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Aplicações do iodo em diagnóstico e terapêutica e como agente de contraste
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A presente revisão bibliográfica incide sobre o importante papel do iodo na fisiologia humana e principais avanços na área da saúde e Medicina Nuclear (MN) que sustentam a sua utilização até à atualidade. A primeira utilização do iodo como meio de contraste ocorreu nos anos 20, período após o qual foram vários os desenvolvimentos de outros agentes de contraste iodados (ACI), tendo em vista o aumento da eficácia e redução da toxicidade. Atualmente, são comercializados diversos ACI em Portugal, com indicação nas mais vastas condições (urografia, exame do trato gastrointestinal, angiografias, mielografia). Entre os 37 isótopos de iodo conhecidos, quatro deles assumem especial relevância no contexto do diagnóstico e terapêutica, apoiado nas partículas emitidas durante o decaimento radioativo. A utilização de 124I é limitada à tomografia por emissão de positrões, uma técnica dispendiosa e de utilização reduzida em contexto clínico. O 125I está fortemente associado às técnicas de braquiterapia. O ano de 1941 ficou marcado pela primeira aplicação eficaz com iodo radioativo na disfunção tiroideia. De facto, os radiofármacos com mais utilidade em diagnóstico (através de cintigrafia ou tomografia computorizada por emissão de fotão único) e em terapêutica são o 123I e o 131I, respetivamente. Este último é um reconhecido agente de teranóstica pela emissão de radiação γ (útil em imagiologia) e de partículas β-, com elevado potencial terapêutico. As indicações para diagnóstico e terapêutica vão além das afeções da tiróide: os estudos de inervação simpática cardíaca (com 123I-iobenguano) e o diagnóstico diferencial da doença de Parkinson (com 123I-ioflupano) e do hiperaldosteronismo primário (com 131I-iodocolesterol) são exemplos já bem estudados; da mesma forma, o 123I/131I-iobenguano é igualmente útil no diagnóstico e tratamento de tumores neuroendócrinos. Tanto a aplicação da inteligência artificial como a radiomarcação de nanomateriais/anticorpos monoclonais parece promissora no âmbito da otimização do diagnóstico e potenciação da eficácia e monitorização terapêutica com radiofármacos.
This literature review focuses on the important role of iodine in human physiology and the main advances in the field of health and Nuclear Medicine (NM) that underpin its use to this day. Iodine was first used as a contrast medium in the 1920s, after which other iodinated contrast media (ICM) were developed to increase efficacy and reduce toxicity. Currently, there are several ICM on the market in Portugal, indicated for a wide range of conditions (urography, gastrointestinal tract examination, angiography, myelography). Of the 37 known iodine isotopes, four are particularly important in the context of diagnosis and therapy, based on the particles emitted during radioactive decay. The use of 124I is limited to positron emission tomography, an expensive technique that is rarely used in clinical settings. 125I is strongly associated with brachytherapy techniques. The year 1941 saw the first effective application of radioactive iodine in thyroid disease. In fact, the most useful radiopharmaceuticals in diagnosis (through scintigraphy or single photon emission computed tomography) and therapy are 123I and 131I, respectively. The latter is a recognized theranostic agent for emitting γ radiation (useful in imaging) and β- particles, with high therapeutic effect. The indications for diagnosis and therapy go beyond thyroid disorders: studies of cardiac sympathetic innervation (with 123I- metaiodobenzylguanidine) and the differential diagnosis of Parkinson's disease (with 123I-ioflupane) and primary hyperaldosteronism (with 131I-iodocholesterol) are examples that have already been well studied; likewise, 123I/131I- metaiodobenzylguanidine is also useful in the diagnosis and treatment of neuroendocrine tumours. Both the application of artificial intelligence and the radiolabeling of nanomaterials/monoclonal antibodies seem promising in terms of optimizing diagnosis and enhancing the efficacy and monitoring of radiopharmaceutical therapy.
This literature review focuses on the important role of iodine in human physiology and the main advances in the field of health and Nuclear Medicine (NM) that underpin its use to this day. Iodine was first used as a contrast medium in the 1920s, after which other iodinated contrast media (ICM) were developed to increase efficacy and reduce toxicity. Currently, there are several ICM on the market in Portugal, indicated for a wide range of conditions (urography, gastrointestinal tract examination, angiography, myelography). Of the 37 known iodine isotopes, four are particularly important in the context of diagnosis and therapy, based on the particles emitted during radioactive decay. The use of 124I is limited to positron emission tomography, an expensive technique that is rarely used in clinical settings. 125I is strongly associated with brachytherapy techniques. The year 1941 saw the first effective application of radioactive iodine in thyroid disease. In fact, the most useful radiopharmaceuticals in diagnosis (through scintigraphy or single photon emission computed tomography) and therapy are 123I and 131I, respectively. The latter is a recognized theranostic agent for emitting γ radiation (useful in imaging) and β- particles, with high therapeutic effect. The indications for diagnosis and therapy go beyond thyroid disorders: studies of cardiac sympathetic innervation (with 123I- metaiodobenzylguanidine) and the differential diagnosis of Parkinson's disease (with 123I-ioflupane) and primary hyperaldosteronism (with 131I-iodocholesterol) are examples that have already been well studied; likewise, 123I/131I- metaiodobenzylguanidine is also useful in the diagnosis and treatment of neuroendocrine tumours. Both the application of artificial intelligence and the radiolabeling of nanomaterials/monoclonal antibodies seem promising in terms of optimizing diagnosis and enhancing the efficacy and monitoring of radiopharmaceutical therapy.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2024, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
Iodo radioativo Agentes de contraste iodados Patologia tiroideia Tumores neuroendócrinos Braquiterapia Mestrado Integrado - 2024