Alfons Verbruggen

The 68Ge/68Ga generator has high potential, but when can we use 68Ga-labelled tracers in clinical routine?

In this issue of the European Journal of Nuclear Medicine and Molecular Imaging, the article by Antunes et al., entitled “Are radiogallium-labelled DOTA-conjugated somatostatin analogues superior to those labelled with other radiometals?”, provides another example of the high potential of the Ge/Ga generator for PET applications in nuclear medicine. The use of Ge/Ga generators in nuclear medicine is very attractive for several reasons:

Molecular imaging of αvβ3 integrin expression in atherosclerotic plaques with a mimetic of RGD peptide grafted to Gd-DTPA†

AIMS The integrin alpha v beta3 is highly expressed in atherosclerotic plaques by medial and intimal smooth muscle cells and by endothelial cells of angiogenic microvessels. In this study, we have assessed non-invasive molecular magnetic resonance imaging (MRI) of plaque-associated alpha v beta3 integrin expression on transgenic ApoE-/- mice with a low molecular weight peptidomimetic of Arg-Gly-Asp (mimRGD) grafted to gadolinium diethylenetriaminepentaacetate (Gd-DTPA-g-mimRGD). The analogous compound Eu-DTPA-g-mimRGD was employed for an in vivo competition experiment and to confirm the molecular targeting. The specific interaction of mimRGD conjugated to Gd-DTPA or to 99mTc-DTPA with alpha v beta3 integrin was furthermore confirmed on Jurkat T lymphocytes. METHODS AND RESULTS The mimRGD was synthesized and conjugated to DTPA. DTPA-g-mimRGD was complexed with GdCl3.6H2O, EuCl3.6H2O, or with [99mTc(CO)3(H2O)3]+. MRI evaluation was performed on a 4.7 T Bruker imaging system. Blood pharmacokinetics of Gd-DTPA-g-mimRGD were assessed in Wistar rats and in c57bl/6j mice. The presence of angiogenic blood vessels and the expression of alpha v beta3 integrin were confirmed in aorta specimens by immunohistochemistry. Gd-DTPA-g-mimRGD produced a strong enhancement of the external structures of the aortic wall and of the more profound layers (possibly tunica media and intima). The aortic lumen seemed to be restrained and distorted. Pre-injection of Eu-DTPA-g-mimRGD diminished the Gd-DTPA-g-mimRGD binding to atherosclerotic plaque and confirmed the specific molecular targeting. A slower blood clearance was observed for Gd-DTPA-g-mimRGD, as indicated by a prolonged elimination half-life and a diminished total clearance. CONCLUSION The new compound is potentially useful for the diagnosis of vulnerable atherosclerotic plaques and of other pathologies characterized by alpha v beta3 integrin expression, such as cancer and inflammation. The delayed blood clearance, the significant enhancement of the signal-to-noise ratio, and the low immunogenicity of the mimetic molecule highlight its potential for an industrial and clinical implementation.

99mTc-MAMA-chrysamine G, a probe for beta-amyloid protein of Alzheimer’s disease

Abstract. Chrysamine G (CG), an analogue of Congo red, is known to bind in vitro to the β-amyloid protein (Aβ 10-43) and to homogenates of several regions of the brain of Alzheimer’s disease (AD) patients. We synthesised a conjugate of 2-(acetamido)-CG with a bis-S-trityl protected monoamide-monoaminedithiol (MAMA-Tr2) tetraligand, which was efficiently deprotected and labelled with a 75% yield with technetium-99m, to obtain 99mTc-MAMA-CG. In mice, 99mTc-MAMA-CG was cleared mainly by the hepatobiliary system, resulting in a fast blood clearance. Brain uptake of 99mTc-MAMA-CG was low. Co-injection with the blood pool tracer iodine-125 human serum albumin (125I-HSA) demonstrated a brain/blood activity ratio for 99mTc-MAMA-CG that was significantly higher than that for 125I-HSA (t test for dependent samples, P<0.02), indicating the ability of 99mTc-MAMA-CG to cross the blood-brain barrier. In vitro autoradiography demonstrated pronounced binding of 99mTc-MAMA-CG to β-amyloid deposits in autopsy sections of the parietal and occipital cortex of an AD patient as compared with controls. Adding 10 µM Congo red during incubation displaced the binding of 99mTc-MAMA-CG. Congo red staining and autoradiography identified the same lesions. 99mTc-MAMA-CG seems to bind selectively to β-amyloid deposition in human brain parenchyma and blood vessels in vitro and thus might be a lead compound for further development of a useful tracer agent for the in vivo diagnosis of Alzheimer’s disease.

