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McNeal KC, Reeves KM, Song PN, Lapi SE, Sorace AG, Larimer BM. [ 18F]FMISO-PET imaging reveals the role of hypoxia severity in checkpoint blockade response. Nucl Med Biol 2024; 134-135:108918. [PMID: 38772123 DOI: 10.1016/j.nucmedbio.2024.108918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/09/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
CONTEXT Hypoxia within the tumor microenvironment is a critical factor influencing the efficacy of immunotherapy, including immune checkpoint inhibition. Insufficient oxygen supply, characteristic of hypoxia, has been recognized as a central determinant in the progression of various cancers. The reemergence of evofosfamide, a hypoxia-activated prodrug, as a potential treatment strategy has sparked interest in addressing the role of hypoxia in immunotherapy response. This investigation sought to understand the kinetics and heterogeneity of tumor hypoxia and their implications in affecting responses to immunotherapeutic interventions with and without evofosfamide. PURPOSE This study aimed to investigate the influence of hypoxia on immune checkpoint inhibition, evofosfamide monotherapy, and their combination on colorectal cancer (CRC). Employing positron emission tomography (PET) imaging, we developed novel analytical methods to quantify and characterize tumor hypoxia severity and distribution. PROCEDURES Murine CRC models were longitudinally imaged with [18F]-fluoromisonidazole (FMISO)-PET to quantify tumor hypoxia during checkpoint blockade (anti-CTLA-4 + and anti-PD1 +/- evofosfamide). Metrics including maximum tumor [18F]FMISO uptake (FMISOmax) and mean tumor [18F]FMISO uptake (FMISOmean) were quantified and compared with normal muscle tissue (average muscle FMISO uptake (mAvg) and muscle standard deviation (mSD)). Histogram distributions were used to evaluate heterogeneity of tumor hypoxia. FINDINGS Severe hypoxia significantly impeded immunotherapy effectiveness consistent with an immunosuppressive microenvironment. Hypoxia-specific PET imaging revealed a striking degree of spatial heterogeneity in tumor hypoxia, with some regions exhibiting significantly more severe hypoxia than others. The study identified FMISOmax as a robust predictor of immunotherapy response, emphasizing the impact of localized severe hypoxia on tumor volume control during therapy. Interestingly, evofosfamide did not directly reduce hypoxia but markedly improved the response to immunotherapy, uncovering an alternative mechanism for its efficacy. CONCLUSIONS These results enhance our comprehension of the interplay between hypoxia and immune checkpoint inhibition within the tumor microenvironment, offering crucial insights for the development of personalized cancer treatment strategies. Non-invasive hypoxia quantification through molecular imaging evaluating hypoxia severity may be an effective tool in guiding treatment planning, predicting therapy response, and ultimately improving patient outcomes across diverse cancer types and tumor microenvironments. It sets the stage for the translation of these findings into clinical practice, facilitating the optimization of immunotherapy regimens by addressing tumor hypoxia and thereby enhancing the efficacy of cancer treatments.
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Affiliation(s)
- Kaytlyn C McNeal
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, United States of America; O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham, Birmingham, AL, United States of America; Graduate Biomedical Science Program, The University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kirsten M Reeves
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, United States of America; O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham, Birmingham, AL, United States of America; Graduate Biomedical Science Program, The University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Patrick N Song
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, United States of America; Graduate Biomedical Science Program, The University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Suzanne E Lapi
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, United States of America; O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Anna G Sorace
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, United States of America; O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham, Birmingham, AL, United States of America; Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Benjamin M Larimer
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, United States of America; O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham, Birmingham, AL, United States of America.
