WO 2014/115152 Al 31 July 20 14 (31.07.2014) W P O P CT

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WO 2014/115152 Al 31 July 20 14 (31.07.2014) W P O P CT (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2014/115152 Al 31 July 20 14 (31.07.2014) W P O P CT (51) International Patent Classification: (72) Inventor; and A61K 51/04 (2006.01) (71) Applicant (for PG only): BEN-HAIM, Shlomo [IL/CH]; c/o Lemuria Alliance SA, 17 Rue des Pierres-du-Niton, (21) International Application Number: CH- 1207 Geneva (CH). PCT/IL20 14/050090 (74) Agents: G.E. EHRLICH (1995) LTD. et al: 11 Mena- (22) International Filing Date: chem Begin Road, 5268104 Ramat Gan (IL). 24 January 2014 (24.01 .2014) (81) Designated States (unless otherwise indicated, for every English (25) Filing Language: kind of national protection available): AE, AG, AL, AM, (26) Publication Language: English AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, (30) Priority Data: DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, 61/756,1 12 24 January 2013 (24.01. 2013) US HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, 61/776,599 11 March 2013 ( 11.03 2013) US KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, 61/803,61 1 20 March 2013 (20.03 2013) us MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, 61/83 1,664 6 June 2013 (06.06 2013) us OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, 61/875,069 ! September 2013 (08.09. 2013) us SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, 61/875,074 ! September 2013 (08.09. 2013) us TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, 61/875,070 ! September 2013 (08.09. 2013) us ZW. 61/925,670 10 January 2014 (10.01. 2014) us 61/925,669 10 January 2014 (10.01. 2014) us (84) Designated States (unless otherwise indicated, for every kind of regional protection available): ARIPO (BW, GH, (71) Applicant for all designated States except PG) : TYLER- GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, TON INTERNATIONAL HOLDINGS INC.; Jayla UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, Place, Wickhams Cay 1, Road Town (VG). TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, [Continued on nextpage] (54) Title: NEURONAL IMAGING AND TREATMENT (57) Abstract: A method is disclosed herein for imaging at least one autonomic nervous system synaptic center in a subject, as well as a method of diagnosing and/or monitoring a medical con dition or disease associated with an autonomic nervous system, and a method of guiding a ther apy of such a medical condition or disease. The methods comprise administering to the subject a radioactive tracer which selectively binds to autonomic nervous system synapses; measuring radioactive emission of the tracer to obtain data describing a distribution of the tracer in the body; and analyzing the data in order to identify at least one region exhibiting a high concentra > tion of the tracer. Further disclosed herein are radioactive tracers, uses thereof, and an apparat us, for use in a method disclosed herein. EE, ES, FI, FR, GB, GR, HR, HU, IE, IS, IT, LT, LU, Published: LV, MC, MK, MT, NL, NO, PL, PT, RO, RS, SE, SI, SK, — with international search report (Art. 21(3)) SM, TR), OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ, GW, KM, ML, MR, NE, SN, TD, TG). Declarations under Rule 4.17: — of inventorship (Rule 4.17(iv)) NEURONAL IMAGING AND TREATMENT RELATED APPLICATIONS: This application claims the benefit of priority of U.S. Provisional Patent Application No. 61/756,112, filed January 24, 2013, U.S. Provisional Patent Application No. 61/776,599, filed March 11, 2013, U.S. Provisional Patent Application No. 61/803,611 filed March 20, 2013, U.S. Provisional Patent Application No. 61/831,664, filed June 6, 2013, U.S. Provisional Patent Application Nos. 61/875,069, 61/875,070 and 61/875,074, filed September 8, 2013, and U.S. Provisional Patent Application Nos. 61/925,669 and 61/925,670, filed January 10, 2014, the contents of which are incorporated herein by reference in their entirety. FIELD AND BACKGROUND OF THE INVENTION The present invention, in some embodiments thereof, relates to methods and systems of imaging and, more particularly, but not exclusively, to methods and systems of medical imaging using a radioactive tracer with affinity to nervous tissue. The autonomic nervous system (ANS) is a part of the peripheral nervous system that controls, usually at an unconscious level, various bodily functions such as heart rate, vasomotor activity, digestion, respiration, reflex actions and the like. The ANS is regulated by the medulla oblongata and hypothalamus in the brain. ANS functions include afferent (sensory) activity - transmitting signals from the viscera to the central nervous system (CNS), as well as efferent (motor) activity - transmitting signals from the CNS to the periphery. Efferent activity in the ANS is typically divided into two divisions, the sympathetic nervous system and the parasympathetic nervous system. To a considerable