Sarita Forsback

18F-EF5: A New PET Tracer for Imaging Hypoxia in Head and Neck Cancer

The aim of this study was to evaluate 2-(2-nitro-1H-imidazol-1-yl)-N-(2,2,3,3,3-pentafluoropropyl)-acetamide (EF5) labeled with 18F-fluorine to image hypoxia in patients with squamous cell carcinoma of the head and neck (HNSCC). Methods: Fifteen patients with HNSCC were studied. Measurement of tumor blood flow was followed by an 18F-EF5 PET/CT scan. On a separate day, 18F-FDG PET/CT was performed to determine the metabolically active tumor volume. In 6 patients, dynamic 18F-EF5 images of the head and neck area were acquired, followed by static images acquired at 1, 2, and 3 h after injection. In the remaining 9 patients, only static images were obtained. 18F-EF5 uptake in tumors was compared with that in neck muscle, and the 18F-EF5 findings were correlated with the 18F-FDG PET/CT studies. Results: A total of 13 primary tumors and 5 lymph node metastases were evaluated for their uptake of 18F-EF5. The median tumor-to-muscle 18F-EF5 uptake ratio (T/M) increased over time and was 1.38 (range, 1.1–3.2) 3 h after tracer injection. The median blood flow in tumors was 36.7 mL/100 g/min (range, 23.3–78.6 mL/100 g/min). Voxel-by-voxel analysis of coregistered blood flow and 18F-EF5 images revealed a distinct pattern, resulting in a T/M of 1.5 at 3 h to be chosen as a cutoff for clinically significant hypoxia. Fourteen of 18 tumors (78%) had subvolumes within the metabolically active tumor volumes with T/M greater than or equal to 1.5. Conclusion: On the basis of these data, the potential of 18F-EF5 to detect hypoxia in HNSCC is encouraging. Further development of 18F-EF5 for eventual targeting of antihypoxia therapies is warranted.

Blood metabolism of [methyl-11C]choline; implications for in vivo imaging with positron emission tomography

Abstract.[methyl-11C]Choline (11C-choline) is a radioligand potentially useful for oncological positron emission tomography (PET). As a first step towards the development of a kinetic model for quantification of 11C-choline uptake, blood metabolism of 11C-choline during PET imaging was studied in humans. High-performance liquid chromatography (HPLC) and thin-layer chromatography (TLC) were used for the analysis of 11C-choline and its radioactive metabolites. Prior to human PET imaging we studied ex vivo the biodistribution and metabolism of intravenously administered 11C-choline in rats. Our results revealed that the radioactivity accumulated particularly in kidney, lung, adrenal gland and liver. Chromatographic analysis showed that the level of unmetabolized 11C-choline in rat plasma decreased from 42%±20% (mean±SD) at 5 min to 21%±10% at 15 min after injection. In accordance with these findings, in humans the unmetabolized 11C-choline represents 62%±19% of the total radioactivity in arterial plasma at 5 min after injection and 27%±12% at 15 min. In human venous plasma the corresponding values were 85%±12% and 48%±12% at 5 and 10 min, respectively. The major metabolite observed in both human and rat plasma was identified as 11C-betaine. In human arterial plasma this maximally represented 82%±9% of the total radioactivity at 25 min after radiotracer injection. By 20 min after injection, the 11C-choline and 11C-betaine in human arterial plasma reached a plateau, and their fractional activities remained nearly constant thereafter. Although most of the circulating 11C-choline in blood is transported to tissues, it does not disappear totally from blood within the first 40 min after tracer injection.

Catalytic decarboxylative fluorination for the synthesis of tri- and difluoromethyl arenes.

Treatment of readily available α,α-difluoro- and α-fluoroarylacetic acids with Selectfluor under Ag(I) catalysis led to decarboxylative fluorination. This operationally simple reaction gave access to tri- and difluoromethylarenes applying a late-stage fluorination strategy. Translation to [(18)F]labeling is demonstrated using [(18)F]Selectfluor bis(triflate), a reagent affording [(18)F]tri- and [(18)F]difluoromethylarenes not within reach with [(18)F]F2.