Visualisation of loss of 5-HT2A receptors with age in healthy volunteers using [18F]altanserin and positron emission tomographic imaging.

We used [18F]altanserin and positron emission tomography (PET) to image serotonin 5-HT2A receptors in humans. The highest [18F]altanserin uptake is found in the cerebral cortex, with specific-to-nonspecific binding ratios varying from 0.53 to 1.91 in humans between 24 and 48 years of age. In all neocortical regions studied, [18F]altanserin uptake correlates negatively with age. No correlations were found between age and uptake in the cerebellum, the regional cerebral blood flow, or the time course of metabolization of [18F]altanserin. The reduction in cerebral 5-HT2A receptor binding thus directly reflects the loss of specific 5-HT2A receptors with age.

Necrosis avid contrast agents: functional similarity versus structural diversity.

Two categories of necrosis-avid contrast agents (NACAs), namely porphyrin- and nonporphyrin-based complexes, have thus far been discovered as necrosis-targeting markers for noninvasive magnetic resonance imaging (MRI) identification of acute myocardial infarction, assessment of tissue or organ viability, and therapeutic evaluation after interventional therapies. In addition to necrosis labeling, other less-specific functions, such as first-pass perfusion, blood pool contrast effect, hepatobiliary contrast enhancement (CE), adrenal and spleen CE, and renal functional imaging, also are demonstrated with NACAs. Despite various investigations with a collection of clues in favor of certain hypotheses, the mechanisms of such a unique targetability for NACAs still remain to be elucidated. However, a few things have become clear that porphyrin-like structures are not necessary for necrosis avidity and the albumin binding is not the supposed driving force but only a parallel nonspecific feature shared by both NACAs and non-NACA substances. Although the research and development of NACAs still remain in preclinical stage at a relatively small scale, their significance rests upon striking enhancement effects, which may warrant their eventual versatile clinical applications. The present review article is intended to summarize the cumulated facts about the evolving research on this topic, to demonstrate experimental observations for better understanding of the mechanisms, to trigger broader public interests and more intensive research activities, and to advocate, toward both academics and industries, further promotion of preclinical and clinical development of this unique and promising class of contrast agents.

First experience in healthy volunteers with technetium-99m l,l-ethylenedicysteine, a new renal imaging agent

Animal studies have indicated that technetium-99m l,l-ethylenedicysteine (99mTc-l,l-EC) may be a promising tracer agent for renal function studies. We have performed a paired study with 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) and 99mTc-l,l-EC in six male volunteers. In both cases, iodine-131-labelled o-iodohippurate was co-injected as an internal biological standard. The analog images between 0 and 30 min p.i. were of identical diagnostic value for both tracer agents. The two renograms were similar in all volunteers. The mean 1-h plasma clearance for 99mTc-MAG3 and 99 mTc-l,l-EC was significantly different, respectively 382.9 ± 17.1 ml/min per 1.73 m2 versus 460.2 ± 47.7 ml/min per 1.73 m2 (P<0.003). The urinary excretion after 30 min p.i. was 69.4% ± 5.6% of the injected dose for 99mTc-MAG3 versus 66.5% ± 2.5% for 99mTc-l,l-EC (P>0.05) and after 60 min p.i. respectively 83.1% ± 3.9% versus 79.8 % ± 4.3 % (P > 0.05). 99mTc-l,l-EC has a very low plasma protein binding (31% ± 6.8%) as compared to 99mTc-MAG3 (88% ± 5.2%) and a larger volume of distribution. Although the exact mechanism responsible for the high plasma clearance of 99mTc-l,l-EC is not yet fully known, we conclude that this new agent merits further clinical evaluation in patients to establish its value as a renal radiopharmaceutical.

