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Positron Emission Tomography Diagnostic Imaging in Multidrug-Resistant Hepatocellular Carcinoma: Focus on 2-Deoxy-2-(18F)Fluoro-d-Glucose

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Abstract

Hepatocellular carcinoma (HCC) is one of the most lethal cancers worldwide. Surgical resection and liver transplantation are still the best options for treatment. Nevertheless, as the number of patients who may benefit from these therapies is limited, alternative therapies have been developed, including chemotherapy. However, partly due to the expression of multidrug resistance (MDR) proteins, it has been found that HCC is a highly chemoresistant tumor. The major family of MDR proteins is the ATP-binding cassette (ABC) transporter superfamily, which includes P-glycoprotein (Pgp) and MDR-associated protein 1 (MRP1). Positron emission tomography using the radiolabeled analog of glucose, 2-deoxy-2-(18F)fluoro-d-glucose ([18F]FDG), has been used in diagnostic imaging of various types of tumors. Clinical studies are inconsistent but experimental studies have shown that [18F]FDG uptake is associated with tumor grade and is inversely proportional to Pgp expression in HCC. These studies unveil that [18F]FDG can be a substrate of Pgp, although that relationship remains unclear. This review sums up the relationship between MDR expression in HCC, and [18F]FDG uptake by tumor cells, showing that this radiopharmaceutical may provide a useful tool for the study of chemoresistance in HCC, and that the use of this marker may contribute to the therapeutic choice on this highly aggressive tumor.

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Acknowledgments and Disclosures

Ana F. Brito would like to thank the Portuguese Foundation for Science and Technology for the award of a PhD scholarship (SFRH/BD/61378/2009).

Ana F. Brito, Mónica Mendes, Ana M. Abrantes, José G. Tralhão and Maria F. Botelho have no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. Biophysics Unit, Faculty of Medicine, University of Coimbra, Pólo III, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal

    Ana F. Brito, Mónica Mendes, Ana M. Abrantes, José G. Tralhão & Maria F. Botelho

  2. Center of Investigation on Environmental, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    Ana F. Brito, Ana M. Abrantes, José G. Tralhão & Maria F. Botelho

  3. Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    Ana F. Brito, Ana M. Abrantes & Maria F. Botelho

  4. Faculty of Sciences and Technology, University of Coimbra, Coimbra, Portugal

    Mónica Mendes

  5. Surgical Department A, CHUC, Coimbra, Portugal

    José G. Tralhão

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  1. Ana F. Brito
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Correspondence to Ana F. Brito.

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A. F. Brito and M. Mendes contributed equally to this work.

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Brito, A.F., Mendes, M., Abrantes, A.M. et al. Positron Emission Tomography Diagnostic Imaging in Multidrug-Resistant Hepatocellular Carcinoma: Focus on 2-Deoxy-2-(18F)Fluoro-d-Glucose. Mol Diagn Ther 18, 495–504 (2014). https://doi.org/10.1007/s40291-014-0106-3

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