problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl13163problendo-13163Research ArticleКлиническая эндокринологияClinical endocrinologyСлезный аппарат как орган риска при проведении радионуклидной терапииThe lacrimal apparatus as an organ at risk during radionuclide therapyhttps://orcid.org/0000-0003-3785-0335ШереметаМ. С.SheremetaM. S.

Шеремета Марина Сергеевна - к.м.н.

Москва

Scopus Author ID: 57200223501

Marina S. Sheremeta - PhD.

Moscow

marina888@yandex.ruhttps://orcid.org/0000-0001-5592-4727ТрухинА. А.TrukhinA. A.

Трухин Алексей Андреевич.

117292, Москва, ул. Дм. Ульянова, д. 11

ORCID: https://orcid.org/0000-0001-5592-4727; ResearcherID: AAK-9193-2020; Scopus Author ID: 57216011386

Alexey A. Trukhin - high school-research teacher.

11 Dm. Ulyanova street, 117292 Moscow

alexey.trukhin12@gmail.comhttps://orcid.org/0000-0003-2990-8111ЯрцевВ. Д.YartsevV. D.

Ярцев Василий Дмитриевич - к.м.н.

Москва

Scopus Author ID: 55982803300

Vasiliy D. Yartsev - PhD.

Moscow

yartsewyartsew@gmail.comhttps://orcid.org/0000-0001-9708-0470ЮдаковД. В.YudakovD. V.

Юдаков Данила Витальевич.

Москва

Scopus Author ID: 1078379

Danila V. Yudakov - master.

Moscow

danila27.03@mail.ruhttps://orcid.org/0000-0002-6954-1126КорчагинаМ. О.KorchaginaM. O.

Корчагина Мария Олеговна.

Москва

ResearcherID: AGL-8912-2022

Maria O. Korchagina - PhD student.

Moscow

mashulia96@list.ruhttps://orcid.org/0000-0002-9272-6348ГоджаеваС. А.GojaevaS. A.

Годжаева Сугра Акифовна.

Москва

Sugra A. Godzhaeva - bachelor.

Moscow

Sugra.godzhaeva@mail.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian FederationФГБНУ «НИИ глазных болезней им. М.М. Краснова»РоссияM.M. Krasnov Scientific Research Institute of Eye DiseasesRussian FederationФГБНУ «НИИ глазных болезней им. М.М. Краснова»; Первый московский государственный медицинский университет имени И.М. СеченоваРоссияM.M. Krasnov Scientific Research Institute of Eye Diseases; I.M. Sechenov First Moscow State Medical UniversityRussian Federation2024270220247011317Copyright © Шеремета М.С., Трухин А.А., Ярцев В.Д., Юдаков Д.В., Корчагина М.О., Годжаева С.А., 20242024Шеремета М.С., Трухин А.А., Ярцев В.Д., Юдаков Д.В., Корчагина М.О., Годжаева С.А.Sheremeta M.S., Trukhin A.A., Yartsev V.D., Yudakov D.V., Korchagina M.O., Gojaeva S.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.probl-endojournals.ru/jour/article/view/13163

В рамках статьи авторы анализировали доступные сведения о поражении слезного аппарата при проведении радио­нуклидной терапии. Отдельно рассмотрены описания поражений системы слезопродукции, главной и добавочных слезных желез, а также слезоотведения. Обнаружено, что поражение слезного аппарата характерно для терапии 131I по поводу рака щитовидной железы, а также для радиолигандной терапии с применением анти-PSMA-антител, меченных 177Lu и 225Ac. При терапии 131I возможно формирование вторичной облитерации слезоотводящих путей, а при применении 177Lu-PSMA и 225Ac-PSMA возможно поражение слезной железы с формированием клинически выраженного «синдрома сухого глаза». Патогенез таких поражений связан с накоплением радиоизотопа в тканях слезного аппарата, накопление при проведении терапии 131I реализуется в связи с экспрессией натрий-йодного симпортера в носослезном протоке, а при проведении терапии 177Lu-PSMA и 225Ac-PSMA радиобиологический эффект реализуется в связи с экспрессией PSMA тканью слезной железы. Анализ доступных источников показал, что на сегодняшний день отсутствуют результаты систематических исследований, посвященных проблеме, имеется дефицит знаний, касающихся индивидуальных рисков развития этих осложнений, не разработаны способы их профилактики, имеющие доказанную эффективность, а применяющиеся методы лечения имеют относительно низкую эффективность. Авторы приходят к заключению, что усиление междисциплинарного взаимодействия, а также организация методологически выверенных и корректных исследований может способствовать решению задач, связанных с изучением рассматриваемых осложнений.

Within the framework of the article, the authors analyzed the available information about the damage to the lacrimal apparatus during radionuclide therapy. In focus of article lesions of the lacrimal production system, the main and accessory lacrimal glands, as well as lacrimal drainage are considered. It was found that damage to the lacrimal apparatus is characteristic of 131I therapy for thyroid cancer, as well as for radioligand therapy using anti-PSMA antibodies labeled with 177Lu and 225Ac. 177Lu-PSMA and 225Ac-PSMA may damage the lacrimal gland with the formation of a clinically pronounced "dry eye syndrome". The pathogenesis of such lesions is associated with the accumulation of a radioisotope in the tissues of the lacrimal apparatus, while during therapy with 131I, accumulation is realized due to the expression of the sodium-iodine symporter in the nasolacrimal duct, and during therapy with 177Lu-PSMA and 225Ac-PSMA, the radiobiological effect is realized in connection with the expression PSMA by lacrimal tissue. An analysis of the available sources showed that to date there are no results of systematic studies on the problem, there is a lack of knowledge regarding the individual risks of developing these complications, methods for their prevention that have proven effectiveness have not been developed, and the treatment methods used, having relatively low efficiency, are not specialized. The authors concluded that the strengthening of interdisciplinary interaction, as well as the organization verification methodology and correct studies, can contribute to solving problems related to the study of the complications under consideration.

онкоэндокринологияофтальмология131-йод177-лютецийрадионуклидная терапиявторичная облитерация слезоотводящих путейслезные железы.radionuclide therapyophthalmology131-iodine177-lutetiumsecondary obliteration of the lacrimal tractlacrimal apparatusМатериал подготовлен в рамках реализации государственного задания Министерства здравоохранения Российской Федерации, регистрационный номер ЕГИСУ НИОКТР 123021000041-6 «Исследование фармакобезопасности тераностических радиофармацевтических лекарственных препаратов с использованием гибридной молекулярной визуализации в диагностике и лечении эндокринных и онкологических заболеваний в детской и взрослой возрастных группах»; при подготовке рукописи авторы сохранили независимость мнений. Авторы выражают признательность руководству ФГБУ «НМИЦ эндокринологии» Минздрава России и ФГБНУ «НИИ глазных болезней им. М.М. 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The authors declare that there are no conflicts of interest present.