Sodium iodide symporter: Its role in nuclear oncology

Full text: Thyroid iodide uptake is basic to the clinical applications of radioiodine in diagnosis and therapy. Iodide uptake occurs across the membrane of thyroid follicular cells via an active transporter process mediated by the sodium/iodide symporter (NIS). The recent cloning of the gene encoding NIS enabled better characterization of the molecular mechanisms underlying the iodide transport, thus opening the way to clarify and expand its role in medicine. NIS contains 13 transmembrane segments, and its gene encodes a glycoprotein of 643 amino acids. Decreased NIS expression levels account for the reduced iodide uptake in thyroid carcinomas. We found that thyroid cancer patients with positive immunostaining for NIS responded to I-131 therapy better than did the patients with negative immunostaining. Thus, NIS gene can be used for radionuclide gene therapy. Targeted expression of functional NIS in cancer cells would enable these cells to concentrate iodide from plasma and would, therefore, offer the possibility of radioiodine therapy. We and others have shown that gene transfer of NIS into a variety of cell types confers increased radioiodine uptake up to several hundred-fold that of controls. There is great interest in exploring the possibility of NIS gene transfer to facilitate radioiodine therapy for non-thyroidal human cancers including hepatoma, prostate, breast, colon cancers as well as thyroid cancer. Recently, several approaches such as, targeted gene transfer, thyroid peroxidase gene co-transfection, retinoic acid treatment and Re-188 therapy instead of I-131, have been tried to improve this novel gene therapy. Imaging reporter gene is useful in non-invasively determining the location, duration and magnitude of transgene expression in living animal. Conventionally, HSV-tk and dopaminergic receptor (D2R) genes have been presented as possible imaging reporter genes. We proved that NIS could serve as an alternative imaging reporter gene. NIS has many advantages as an imaging reporter gene due to the wide availability of its substrate, radioiodine and free Tc-99m, and the well-understood metabolism and clearance of radioiodine in the body. We could monitor not only exogenous gene expression, but also endogenous gene expression such as p53 and, nuclear receptor activity such as retinoic acid receptor using cis-reporter imaging gene system. This reporter gene imaging can also be used for monitoring cancer cells, stem cells and immune cells. For example, the hNIS gene was transfected to hepatoma cells. The effect of anticancer regimen can be monitored easily by a gamma camera system using Tc-99m or radioiodines. In conclusion, the NIS has the potential to expand the molecular medicine in the future. (author)