Etienne Rousseau1, Joseph Lau2, Zhengxing Zhang2, Carlos F Uribe2, Hsiou-Ting Kuo2, Chengcheng Zhang2, Jutta Zeisler2, Nadine Colpo2, Kuo-Shyan Lin3, François Bénard4. 1. Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC V5Z 1L3, Canada; Département de Médecine Nucléaire et Radiobiologie, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada. 2. Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC V5Z 1L3, Canada. 3. Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC V5Z 1L3, Canada; Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada. Electronic address: klin@bccrc.ca. 4. Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC V5Z 1L3, Canada; Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada. Electronic address: fbenard@bccrc.ca.
Abstract
INTRODUCTION: [177Lu]Lu-DOTATATE peptide receptor radionuclide therapy is used for treatment of neuroendocrine tumours. We investigated whether prolonging blood residence time of [177Lu]Lu-DOTATATE with albumin binders could increase tumour accumulation and tumour-to-kidney ratios for improved therapeutic efficacy. METHODS: DOTATATE and its derivatives with an albumin-binder motif (GluAB-DOTATATE and AspAB-DOTATATE) were prepared by solid-phase peptide synthesis. Binding affinities of the Lu-labeled peptides for human somatostatin receptor 2 (SSTR2) were measured with membrane competition binding assays. Compounds were radiolabeled with [177Lu]LuCl3 and purified by HPLC. SPECT imaging and biodistribution studies (1, 4, 24, 72, and 120 h) were performed in immunodeficient mice bearing AR42J pancreatic tumour xenografts. RESULTS: GluAB-DOTATATE and AspAB-DOTATATE were synthesized in 18.8% and 14.3% yields, while Lu-GluAB-DOTATATE and Lu-AspAB-DOTATATE were obtained in 86.5% and 50.0% yields, respectively. The compounds exhibited nanomolar binding affinity (Ki: 8.72-8.95 nM) for SSTR2. The 177Lu-labeled peptides were obtained in non-decay-corrected isolated yields of ≥41%, with >96% radiochemical purity, and molar activities in the range of 314-497 GBq/μmol. In vivo, [177Lu]Lu-GluAB-DOTATATE and [177Lu]Lu-AspAB-DOTATATE had significantly higher blood activity at 1, 4 and 24 h compared to [177Lu]Lu-DOTATATE. Tumour uptake of [177Lu]Lu-DOTATATE was 21.35 ± 5.90%ID/g at 1 h and decreased to 10.10 ± 5.78%ID/g at 120 h. For [177Lu]Lu-GluAB-DOTATATE tumour uptake increased from 21.89 ± 6.86%ID/g at 1 h to 24.44 ± 5.84%ID/g at 4 h, before decreasing to 12.02 ± 1.84%ID/g at 120 h. For [177Lu]Lu-AspAB-DOTATATE tumour uptake was 11.12 ± 3.18%ID/g at 1 h, 18.41 ± 4.36%ID/g at 24 h, and decreased to 16.90 ± 8.97%ID/g at 120 h. Renal uptake was 7.49 ± 1.62%ID/g for [177Lu]Lu-DOTATATE, 31.14 ± 7.06%ID/g for [177Lu]Lu-GluAB-DOTATATE, and 28.82 ± 13.82%ID/g for [177Lu]Lu-AspAB-DOTATATE at 1 h and decreased thereafter. CONCLUSION: The addition of albumin binder motifs to [177Lu]Lu-DOTATATE enhanced mean residence time in blood. Increased tumour uptake was observed for [177Lu]Lu-AspAB-DOTATATE compared to [177Lu]Lu-DOTATATE at later time points, but its higher kidney uptake diminished the therapeutic index.
INTRODUCTION: [177Lu]Lu-DOTATATE peptide receptor radionuclide therapy is used for treatment of neuroendocrine tumours. We investigated whether prolonging blood residence time of [177Lu]Lu-DOTATATE with albumin binders could increase tumour accumulation and tumour-to-kidney ratios for improved therapeutic efficacy. METHODS:DOTATATE and its derivatives with an albumin-binder motif (GluAB-DOTATATE and AspAB-DOTATATE) were prepared by solid-phase peptide synthesis. Binding affinities of the Lu-labeled peptides for humansomatostatin receptor 2 (SSTR2) were measured with membrane competition binding assays. Compounds were radiolabeled with [177Lu]LuCl3 and purified by HPLC. SPECT imaging and biodistribution studies (1, 4, 24, 72, and 120 h) were performed in immunodeficient mice bearing AR42J pancreatic tumour xenografts. RESULTS:GluAB-DOTATATE and AspAB-DOTATATE were synthesized in 18.8% and 14.3% yields, while Lu-GluAB-DOTATATE and Lu-AspAB-DOTATATE were obtained in 86.5% and 50.0% yields, respectively. The compounds exhibited nanomolar binding affinity (Ki: 8.72-8.95 nM) for SSTR2. The 177Lu-labeled peptides were obtained in non-decay-corrected isolated yields of ≥41%, with >96% radiochemical purity, and molar activities in the range of 314-497 GBq/μmol. In vivo, [177Lu]Lu-GluAB-DOTATATE and [177Lu]Lu-AspAB-DOTATATE had significantly higher blood activity at 1, 4 and 24 h compared to [177Lu]Lu-DOTATATE. Tumour uptake of [177Lu]Lu-DOTATATE was 21.35 ± 5.90%ID/g at 1 h and decreased to 10.10 ± 5.78%ID/g at 120 h. For [177Lu]Lu-GluAB-DOTATATEtumour uptake increased from 21.89 ± 6.86%ID/g at 1 h to 24.44 ± 5.84%ID/g at 4 h, before decreasing to 12.02 ± 1.84%ID/g at 120 h. For [177Lu]Lu-AspAB-DOTATATEtumour uptake was 11.12 ± 3.18%ID/g at 1 h, 18.41 ± 4.36%ID/g at 24 h, and decreased to 16.90 ± 8.97%ID/g at 120 h. Renal uptake was 7.49 ± 1.62%ID/g for [177Lu]Lu-DOTATATE, 31.14 ± 7.06%ID/g for [177Lu]Lu-GluAB-DOTATATE, and 28.82 ± 13.82%ID/g for [177Lu]Lu-AspAB-DOTATATE at 1 h and decreased thereafter. CONCLUSION: The addition of albumin binder motifs to [177Lu]Lu-DOTATATE enhanced mean residence time in blood. Increased tumour uptake was observed for [177Lu]Lu-AspAB-DOTATATE compared to [177Lu]Lu-DOTATATE at later time points, but its higher kidney uptake diminished the therapeutic index.