vedomostiregmedРегуляторные исследования и экспертиза лекарственных средствRegulatory Research and Medicine Evaluation3034-30623034-3453Federal State Budgetary Institution ‘Scientific Centre for Expert Evaluation of Medicinal Products’ of the Ministry of Health of the Russian Federation (FSBI ‘SCEEMP’)10.30895/1991-2919-2022-12-4-425-443vedomostiregmed-520Research ArticleДИАГНОСТИКА ЗАБОЛЕВАНИЙDISEASE DIAGNOSTICSВозможности тераностики в визуализации микроокружения опухоли и элиминации его иммуносупрессивных компонентовPotential of Theranostics in Visualisation of the Tumour Microenvironment and Elimination of Its Immunosuppressive Componentshttps://orcid.org/0000-0003-3882-1720МолчановО. Е.MolchanovO. E.

Молчанов Олег Евгеньевич, д-р мед. наук

197758, Санкт-Петербург, п. Песочный, Ленинградская ул., д. 70

Oleg E. Molchanov, Dr. Sci. (Med.).

197758, St. Petersburg, Pesochny, Leningradskaya St., 70

molchanovo@mail.ruhttps://orcid.org/0000-0001-8174-7461МайстренкоД. Н.MaystrenkoD. N.

Майстренко Дмитрий Николаевич, д-р мед. наук

197758, Санкт-Петербург, п. Песочный, Ленинградская ул., д. 70

Dmitry N. Maystrenko, Dr. Sci. (Med.).

197758, St. Petersburg, Pesochny, Leningradskaya St., 70

may64@inbox.ruhttps://orcid.org/0000-0002-1630-0564СтанжевскийА. А.StanzhevskiyA. A.

Станжевский Андрей Алексеевич, д-р мед. наук

197758, Санкт-Петербург, п. Песочный, Ленинградская ул., д. 70

Andrey A. Stanzhevskiy, Dr. Sci. (Med.).

197758, St. Petersburg, Pesochny, Leningradskaya St., 70

stanzhevsky@yandex.ruФедеральное государственное бюджетное учреждение «Российский научный центр радиологии и хирургических технологий имени академика А.М. Гранова» Министерства здравоохранения Российской ФедерацииРоссияA.M. Granov Russian Research Centre for Radiology and Surgical TechnologiesRussian Federation202203112022124425443Copyright © Молчанов О.Е., Майстренко Д.Н., Станжевский А.А., 20222022Молчанов О.Е., Майстренко Д.Н., Станжевский А.А.Molchanov O.E., Maystrenko D.N., Stanzhevskiy A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vedomostincesmp.ru/jour/article/view/520

Одним из перспективных направлений ядерной медицины является тераностика — использование радиофармпрепаратов для диагностики и лечения онкологических заболеваний, особое направление тераностики — иммунотераностика. Цель работы — обобщить возможности тераностики в визуализации микроокружения опухоли и элиминации его иммуносупрессивных компонентов. В статье представлены данные о составе и взаимодействии различных субпопуляций клеток в микроокружении опухоли, а также о роли стволовых опухолевых клеток в его формировании. Описаны дефекты сигнальных путей и потенциальные мишени для тераностики стволовых опухолевых клеток, а также механизм взаимодействия опухоли и иммунной системы в процессе канцерогенеза. Подробно разобраны подходы к оценке типа микроокружения с целью индивидуализации лечения и разработки рационального дизайна клинических исследований тераностических пар. Приведены собственные данные о характере распределения субпопуляций лимфоцитов и супрессорных клеток миелоидного происхождения у пациентов с метастатическими формами различных опухолей. Рассмотрены нюансы создания и использования различных молекул адресной доставки при разработке диагностических и терапевтических радиофармпрепаратов. Описаны наиболее перспективные диагностические и терапевтические изотопы с точки зрения возможности оценки микроокружения и воздействия на него. В статье освещены современные и перспективные методы предварительного таргетинга для снижения токсичности и повышения эффективности тераностики. Рассмотрены также достоинства и недостатки тераностики по сравнению с другими методами системного лечения метастатических форм опухолей. Обозначены пути преодоления недостатков тераностики.

Theranostics is a promising branch of nuclear medicine that uses radiopharmaceuticals for diagnosis and treatment of cancer, and immunotheranostics is a special area in it. The aim of the study was to summarise the potential of theranostics for visualisation of the tumour microenvironment and elimination of its immunosuppressive components. The article presents up-to-date information on the composition and interaction of various cell subpopulations in the tumour microenvironment, as well as on the role of cancer stem cells in its formation. It describes defects of signalling pathways and potential targets for theranostics of cancer stem cells. Also, the article provides a description of the mechanism of interaction between the tumour and the immune system in the process of carcinogenesis. The review offers a detailed analysis of approaches to assessing the type of tumour microenvironment in order to individualise treatment and develop a rational design of clinical studies of theranostic couples. The authors present their own data on the distribution of subpopulations of lymphocytes and myeloid-derived suppressor cells in patients with metastatic tumours. The authors have considered the nuances of creating and using various molecules for targeted delivery in the development of diagnostic and therapeutic radiopharmaceuticals. The most promising diagnostic and therapeutic isotopes are described from the point of view of assessing the microenvironment and the possibility of influencing it. The article highlights modern and promising methods of pre-targeting to reduce the toxicity and increase the effectiveness of theranostics. Furthermore, having compared the advantages and disadvantages of theranostics with those of other systemic treatment options for metastatic tumours, the authors outline possible ways to overcome the shortcomings of theranostics.

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The authors declare that there are no conflicts of interest present.