping and its linked modelling provide a quantitative framework for studying in situ the regulation of haematopoiesis in health and disease., Author(s): Katrin Busch [sup.1] , Kay Klapproth [sup.1] , Melania Barile [sup.2] , Michael Flossdorf [sup.2] , Tim Holland-Letz [sup.3] , Susan M. Schlenner [sup.4] [sup.5] , Michael Reth [sup.6] [...]