Meet the Editors | Interview with Prof. Dr. Alberto Signore— Section Editor-in-Chief of “Radiolabeled Blood Elements and Other Imaging Modalities” in Hemato

Name: Prof. Dr. Alberto Signore, MD, PhD.
Affiliation: Department of Surgical-Medical Sciences and Translational Medicine, University of Rome “Sapienza”, Rome, Italy
Interests: nuclear medicine; infection imaging; inflammation imaging; thyroid cancer imaging; pre-clinical imaging; imaging immuno-therapy; imaging autoimmune diseases; PET imaging in hematological disorders.

 

1. Can you talk a bit about your current research in radiolabeled blood elements, and what brings you to Hemato?

The first paper on radiolabeled blood cells appeared in the late 1970s. In the 1980s and 1990s, the topic became extremely popular, with excellent publications in major journals mainly by nuclear medicine physicians. With the new century, many clinicians (mainly hematologists, specialists in infective diseases, orthopedic surgeons, vascular surgeons, diabetologists, rheumatologists, and gastroenterologists) became interested in this technique and conducted several clinical trials. However, the technique was not standardized all over the world and, often, results were not reproducible in different centers. Therefore, in the last 15 years, while I was coordinator of the Committee for imaging Infections of the European Association of Nuclear Medicine (EANM), I started a huge program in three main phases.

Phase 1 included the standardization of the technique for labeling white blood cells and image acquisition and interpretation. This was accomplished with the agreement of several specialists in the field and the publication of two major guidelines.

Phase 2 included establishing a scientific partnership with several other European societies for the preparation of clinical guidelines on a diagnostic flowchart for diagnosis and follow-up of several infective/inflammatory diseases. To this end, we established cooperation with the European Bone & Joint Infection Society (EBJIS), the European Society of Radiology (ESR), the European Society of Neuroradiology (ESNR), the European Society of Clinical Microbiology ad Infective Diseases (ESCMID), the European Crohn's and Colitis Organization (ECCO), the European Society of Gastrointestinal Radiology (ESGAR), the European Alliance of Associations for Rheumatology (EULAR), the European Association for the Study of Diabetes (EASD), the European Society of Vascular Surgery (ESVS), the World Association against Infection of Orthopaedics and Trauma (WAIOT) and with the European Society of Cardiology (ESC). Several clinical guidelines have been published or are about to be published.

In phase 3 of the program, we aimed to divulge the use and clinical utility of these nuclear medicine techniques amongst clinicians of different specialties around the world utilizing publications, courses, congresses, and clinical collaboration for large multi-center clinical studies. Unfortunately, the COVID-19 pandemic has delayed this last phase, but having a journal dedicated to publishing these studies could be an important tool to reach this goal. Every month, there are 10 to 20 papers published in several journals on this topic and I hope to recruit all major papers in this new section of Hemato.

2. What developments are occurring in your field of expertise that excite you at this time?

Blood cells, including granulocytes, erythrocytes, plates, lymphocytes, monocytes, and dendritic cells, can be labeled using several different approaches and using several different tracers.

Two major approaches are ex vivo or in vivo cell labeling. In the first case, cells are isolated from the patient, labeled in vitro in sterile conditions, and re-administered to the patient. The second approach requires the use of a specific radiolabeled probe (usually a monoclonal antibody or its fragment) that is injected into the patient and binds in vivo to the target cell population. Both approaches have pros and cons.

As far as the tracer is concerned, we could label cells or probes with a fluorescent dye (low penetrance in tissues, poor human use) or with a radioactive isotope. Due to the high radiosensitivity of cells, the choice of isotopes is modest and, to date, mainly limited to 111-Indium and 99m-Technetium. Both isotopes have pros and cons, the most relevant negative aspect being their detection by a gamma camera with low image resolution (approx. 6-8 mm).

Therefore, research is always looking at new antibodies or peptides to label, to increase specificity and reduce toxicity, but also looking at new isotopes, particularly for PET/CT imaging with high resolution (3-4 mm). In addition, new cell types become interesting to follow in vivo, such as PD1+ cells or NK cells in oncology, or dendritic and stamina cells in hematology, etc.

3. What are the qualities that you look for in an article, and what would attract authors to want to publish in Hemato?

Novelty and clinical impact of the main message. The topic of radiolabeled blood cells is in between Nuclear Medicine, Hematology, Infection, Orthopedics and other minor specialties. All papers in this field are welcome.

Of course, Hemato is also looking for all papers in which Nuclear Medicine (both gamma-camera and PET studies) is involved in hematological disorders using commercially available radiopharmaceuticals, fluorodeoxyglucose (FDG) at first.

4. Do you have any valuable suggestions you would like to share with young researchers/editorial editors?

Although the topic of radiolabeled cells is very interesting, I would suggest to start recruiting papers on the use of PET/CT in hematological diseases and stimulate all young doctors/researchers to submit clinical studies. This will allow us to rapidly get a good Impact Factor and be mentioned in Scopus and PubMed. Once this is done, more research papers will be submitted and particularly on the topic of radiolabeled blood cells.