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Kniess T, Zessin J, Mäding P, Kuchar M, Kiss O, Kopka K. Synthesis of [ 18F]FMISO, a hypoxia-specific imaging probe for PET, an overview from a radiochemist's perspective. EJNMMI Radiopharm Chem 2023; 8:5. [PMID: 36897480 PMCID: PMC10006378 DOI: 10.1186/s41181-023-00190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND [18F]fluoromisonidazole ([18F]FMISO, 1H-1-(3-[18F]fluoro-2-hydroxypropyl)-2-nitroimidazole) is a commonly used radiotracer for imaging hypoxic conditions in cells. Since hypoxia is prevalent in solid tumors, [18F]FMISO is in clinical application for decades to explore oxygen demand in cancer cells and the resulting impact on radiotherapy and chemotherapy. RESULTS Since the introduction of [18F]FMISO as positron emission tomography imaging agent in 1986, a variety of radiosynthesis procedures for the production of this hypoxia tracer has been developed. This paper gives a brief overview on [18F]FMISO radiosyntheses published so far from its introduction until now. From a radiopharmaceutical chemist's perspective, different precursors, radiolabeling approaches and purification methods are discussed as well as used automated radiosynthesizers, including cassette-based and microfluidic systems. CONCLUSION In a GMP compliant radiosynthesis using original cassettes for FASTlab we produced [18F]FMISO in 49% radiochemical yield within 48 min with radiochemical purities > 99% and molar activities > 500 GBq/µmol. In addition, we report an easy and efficient radiosynthesis of [18F]FMISO, based on in-house prepared FASTlab cassettes, providing the radiotracer for research and preclinical purposes in good radiochemical yields (39%), high radiochemical purities (> 99%) and high molar activity (> 500 GBq/µmol) in a well-priced option.
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Affiliation(s)
- Torsten Kniess
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany.
| | - Jörg Zessin
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany
| | - Peter Mäding
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany
| | - Manuela Kuchar
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany
| | - Oliver Kiss
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany
| | - Klaus Kopka
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany.,Faculty of Chemistry and Food Chemistry, School of Science, Technische Universität Dresden, Mommsenstraße 4, 01069, Dresden, Germany.,National Center for Tumor Diseases (NCT) Dresden, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Reeves KM, Song PN, Angermeier A, Della Manna D, Li Y, Wang J, Yang ES, Sorace AG, Larimer BM. 18F-FMISO PET Imaging Identifies Hypoxia and Immunosuppressive Tumor Microenvironments and Guides Targeted Evofosfamide Therapy in Tumors Refractory to PD-1 and CTLA-4 Inhibition. Clin Cancer Res 2021; 28:327-337. [PMID: 34615724 DOI: 10.1158/1078-0432.ccr-21-2394] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Hypoxia is a common characteristic of many tumor microenvironments, and it has been shown to promote suppression of anti-tumor immunity. Despite strong biological rationale, longitudinal correlation of hypoxia and response to immunotherapy has not been investigated. EXPERIMENTAL DESIGN In this study, we probed the tumor and its surrounding microenvironment with 18F-FMISO PET imaging to non-invasively quantify tumor hypoxia in vivo prior to and during PD-1 and CTLA-4 checkpoint blockade in preclinical models of breast and colon cancer. RESULTS Longitudinal imaging identified hypoxia as an early predictive biomarker of therapeutic response (prior to anatomic changes in tumor volume) with a decreasing standard uptake value (SUV) ratio in tumors that effectively respond to therapy. PET signal correlated with ex vivo markers of tumor immune response including cytokines (Ifng, Gzmb, and Tnf), damage-associated molecular pattern receptors (Tlr2/4) and immune cell populations (macrophages, dendritic cells, and cytotoxic T cells). Responding tumors were marked by increased inflammation that were spatially distinct from hypoxic regions, providing a mechanistic understanding of the immune signaling pathways activated. To exploit image-guided combination therapy, hypoxia signal from PET imaging was used to guide the addition of a hypoxia targeted treatment to non-responsive tumors, which ultimately provided therapeutic synergy and rescued response as determined by longitudinal changes in tumor volume. CONCLUSIONS The results generated from this work provide an immediately translatable paradigm for measuring and targeting hypoxia to increase response to immune checkpoint therapy and using hypoxia imaging to guide combinatory therapies.