Radiopharmaceuticals: state of the art

In the past four years most of the effort in radiopharmaceutical chemistry has been devoted to compounds for positron emission tomography, but widespread use of this technique is still compromised by its high cost. On the other hand, steady progress has also been made in the development of technetium-99m-labelled radiopharmaceuticals. A variety of99mTc-labelled agents is now available or in clinical evaluation for the study of brain perfusion (99mTc-labelled HMPAO, ECD, MRP20), myocardial perfusion (99mTc-labelled MIBI, teboroxime and phosphines) and renal function (99mTc-MAG3,99mTc-L,L-EC). Different direct reduction methods and indirect conjugation methods have been developed to label antibodies or their fragments efficiently with99mTc with preservation of immunoreactivity. However, the strict requirements of the regulatory authorities with respect to purification and quality of these preparations limit their use drastically in clinical practice. Radiopharmaceuticals labelled with beta-emitting radionuclides for radioimmunotherapy and palliative treatment of skeletal metastases are receiving increasing interest. Numerous agents are now available for imaging inflammation, but more clinical experience is required to determine which of them is the most appropriate. The growing importance of radiolabelled receptor-imaging agents is apparent from the commercial availability of the first such compound in Europe.

Synthesis and biological evaluation of a 99mTc-labelled sulfonamide conjugate for in vivo visualization of carbonic anhydrase IX expression in tumor hypoxia

INTRODUCTION Carbonic anhydrase (CA) IX is a transmembrane protein overexpressed in many frequently occurring tumors associated with tumor hypoxia. Sulfonamides and their bioisosteres are known to inhibit CA IX activity. In this study, 4-(2-aminoethyl)benzenesulfonamide was conjugated to a tridentate ligand, N-2-picolyl-N-acetic acid and labeled with a (99m)Tc(I)-tricarbonyl moiety resulting in [(99m)Tc(CO)(3) (L)] (L=N-(pyridin-2-yl-methyl)-N[2-(4-sulfamoylphenyl)-ethyl]aminoethyl acetate) complex, [(99m)Tc]-5. Similarly the corresponding rhenium congener (Re-4) was synthesized. The in vitro CA IX affinity and inhibitory activity of Re-4 were determined and [(99m)Tc]-5 was evaluated as a tracer for in vivo visualisation of CA IX expression. METHODS Evaluation of the in vitro affinity (inhibition constant, K(i)) of Re-4 for CA isozymes I, II, IX and XII was carried out by assaying the CA catalyzed CO(2) hydration activity and efficacy studies were performed in HT 29 cell lines expressing CA IX under normoxia or hypoxia. Biodistribution studies of [(99m)Tc]-5 were performed in xenograft mice bearing CA IX expressing tumors. RESULTS The in vitro affinity of Re-4 for CA IX was 58 nM and CA IX induced acidification of extracellular medium was efficiently reduced (P<.05) in the presence of 1 mM Re-4. Biodistribution studies indicated a maximal tumor uptake of [(99m)Tc]-5 of 0.1% ID/g at 30 min post injection. CONCLUSION [(99m)Tc]-5 and its rhenium congener were synthesized and characterized. In vitro studies showed that the rhenium compound has a high affinity for CA IX and effectively inhibits CA IX activity. In vivo studies revealed a limited tracer accumulation in a CA IX expressing tumor but with increasing tumor-to-blood activity ratios as a function of time.