degree, these divisions act in parallel to one another, and often have opposing effects. The sympathetic division is usually associated with mobilization of a quick response, whereas the parasympathetic division is usually associated with lower activities. The peripheral nervous system also includes the somatic nervous system (SoNS), which controls voluntary movements via efferent neurons and conducts, via afferent neurons, impulses of pain, touch and temperature from the body surface, and muscle, tendon and joint sense from within the body. Afferent (sensory) neurons of the ANS and SoNS extend from peripheral organs to synapses in the spinal cord. Cell bodies of afferent neurons are aggregated in spinal ganglia, just outside the spinal cord. Efferent SoNS neurons are located in the spinal cord and extend to synapses at neuromuscular junctions at the innervated muscle. In contrast to afferent and SoNS efferent activity, ANS efferent innervation is characterized by the involvement of two sequential efferent neurons which communicate via a synapse in a ganglion. The preganglionic neuron carries a signal from the central nervous system to the ganglion, and the postganglionic neuron carries a signal from the ganglion to the target (e.g., an innervated organ). Sympathetic ganglia include the paravertebral ganglia, which are located along the spine, prevertebral ganglia, which are located in the abdomen and innervate abdominal organs, and the adrenal medulla in the adrenal gland, which is a modified ganglion in which the postganglionic cells release hormones into the blood instead of acting as neurons. In comparison to sympathetic ganglia, parasympathetic ganglia are usually small and located close to the organ they innervate, that is, the postganglionic neurons are relatively short. Acetylcholine is the primary neurotransmitter secreted at synapses by sympathetic and parasympathetic preganglionic neurons in ganglia, by SoNS neurons and parasympathetic postganglionic neurons at innervated organs, and by sympathetic postganglionic neurons at sweat glands. Acetylcholine receptors in ANS ganglia and neuromuscular junctions are typically nicotinic receptors, and acetylcholine receptors at ANS synapses in innervated organs are typically muscarinic receptors. In contrast, sympathetic postganglionic neurons generally secrete adrenergic neurotransmitters, primarily norepinephrine (noradrenaline). The sympathetic and parasympathetic nervous systems are not entirely separate. For example, cardiac ganglia, typically considered as part of the parasympathetic nervous system, also include adrenergic synapses of sympathetic neurons, which provide input to parasympathetic postganglionic neurons, and a similar sympathetic input to parasympathetic postganglionic neurons occurs in pelvic prevertebral ganglia [Smith, Am J Physiol 1999, 276:R455-R467; Arora et al., Anat Rec A Discov Mol Cell Evol Biol 2003, 271:249-258]. Atrial fibrillation may be treated by ablation or surgery aimed at disrupting autonomic signaling to atria, as both sympathetic and parasympathetic stimuli appear to be involved in atrial fibrillation. Neurons around the pulmonary veins, and the nearby cardiac ganglionated plexuses, have been reported to be effective targets for ablation and/or surgery [Arora, Circ Arrhythm Electrophysiol 2012, 5:850-859; Tan et al., Heart Rhythm 2007, 4:S57-S60]. A variety of medical imaging techniques are available for obtaining images of internal organs. Techniques such as X-ray computerized tomography (CT), magnetic resonance imaging (MRI), and ultrasound scans utilize an external source of irradiation; whereas techniques such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT) utilize nuclear radiation emitted by a radioactive tracer within the body. In such techniques, data may be obtained in a manner which provides 3- dimensional information, such that the data can be processed so as to generate a volumetric image. Orbiting detectors from multiple directions may be used to generate a volumetric image by computed tomography. PET and SPECT use a collimator to allow only radiation from a certain direction to reach the detector. Typically, this collimator is constructed to provide a multiplicity of small holes in a dense, high-atomic number material such as lead or tungsten. Radiation will pass through a hole if it travels in a direction aligned with a hole but will tend to be absorbed by the collimator material if it travels in a different direction. Radioactive tracers may be selected so as to allow for selective imaging of a particular tissue type or activity. Langer & Haldin [Eur J Nucl Med 2002, 29:416-434] describe PET and SPECT radioactive tracers for mapping the cardiac nervous system, including catecholamines and catecholamine analogs such as mlBG (m-iodobenzylguanidine) and - hydroxyephedrine for imaging adrenergic synapses, and vesamicol derivatives for imaging cholinergic synapses.
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