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Affiliation(s)
| | | | - Allyson Angermeier
- Cellular, Molecular, and Developmental Biology, University of Alabama at Birmingham
| | | | - Yufeng Li
- Division of Preventive Medicine, University of Alabama at Birmingham
| | - Jianbo Wang
- Cellular, Developmental and Integrative Biology, University of Alabama at Birmingham
| | - Eddy S Yang
- Department of Radiation Oncology, University of Alabama at Birmingham
| | - Anna G Sorace
- Radiology and Biomedical Engineering, University of Alabama at Birmingham
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2-Nitroimidazole-Furanoside Derivatives for Hypoxia Imaging-Investigation of Nucleoside Transporter Interaction, 18F-Labeling and Preclinical PET Imaging. Pharmaceuticals (Basel) 2019; 12:ph12010031. [PMID: 30781409 PMCID: PMC6469291 DOI: 10.3390/ph12010031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 11/16/2022] Open
Abstract
The benefits of PET imaging of tumor hypoxia in patient management has been demonstrated in many examples and with various tracers over the last years. Although, the optimal hypoxia imaging agent has yet to be found, 2-nitroimidazole (azomycin) sugar derivatives—mimicking nucleosides—have proven their potential with [18F]FAZA ([18F]fluoro-azomycin-α-arabinoside) as a prominent representative in clinical use. Still, for all of these tracers, cellular uptake by passive diffusion is postulated with the disadvantage of slow kinetics and low tumor-to-background ratios. We recently evaluated [18F]fluoro-azomycin-β-deoxyriboside (β-[18F]FAZDR), with a structure more similar to nucleosides than [18F]FAZA and possible interaction with nucleoside transporters. For a deeper insight, we comparatively studied the interaction of FAZA, β-FAZA, α-FAZDR and β-FAZDR with nucleoside transporters (SLC29A1/2 and SLC28A1/2/3) in vitro, showing variable interactions of the compounds. The highest interactions being for β-FAZDR (IC50 124 ± 33 µM for SLC28A3), but also for FAZA with the non-nucleosidic α-configuration, the interactions were remarkable (290 ± 44 µM {SLC28A1}; 640 ± 10 µM {SLC28A2}). An improved synthesis was developed for β-FAZA. For a PET study in tumor-bearing mice, α-[18F]FAZDR was synthesized (radiochemical yield: 15.9 ± 9.0% (n = 3), max. 10.3 GBq, molar activity > 50 GBq/µmol) and compared to β-[18F]FAZDR and [18F]FMISO, the hypoxia imaging gold standard. We observed highest tumor-to-muscle ratios (TMR) for β-[18F]FAZDR already at 1 h p.i. (2.52 ± 0.94, n = 4) in comparison to [18F]FMISO (1.37 ± 0.11, n = 5) and α-[18F]FAZDR (1.93 ± 0.39, n = 4), with possible mediation by the involvement of nucleoside transporters. After 3 h p.i., TMR were not significantly different for all 3 tracers (2.5–3.0). Highest clearance from tumor tissue was observed for β-[18F]FAZDR (56.6 ± 6.8%, 2 h p.i.), followed by α-[18F]FAZDR (34.2 ± 7.5%) and [18F]FMISO (11.8 ± 6.5%). In conclusion, both isomers of [18F]FAZDR showed their potential as PET hypoxia tracers. Differences in uptake behavior may be attributed to a potential variable involvement of transport mechanisms.