Preclinical Evaluation of 18F-JNJ41510417 as a Radioligand for PET Imaging of Phosphodiesterase-10A in the Brain

Phosphodiesterases are enzymes that inactivate the intracellular second messengers 3′,5′-cyclic adenosine-monophosphate and/or cyclic guanosine-monophosphate. Of all 11 known phosphodiesterase families, phosphodiesterase-10A (PDE10A) has the most restricted distribution, with high expression in the striatum. PDE10A inhibitors are pursued as drugs for treatment of neuropsychiatric disorders. We have synthesized and evaluated 18F-JNJ41510417 as a selective and high-affinity radioligand for in vivo brain imaging of PDE10A using PET. Methods: The biodistribution of 18F-JNJ41510417 was evaluated in rats. Rat plasma and perfused brain homogenates were analyzed by high-performance liquid chromatography to quantify radiometabolites. Dynamic small-animal PET was performed in rats and in wild-type and PDE10A knock-out mice and compared with ex vivo autoradiography. Blocking and displacement experiments were performed using the nonradioactive analog and other selective PDE10A inhibitors. Results: Tissue distribution studies showed predominant hepatobiliary excretion, sufficient brain uptake (0.56 ± 0.00 percentage injected dose at 2 min after tracer injection), and continuous accumulation of the tracer in the striatum over time; rapid washout of nonspecific binding from other brain regions was observed. Polar radiometabolites were detected in plasma and brain tissue. Dynamic small-animal PET showed continuous tracer accumulation in the striatum, with rapid decline in the cortex and cerebellum. Pretreatment and chase experiments with PDE10A inhibitors showed that the tracer binding to PDE10A was specific and reversible. Imaging in PDE10A knock-out and wild-type mice further confirmed that binding in the striatum was specific for PDE10A. Conclusion: Experiments in rats and PDE10A knock-out mice indicate that 18F-JNJ41510417 binds specifically and reversibly to PDE10A in the striatum, suggesting that this new fluorinated quinoline derivative is a promising candidate for in vivo imaging of PDE10A using PET.

A Dual-targeting Anticancer Approach: Soil and Seed Principle

PURPOSE To test the hypothesis that targeting the microenvironment (soil) may effectively kill cancer cells (seeds) through a small-molecular weight sequential dual-targeting theragnostic strategy, or dual-targeting approach. MATERIALS AND METHODS With approval from the institutional animal care and use committee, 24 rats were implanted with 48 liver rhabdomyosarcomas (R1). First, the vascular-disrupting agent combretastatin A4 phosphate (CA4P) was injected at a dose of 10 mg/kg to cause tumor necrosis, which became a secondary target. Then, the necrosis-avid agent hypericin was radiolabeled with iodine 131 to form (131)I-hypericin, which was injected at 300 MBq/kg 24 hours after injection of CA4P. Both molecules have small molecular weight, are naturally or synthetically derivable, are intravenously injectable, and are of unique targetablities. The tumor response in the dual-targeting group was compared with that in vehicle-control and single-targeting (CA4P or (131)I-hypericin) groups with in vivo magnetic resonance imaging and scintigrams and ex vivo gamma counting, autoradiography, and histologic analysis. Tumor volumes, tumor doubling time (TDT), and radiobiodistribution were analyzed with statistical software. P values below .05 were considered to indicate a significant difference. RESULTS Eight days after treatment, the tumor volume of rhabdomyosarcoma in the vehicle-control group was double that in both single-targeting groups (P < .001) and was five times that in the dual-targeting group (P < .0001), without treatment-related animal death. The TDT was significantly longer in the dual-targeting group (P < .0001). Necrosis appeared as hot spots on scintigrams, corresponding to 3.13% of the injected dose of (131)I-hypericin per gram of tissue (interquartile range, 2.92%-3.97%) and a target-to-liver ratio of 20. The dose was estimated to be 100 times the cumulative dose of 50 Gy needed for radiotherapeutic response. Thus, accumulated (131)I-hypericin from CA4P-induced necrosis killed residual cancer cells with ionizing radiation and inhibited tumor regrowth. CONCLUSION This dual-targeting approach may be a simple and workable solution for cancer treatment and deserves further exploitation.