Striatal Dopamine Synthesis in First-degree Relatives of Patients with Schizophrenia

BACKGROUND First degree relatives (FDR) of patients with schizophrenia have higher risk of developing schizophrenia than the general population. Previous positron emission tomography (PET) studies have shown that striatal presynaptic dopamine synthesis capacity is increased in schizophrenia. We investigated whether this same phenomenon is shared by individuals with increased genetic risk for schizophrenia. METHODS We used 6-[18F]-fluorodopa (FDOPA) PET imaging to measure striatal dopamine synthesis capacity. We studied 17 nonpsychotic subjects with an FDR with schizophrenia. This group was compared to 17 healthy subjects with no FDRs with schizophrenia. RESULTS A conventional region of interest (ROI)-analysis indicated that FDOPA uptake (K(i)) in the caudate-putamen was statistically significantly higher in the FDR group than in the control group. A voxel-level analysis confirmed these results. CONCLUSIONS These results suggest that the changes of striatal presynaptic dopamine synthesis seen previously in neuroleptic-naive schizophrenic patients is also present in FDRs of patients with schizophrenia. These findings have implications for the early detection of psychosis as well as for pharmacological interventions in individuals at risk for psychosis.

Radiosynthesis and Evaluation of [18F]Selectfluor bis(triflate)†

Positron (b) emission tomography (PET) is a noninvasive molecular imaging technique that allows for the in vivo investigation of physiological processes. As a radioisotope, fluorine-18 benefits from an advantageous half-life (109.7 min), a clean decay process (97% b emission), and a short b trajectory, which is a property that enables the acquisition of high-resolution images. The global use of the radiotracer [F]-2-fluoro-2-deoxy-d-glucose has generated a vast amount of invaluable clinical data and has stimulated a worldwide interest in PET and F radiochemistry. For applications other than radiolabeling, nucleophilic and electrophilic fluorination are complementary processes that are used indiscriminately; the method of choice depends on the reactivity profile of the precursor to be fluorinated. A similar degree of synthetic flexibility would facilitate significantly the production and evaluation of new F radiotracers but to date, this is far from the reality because the range of reactions suitable for F labeling remains limited in comparison with the number of transformations available to access nonlabeled fluorinated material. Electrophilic F-fluorination suffers from well-recognized drawbacks. The carrieradded method employed for the production of [F]F2 gas gives labeled products with low specific activity (SA). In addition, [F]F2, a reagent that requires specialist equipment for its handling, can react unselectively and lead to a mixture of products. This complication lowers the radiochemical yield (RCY) and may lead to problematic and time-consuming purification processes. Despite these limitations, clinical doses of the radiotracers [F]-2-fluoro-l-tyrosine and [F]-6-fluoro3,4-dihydroxy-l-phenylalanine are currently prepared relying on an electrophilic fluorodestannylation reaction using [F]F2. [4]

Electrophilic synthesis of 6-[18F]fluoro-L-DOPA using post-target produced [18F]F2

Abstract New diagnostic uses of 6-[ 18F]fluoro-L-DOPA ([ 18F]FDOPA) for endocrine cancers and for focal hyperinsulism of infancy have renewed interest in simple and reproducible methods to synthesize it in high quantity. Fluorodestannylation is a simple and regioselective means to produce [ 18F]FDOPA. We have successfully used post-target produced [ 18F]F2 as a labeling agent in fluorodestannylation. We are able to produce in one synthesis enough [ 18F]FDOPA for several human PET studies at Turku PET Centre. The average radiochemical yield in 50 syntheses was 6.4±1.7% (calculated from [ 18F]F−), with radiochemical purity >98% and mean specific radioactivity at the end of synthesis 3.7±0.9 GBq/μmol. With this method the amounts of the reagents used in the synthesis are considerably reduced in comparison to other electrophilic labeling approaches. Thus the manipulations during the synthesis and the purification of the product are simplified.

Increased medial orbitofrontal [18F]fluorodopa uptake in Parkinsonian impulse control disorders

Impulse control disorders (ICDs) occur frequently in PD patients.