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Fuchs K, Kuehn A, Mahling M, Guenthoer P, Hector A, Schwenck J, Hartl D, Laufer S, Kohlhofer U, Quintanilla-Martinez L, Reischl G, Röcken M, Pichler BJ, Kneilling M. In Vivo Hypoxia PET Imaging Quantifies the Severity of Arthritic Joint Inflammation in Line with Overexpression of Hypoxia-Inducible Factor and Enhanced Reactive Oxygen Species Generation. J Nucl Med 2017; 58:853-860. [PMID: 28183987 DOI: 10.2967/jnumed.116.185934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/11/2017] [Indexed: 12/30/2022] Open
Abstract
Hypoxia is essential for the development of autoimmune diseases such as rheumatoid arthritis (RA) and is associated with the expression of reactive oxygen species (ROS), because of the enhanced infiltration of immune cells. The aim of this study was to demonstrate the feasibility of measuring hypoxia noninvasively in vivo in arthritic ankles with PET/MRI using the hypoxia tracers 18F-fluoromisonidazole (18F-FMISO) and 18F-fluoroazomycinarabinoside (18F-FAZA). Additionally, we quantified the temporal dynamics of hypoxia and ROS stress using L-012, an ROS-sensitive chemiluminescence optical imaging probe, and analyzed the expression of hypoxia-inducible factors (HIFs). Methods: Mice underwent noninvasive in vivo PET/MRI to measure hypoxia or optical imaging to analyze ROS expression. Additionally, we performed ex vivo pimonidazole-/HIF-1α immunohistochemistry and HIF-1α/2α Western blot/messenger RNA analysis of inflamed and healthy ankles to confirm our in vivo results. Results: Mice diseased from experimental RA exhibited a 3-fold enhancement in hypoxia tracer uptake, even in the early disease stages, and a 45-fold elevation in ROS expression in inflamed ankles compared with the ankles of healthy controls. We further found strong correlations of our noninvasive in vivo hypoxia PET data with pimonidazole and expression of HIF-1α in arthritic ankles. The strongest hypoxia tracer uptake was observed as soon as day 3, whereas the most pronounced ROS stress was evident on day 6 after the onset of experimental RA, indicating that tissue hypoxia can precede ROS stress in RA. Conclusion: Collectively, for the first time to our knowledge, we have demonstrated that the noninvasive measurement of hypoxia in inflammation using 18F-FAZA and 18F-FMISO PET imaging represents a promising new tool for uncovering and monitoring rheumatic inflammation in vivo. Further, because hypoxic inflamed tissues are associated with the overexpression of HIFs, specific inhibition of HIFs might represent a new powerful treatment strategy.
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Affiliation(s)
- Kerstin Fuchs
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Anna Kuehn
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Moritz Mahling
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Philipp Guenthoer
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Andreas Hector
- Children's Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Schwenck
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University, Tuebingen, Tuebingen, Germany
| | - Dominik Hartl
- Children's Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany.,Immunology, Inflammation and Infectious Diseases Discovery and Translational Area, Roche Pharma Research & Early Development (pRED), Roche Innovation Center Basel, Basel, Switzerland
| | - Stefan Laufer
- Department of Pharmacy & Biochemistry, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ursula Kohlhofer
- Institute of Pathology and Neuropathology, Eberhard Karls University Tuebingen and Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany; and
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University Tuebingen and Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany; and
| | - Gerald Reischl
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Martin Röcken
- Department of Dermatology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Bernd J Pichler
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Manfred Kneilling
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany .,Department of Dermatology, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Antuganov DO, Ryzhkova DV, Zykov MP. Methods for synthesis of [18F]fluoromisonidazole, a radiopharmaceutical for imaging of hypoxic foci. RADIOCHEMISTRY 2015. [DOI: 10.1134/s1066362215060107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Zheng MQ, Collier L, Bois F, Kelada OJ, Hammond K, Ropchan J, Akula MR, Carlson DJ, Kabalka GW, Huang Y. Synthesis of [(18)F]FMISO in a flow-through microfluidic reactor: Development and clinical application. Nucl Med Biol 2015; 42:578-84. [PMID: 25779036 DOI: 10.1016/j.nucmedbio.2015.