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30 August 2022 | Story André Damons | Photo André Damons
UFS Nuclear Medicine
The team of doctors in the Department of Nuclear Medicine behind the success story are, from the left (standing): Dr Osayande Evbuomwan, nuclear medicine specialist and Senior Lecturer; Dr Gerrit Engelbrecht, Clinical Head of the Department of Nuclear Medicine at the UFS; and Dr Walter Endres, nuclear medicine registrar. In front is Dr Tebatso Tebeila, nuclear medicine registrar.

The University of the Free State (UFS) Department of Nuclear Medicine is proud to announce the successful treatment outcome of a patient with metastatic castrate-resistant prostate cancer (MCRPC) – an advanced stage of prostate cancer – by using Lutetium 177 PSMA (Lu-177 PSMA) therapy. This was initially a case of advanced stage prostate cancer, which had failed first-line chemotherapy, leaving little or no other treatment options.

This is a proud and happy moment for the department and the UFS, which started this treatment just over a year ago. The university and the Free State province are now joining other South African medical universities, such as the University of Pretoria, and other provinces in using this method to treat MCRPC patients. Lutetium 177 PSMA (Lu-177 PSMA) therapy is used on MCRPC patients who are not eligible for chemotherapy or have failed first- or second-line chemotherapy.

Dr Gerrit Engelbrecht, Clinical Head of the Department of Nuclear Medicine at the UFS, says the department is proud to be able to offer this treatment option to some of these patients. “It is a big win for the Free State and our oncology patients to be able to offer these expert services.” The UFS and Universitas Academic Hospital have now been able to join up with other academic institutions and hospitals in other provinces to offer these services. So far, three patients have been offered this therapeutic option, with the third patient currently undergoing his treatment.

Funds and equipment for proper treatment selection are needed

The expertise is no longer an issue for the UFS, as Dr Osayande Evbuomwan, nuclear medicine specialist and consultant, was trained and exposed to this therapy at the University of the Witwatersrand during his training as a nuclear medicine resident. Current registrars in the Department of Nuclear Medicine at the UFS are also being trained in the application of this treatment modality. However, proper patient selection is key in the management of these cases with Lu 177 PSMA. Without a PET/CT camera, it is challenging to appropriately select the patients who are most likely to respond to this therapy. This is an example of how PET/CT is crucial in the management and monitoring of oncology patients.

Both Drs Engelbrecht and Evbuomwan hope that the training of more registrars will increase their department’s capacity to treat more patients. They also hope that funds will be made available to acquire a much-needed PET/CT camera, which will greatly assist them in identifying the correct patients in need of this treatment. 

With the permission of the patient, the images above show the dramatic treatment response following Lu-177 PSMA therapy. The images on the left show widespread bone disease from the prostate cancer, including the skull. The images on the right show the dramatic response after completing four cycles of Lu 177 PSMA, with the normal excretion of the radiotracer seen in the liver, kidneys, and bladder.


Treatment puts the department, UFS, and hospital on the map

According to Dr Evbuomwan, the ability to administer this treatment puts the department, the UFS, and the hospital on the map, alongside other top universities within and outside the country. Says he: “It also creates an avenue for us to gather data for training, research purposes, and publications. We are now able to offer a promising, safe, and highly efficacious therapy for patients with MCRPC in the Free State. Some of these patients will no longer have to travel to other provinces to receive this treatment.”


“We are also well aware that not every patient will respond this way; however, proper patient selection is key in identifying responders – an area that is still being researched. We also do not know how long these patients will have their disease under control after the treatment. Nuclear medicine’s greatest cancer therapy success story is the treatment of well-differentiated thyroid cancer with radioactive iodine.” 

“After treatment, most of these patients remain cancer-free for a very long period of time, if not for life. With continuing research in the field of MCRPC radioligand therapy, we aim to improve the treatment modality, hopefully getting it to the success level of thyroid cancer therapy.”

 

News Archive

Research eradicates bacteria from avocado facility
2017-01-17

 Description: Listeria monocytogenes Tags: Listeria monocytogenes

Listeria monocytogenes as seen under an electron
microscope. The photo was taken with a transmission
electron microscope at the microscopy unit of the UFS.
Bacteriophages (lollipop-like structures) can be seen
next to the bacterial cells.
Photo: Supplied

“The aim of my project was to identify and characterise the contamination problem in an avocado-processing facility and then to find a solution,” said Dr Amy Strydom, postdoctoral fellow in the Department of Microbial Biochemical and Food Biotechnology at the University of the Free State (UFS).

Her PhD, “Control of Listeria monocytogenes in an Avocado-processing Facility”, aimed to identify and characterise the contamination problem in a facility where avocados were processed into guacamole. Dr Strydom completed her MSc in food science in 2009 at Stellenbosch University and this was the catalyst for her starting her PhD in microbiology in 2012 at the UFS. The research was conducted over a period of four years and she graduated in 2016. The research project was funded by the National Research Foundation.

The opportunity to work closely with the food industry further motivated Dr Strydom to conduct her research. The research has made a significant contribution to a food producer (avocado facility) that will sell products that are not contaminated with any pathogens. The public will then buy food that is safe for human consumption.


What is Listeria monocytogenes?

Listeria monocytogenes is a food-borne pathogenic bacterium. When a food product is contaminated with L. monocytogenes, it will not be altered in ways that are obvious to the consumer, such as taste and smell. When ingested, however, it can cause a wide range of illnesses in people with impaired immune systems. “Risk groups include newborn babies, the elderly, and people suffering from diseases that weaken their immune systems,” Dr Strydom said. The processing adjustments based on her findings resulted in decreased numbers of Listeria in the facility.

The bacteria can also survive and grow at refrigeration temperatures, making them dangerous food pathogens, organisms which can cause illnesses [in humans]. Dr Strydom worked closely with the facility and developed an in-house monitoring system by means of which the facility could test their products and the processing environment. She also evaluated bacteriophages as a biological control agent in the processing facility. Bacteriophages are viruses that can only infect specific strains of bacteria. Despite bacteriophage products specifically intended for the use of controlling L. monocytogenes being commercially available in the food industry, Dr Strydom found that only 26% of the L. monocytogenes population in the facility was destroyed by the ListexP100TM product. “I concluded that the genetic diversity of the bacteria in the facility was too high and that the bacteriophages could not be used as a control measure. However, there is much we do not understand about bacteriophages, and with a few adjustments, we might be able to use them in the food industry.”

Microbiological and molecular characterisation of L. monocytogenes

The bacteria were isolated and purified using basic microbiological culturing. Characterisation was done based on specific genes present in the bacterial genome. “I amplified these genes with polymerase chain reaction (PCR), using various primers targeting these specific genes,” Dr Strydom said. Some amplification results were analysed with a subsequent restriction digestion where the genes were cut in specific areas with enzymes to create fragments. The lengths of these fragments can be used to differentiate between strains. “I also compared the whole genomes of some of the bacterial strains.” The bacteriophages were then isolated from waste water samples at the facility using the isolated bacterial strains. “However, I was not able to isolate a bacteriophage that could infect the bacteria in the facility.

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