Detection of Hypoxia by [18F]EF5 in Atherosclerotic Plaques in Mice

Objective—Atherosclerotic plaques with large lipid cores and inflammation contain regions of hypoxia. We examined the uptake of 2-(2-nitro-1H-imidazol-1-yl)-N-(2,2,3,3,3-pentafluoropropyl) acetamide ([18F]EF5), a specific marker of hypoxia labeled for positron emission tomography, in mouse atherosclerotic plaques. Methods and Results—Atherosclerotic mice of 2 different genetic backgrounds (low-density lipoprotein receptor−/− apolipoprotein B100/100 and insulin-like growth factor II/low-density lipoprotein receptor−/− apolipoprotein B100/100) were first fed a Western diet to induce development of plaques with variable phenotypes and then injected with [18F]EF5. C57BL/6N mice served as controls. Aortas were dissected for biodistribution studies, autoradiography, histology, and immunohistochemistry. Uptake of [18F]EF5 was significantly higher in the aortas of mice with large atherosclerotic plaques than in the C57BL/6N controls. Furthermore, autoradiography demonstrated, on average, 2.0-fold higher [18F]EF5 uptake in atherosclerotic plaques than in the adjacent normal vessel wall. Hypoxia in plaques was verified by using an EF5 adduct-specific antibody and pimonidazole. The blood clearance of [18F]EF5 was slow, with blood radioactivity remaining relatively high up to 180 minutes after injection. Conclusion—Large atherosclerotic plaques in mice contained hypoxic areas and showed uptake of [18F]EF5. Despite its slow blood clearance, the high uptake of [18F]EF5 in plaques suggested that plaque hypoxia is a potential target for identifying high-risk plaques noninvasively.

A novel electrophilic synthesis and evaluation of medium specific radioactivity (1R,2S)-4-[18F]fluorometaraminol, a tracer for the assessment of cardiac sympathetic nerve integrity with PET

(1R,2S)-4-[18F]fluorometaraminol (4-[18F]FMR), a tracer for cardiac sympathetic innervation, was synthesized by electrophilic aromatic substitution. A trimethylstannyl precursor, protected with tert-butoxycarbonyl protecting groups, was radiofluorinated with high specific radioactivity [18F]F2. Specific radioactivity of 4-[18F]FMR, in average 11.8 +/-3.3 GBq/micromol, was improved 40-800-fold in comparison to the previous electrophilic fluorinations. The biodistribution of 4-[18F]FMR in rat was in accordance with the known distribution of sympathetic innervation. 4-[18F]FMR showed no metabolic degradation in left ventricle of rat heart, where the uptake was high, rapid and specific.

Dopamine and Opioid Neurotransmission in Behavioral Addictions: A Comparative PET Study in Pathological Gambling and Binge Eating

Although behavioral addictions share many clinical features with drug addictions, they show strikingly large variation in their behavioral phenotypes (such as in uncontrollable gambling or eating). Neurotransmitter function in behavioral addictions is poorly understood, but has important implications in understanding its relationship with substance use disorders and underlying mechanisms of therapeutic efficacy. Here, we compare opioid and dopamine function between two behavioral addiction phenotypes: pathological gambling (PG) and binge eating disorder (BED). Thirty-nine participants (15 PG, 7 BED, and 17 controls) were scanned with [11C]carfentanil and [18F]fluorodopa positron emission tomography using a high-resolution scanner. Binding potentials relative to non-displaceable binding (BPND) for [11C]carfentanil and influx rate constant (Ki) values for [18F]fluorodopa were analyzed with region-of-interest and whole-brain voxel-by-voxel analyses. BED subjects showed widespread reductions in [11C]carfentanil BPND in multiple subcortical and cortical brain regions and in striatal [18F]fluorodopa Ki compared with controls. In PG patients, [11C]carfentanil BPND was reduced in the anterior cingulate with no differences in [18F]fluorodopa Ki compared with controls. In the nucleus accumbens, a key region involved in reward processing, [11C]Carfentanil BPND was 30–34% lower and [18F]fluorodopa Ki was 20% lower in BED compared with PG and controls (p<0.002). BED and PG are thus dissociable as a function of dopaminergic and opioidergic neurotransmission. Compared with PG, BED patients show widespread losses of mu-opioid receptor availability together with presynaptic dopaminergic defects. These findings highlight the heterogeneity underlying the subtypes of addiction and indicate differential mechanisms in the expression of pathological behaviors and responses to treatment.