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The PET radiotracer [(18)F]FMISO has been used in the clinic to image hypoxia in tumors. The aim of the present study was to optimize the radiochemical parameters for the preparation of [(18)F]FMISO using a microfluidic reaction system. The main parameters evaluated were (1) precursor concentration, (2) reaction temperature, and (3) flow rate through the microfluidic reactor. Optimized conditions were then applied to the batch production of [(18)F]FMISO for clinical research use. METHODS For the determination of optimal reaction conditions within a flow-through microreactor synthesizer, 5-400 μL the precursor and dried [(18)F]fluoride solutions in acetonitrile were simultaneously pushed through the temperature-controlled reactor (60-180 °C) with defined flow rates (20-120 μL/min). Radiochemical incorporation yields to form the intermediate species were determined using radio-TLC. Hydrolysis to remove the protecting group was performed following standard vial chemistry to afford [(18)F]FMISO. RESULTS Optimum reaction parameters for the microfluidic set-up were determined as follows: 4 mg/mL of precursor, 170 °C, and 100 μL/min pump rate per reactant (200 μL/min reaction overall flow rate) to prepare the radiolabeled intermediate. The optimum hydrolysis condition was determined to be 2N HCl for 5 min at 100 °C. Large-scale batch production using the optimized conditions gave the final, ready for human injection [(18)F]FMISO product in 28.4 ± 3.0% radiochemical yield, specific activity of 119 ± 26 GBq/μmol, and >99% radiochemical and chemical purity at the end of synthesis (n = 4). CONCLUSION By using the NanoTek microfluidic synthesis system, [(18)F]FMISO was successfully prepared with good specific activity and high radiochemical purity for human use. The product generated from large-scale batch production using flow chemistry is currently being used in clinical research.
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Affiliation(s)
- Ming-Qiang Zheng
- PET Center, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, United States.
| | - Lee Collier
- Advion, Ithaca, NY, United States; Department of Radiology, University of Tennessee, Knoxville, TN, United States.
| | - Frederic Bois
- PET Center, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, United States
| | - Olivia J Kelada
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, United States
| | | | - Jim Ropchan
- PET Center, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, United States
| | - Murthy R Akula
- Department of Radiology, University of Tennessee, Knoxville, TN, United States
| | - David J Carlson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, United States
| | - George W Kabalka
- Department of Chemistry, University of Tennessee, Knoxville, TN, United States; Department of Radiology, University of Tennessee, Knoxville, TN, United States
| | - Yiyun Huang
- PET Center, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, United States
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Wuest M, Wuest F. Positron emission tomography radiotracers for imaging hypoxia. J Labelled Comp Radiopharm 2014; 56:244-50. [PMID: 24285331 DOI: 10.1002/jlcr.2997] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 07/27/2012] [Accepted: 11/06/2012] [Indexed: 11/11/2022]
Abstract
Localized hypoxia, the physiological hallmark of many clinical pathologies, is the consequence of acute or chronic ischemia in the affected region or tissue. The versatility, sensitivity, quantitative nature, and increasing availability of positron emission tomography (PET) make it the preclinical and clinical method of choice for functional imaging of tissue hypoxia at the molecular level. The progress and current status of radiotracers for hypoxia-specific PET imaging are reviewed in this article including references mainly focused on radiochemistry and also relevant to molecular imaging of hypoxia in preclinical and clinical studies.
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Affiliation(s)
- Melinda Wuest
- Department of Oncology, University of Alberta, Edmonton, AB, T6G 1Z2, Canada
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Rensch C, Jackson A, Lindner S, Salvamoser R, Samper V, Riese S, Bartenstein P, Wängler C, Wängler B. Microfluidics: a groundbreaking technology for PET tracer production? Molecules 2013; 18:7930-56. [PMID: 23884128 PMCID: PMC6270045 DOI: 10.3390/molecules18077930] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 06/21/2013] [Accepted: 07/03/2013] [Indexed: 11/16/2022] Open
Abstract
Application of microfluidics to Positron Emission Tomography (PET) tracer synthesis has attracted increasing interest within the last decade. The technical advantages of microfluidics, in particular the high surface to volume ratio and resulting fast thermal heating and cooling rates of reagents can lead to reduced reaction times, increased synthesis yields and reduced by-products. In addition automated reaction optimization, reduced consumption of expensive reagents and a path towards a reduced system footprint have been successfully demonstrated. The processing of radioactivity levels required for routine production, use of microfluidic-produced PET tracer doses in preclinical and clinical imaging as well as feasibility studies on autoradiolytic decomposition have all given promising results. However, the number of microfluidic synthesizers utilized for commercial routine production of PET tracers is very limited. This study reviews the state of the art in microfluidic PET tracer synthesis, highlighting critical design aspects, strengths, weaknesses and presenting several characteristics of the diverse PET market space which are thought to have a significant impact on research, development and engineering of microfluidic devices in this field. Furthermore, the topics of batch- and single-dose production, cyclotron to quality control integration as well as centralized versus de-centralized market distribution models are addressed.
