RT Journal Article SR Electronic T1 223Ra Induces Transient Functional Bone Marrow Toxicity JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 1544 OP 1550 DO 10.2967/jnumed.121.263310 VO 63 IS 10 A1 Parlani, Maria A1 Boccalatte, Francesco A1 Yeaton, Anna A1 Wang, Feng A1 Zhang, Jianhua A1 Aifantis, Iannis A1 Dondossola, Eleonora YR 2022 UL http://jnm.snmjournals.org/content/63/10/1544.abstract AB 223Ra is a bone-seeking, α-particle–emitting radionuclide approved for the treatment of patients with metastatic prostate cancer and is currently being tested in a variety of clinical trials for primary and metastatic cancers to bone. Clinical evaluation of 223Ra hematologic safety showed a significantly increased rate of neutropenia and thrombocytopenia in patients, hinting at myelosuppression as a side effect. Methods: In this study, we investigated the consequences of 223Ra treatment on bone marrow biology by combining flow cytometry, single-cell RNA sequencing, three-dimensional multiphoton microscopy and bone marrow transplantation analyses. Results: 223Ra accumulated in bones and induced zonal radiation damage confined to the bone interface, followed by replacement of the impaired areas with adipocyte infiltration, as monitored by 3-dimensional multiphoton microscopy ex vivo. Flow cytometry and single-cell transcriptomic analyses on bone marrow hematopoietic populations revealed transient, nonspecific 223Ra-mediated cytotoxicity on resident populations, including stem, progenitor, and mature leukocytes. This toxicity was paralleled by a significant decrease in white blood cells and platelets in peripheral blood—an effect that was overcome within 40 d after treatment. 223Ra exposure did not impair full hematopoietic reconstitution, suggesting that bone marrow function is not permanently hampered. Conclusion: Our results provide a comprehensive explanation of 223Ra reversible effects on bone marrow cells and exclude long-term myelotoxicity, supporting safety for patients.