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Affiliation(s)
- Christian Rensch
- GE Global Research, Freisinger Landstrasse 50, Garching bei Munich 85748, Germany; E-Mails: (R.S.); (V.S.)
| | - Alexander Jackson
- GE Healthcare, Life Sciences, The Grove Centre, White Lion Rd., Amersham HP7 9LL, UK; E-Mails: (A.J.); (S.R.)
| | - Simon Lindner
- University Hospital Munich, Department of Nuclear Medicine, Ludwig Maximilians-University, Munich 81377, Germany; E-Mails: (S.L.); (P.B.); (C.W.)
| | - Ruben Salvamoser
- GE Global Research, Freisinger Landstrasse 50, Garching bei Munich 85748, Germany; E-Mails: (R.S.); (V.S.)
| | - Victor Samper
- GE Global Research, Freisinger Landstrasse 50, Garching bei Munich 85748, Germany; E-Mails: (R.S.); (V.S.)
| | - Stefan Riese
- GE Healthcare, Life Sciences, The Grove Centre, White Lion Rd., Amersham HP7 9LL, UK; E-Mails: (A.J.); (S.R.)
| | - Peter Bartenstein
- University Hospital Munich, Department of Nuclear Medicine, Ludwig Maximilians-University, Munich 81377, Germany; E-Mails: (S.L.); (P.B.); (C.W.)
| | - Carmen Wängler
- University Hospital Munich, Department of Nuclear Medicine, Ludwig Maximilians-University, Munich 81377, Germany; E-Mails: (S.L.); (P.B.); (C.W.)
- Biomedical Chemistry, Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim of Heidelberg University, Mannheim 68167, Germany
| | - Björn Wängler
- Molecular Imaging and Radiochemistry, Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim of Heidelberg University, Mannheim 68167, Germany
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Fully automated radiosynthesis of [18F]Fluoromisonidazole with single neutral alumina column purification: optimization of reaction parameters. J Radioanal Nucl Chem 2010. [DOI: 10.1007/s10967-010-0644-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nandy S, Rajan MGR, Korde A, Krishnamurthy NV. The possibility of a fully automated procedure for radiosynthesis of fluorine-18-labeled fluoromisonidazole using a simplified single, neutral alumina column purification procedure. Appl Radiat Isot 2010; 68:1937-43. [PMID: 20493720 DOI: 10.1016/j.apradiso.2010.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 03/23/2010] [Accepted: 04/01/2010] [Indexed: 11/28/2022]
Abstract
A novel fully automated radiosynthesis procedure for [(18)F]Fluoromisonidazole using a simple alumina cartridge-column for purification instead of conventionally used semi-preparative HPLC was developed. [(18)F]FMISO was prepared via a one-pot, two-step synthesis procedure using a modified nuclear interface synthesis module. Nucleophilic fluorination of the precursor molecule 1-(2'-nitro-1'-imidazolyl)-2-O-tetrahydropyranyl-3-O-toluenesulphonylpropanediol (NITTP) with no-carrier added [(18)F]fluoride followed by hydrolysis of the protecting group with 1M HCl. Purification was carried out using a single neutral alumina cartridge-column instead of semi-preparative HPLC. The maximum overall radiochemical yield obtained was 37.49+/-1.68% with 10mg NITTP (n=3, without any decay correction) and the total synthesis time was 40+/-1 min. The radiochemical purity was greater than 95% and the product was devoid of other chemical impurities including residual aluminum and acetonitrile. The biodistribution study in fibrosarcoma tumor model showed maximum uptake in tumor, 2h post injection. Finally, PET/CT imaging studies in normal healthy rabbit, showed clear uptake in the organs involved in the metabolic process of MISO. No bone uptake was observed excluding the presence of free [(18)F]fluoride. The reported method can be easily adapted in any commercial FDG synthesis module.
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Affiliation(s)
- Saikat Nandy
- Radiation Medicine Centre, Bio-Medical Group, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Parel, Mumbai-400 012, India
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Wadsak W, Mitterhauser M. Basics and principles of radiopharmaceuticals for PET/CT. Eur J Radiol 2010; 73:461-9. [PMID: 20181453 DOI: 10.1016/j.ejrad.2009.12.022] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/15/2009] [Indexed: 11/28/2022]
Abstract
The presented review provides general background on PET radiopharmaceuticals for oncological applications. Special emphasis is put on radiopharmacological, radiochemical and regulatory aspects. This review is not meant to give details on all different PET tracers in depth but to provide insights into the general principles coming along with their preparation and use. The PET tracer plays a pivotal role because it provides the basis both for image quality and clinical interpretation. It is composed of the radionuclide (signaller) and the molecular vehicle which determines the (bio-)chemical properties (e.g. binding characteristics, metabolism, elimination rate).
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Affiliation(s)
- W Wadsak
- Department of Nuclear Medicine, Medical University of Vienna, Austria
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13
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Synthesis and radiolabeling of new N-[(4-[18F]Fluorobenzylidene) aminooxy) alkyl]-2-nitroimidazoles as possible hypoxia imaging pharmaceuticals. J Radioanal Nucl Chem 2009. [DOI: 10.1007/s10967-009-0313-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Wang M, Zhang Y, Zhang Y, Yuan H. Automated synthesis of hypoxia imaging agent [18F]FMISO based upon a modified Explora FDG4 module. J Radioanal Nucl Chem 2009. [DOI: 10.1007/s10967-008-7395-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Chemistry of Radiohalogens (F, Br. and I). Mol Imaging 2009. [DOI: 10.1007/978-3-540-76735-0_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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16
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Vallabhajosula S. (18)F-labeled positron emission tomographic radiopharmaceuticals in oncology: an overview of radiochemistry and mechanisms of tumor localization. Semin Nucl Med 2008; 37:400-19. [PMID: 17920348 DOI: 10.1053/j.semnuclmed.2007.08.004] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Molecular imaging is the visualization, characterization, and measurement of biological processes at the molecular and cellular levels in a living system. At present, positron emission tomography/computed tomography (PET/CT) is one the most rapidly growing areas of medical imaging, with many applications in the clinical management of patients with cancer. Although [(18)F]fluorodeoxyglucose (FDG)-PET/CT imaging provides high specificity and sensitivity in several kinds of cancer and has many applications, it is important to recognize that FDG is not a "specific" radiotracer for imaging malignant disease. Highly "tumor-specific" and "tumor cell signal-specific" PET radiopharmaceuticals are essential to meet the growing demand of radioisotope-based molecular imaging technology. In the last 15 years, many alternative PET tracers have been proposed and evaluated in preclinical and clinical studies to characterize the tumor biology more appropriately. The potential clinical utility of several (18)F-labeled radiotracers (eg, fluoride, FDOPA, FLT, FMISO, FES, and FCH) is being reviewed by several investigators in this issue. An overview of design and development of (18)F-labeled PET radiopharmaceuticals, radiochemistry, and mechanism(s) of tumor cell uptake and localization of radiotracers are presented here. The approval of clinical indications for FDG-PET in the year 2000 by the Food and Drug Administration, based on a review of literature, was a major breakthrough to the rapid incorporation of PET into nuclear medicine practice, particularly in oncology. Approval of a radiopharmaceutical typically involves submission of a "New Drug Application" by a manufacturer or a company clearly documenting 2 major aspects of the drug: (1) manufacturing of PET drug using current good manufacturing practices and (2) the safety and effectiveness of a drug with specific indications. The potential routine clinical utility of (18)F-labeled PET radiopharmaceuticals depends also on regulatory compliance in addition to documentation of potential safety and efficacy by various investigators.
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Affiliation(s)
- Shankar Vallabhajosula
- Division of Nuclear Medicine, Department of Radiology,New York Presbyterian Hospital, Cornell University, New York, NY 10021, USA.
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Tang G. Synthesis of 18F-fluoromisonidazole Tracer for Positron Emission Tomography. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Eschmann SM, Paulsen F, Bedeshem C, Machulla HJ, Hehr T, Bamberg M, Bares R. Hypoxia-imaging with (18)F-Misonidazole and PET: changes of kinetics during radiotherapy of head-and-neck cancer. Radiother Oncol 2007; 83:406-10. [PMID: 17543402 DOI: 10.1016/j.radonc.2007.05.014] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 05/14/2007] [Accepted: 05/16/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE PET with (18)F-Misonidazole (FMISO-PET) is a non-invasive method for measuring tumor hypoxia. We analysed changes of FMISO-uptake during radiotherapy and their impact on patient outcome. MATERIALS AND METHODS Fourteen patients with HNC underwent repeated FMISO-PET prior to radiotherapy and after 30Gy. Dynamic and static PET-scans (2+4h p.i.) were acquired. FMISO-uptake was quantified by calculating standard uptake values (SUV) and tumor-muscle-ratios (TMR). Kinetic curve types representing tissue hypoxia were defined. Change of curve type was correlated with patient outcome. RESULTS The mean SUV 4h p.i. and the TMR decreased significantly during radiotherapy. SUV decreased clearly in 12/14 patients, and increased in 2 patients. TMR decreased in 11 patients, and increased in 3 patients. Prior to radiotherapy, three different shapes of kinetic curve types indicative for the degree of hypoxia could be defined in 12/14 patients: (1) accumulation type (severe hypoxia (n=8)), (2) intermediate type (intermediate degree of hypoxia (n=3)), and (3) wash-out type (low degree of hypoxia (n=1)). Curve type changed towards a lower degree of hypoxia at 30Gy in all but 3 patients. In three patients curve type remained unchanged. CONCLUSIONS The changes in tumor FMISO-uptake during radiotherapy indicate radio-induced reoxygenation.
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Krasikova R. Synthesis modules and automation in F-18 labeling. ERNST SCHERING RESEARCH FOUNDATION WORKSHOP 2006:289-316. [PMID: 17172160 DOI: 10.1007/978-3-540-49527-7_11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fast implementation of PET into clinical studies and research has resulted in high demands in the automated modules for the preparation of PET radiopharmaceuticals in a safe and reproducible manner. 18F-labeled radiotracers are of considerable interest due to longer half-life of fluorine-18 allowing remote site application, as demonstrated by [18F]FDG. In this chapter, the state of the art of commercially available modules for [18F]FDG is reviewed with the emphasis on multibatch production of this important radiotracer. Examples are given on the syntheses of other clinically relevant 18F-labeled radiotracers by using existing [18F]FDG synthesizers or with the help of general-purpose [18F]nucleophilic fluorination modules. On-going research and progress in the automation of complex radio labeling procedures followed by development of flexible multipurpose automated apparatus are discussed. The contribution of radiochemists in facilitating automation via introduction of new 18F-labeling techniques and labeling synthons, on-line reactions and purifications etc. is outlined.
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Affiliation(s)
- R Krasikova
- Institute of the Human Brain, Russian Academy of Science, Petersburg.
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20
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Oh SJ, Chi DY, Mosdzianowski C, Kim JY, Gil HS, Kang SH, Ryu JS, Moon DH. Fully automated synthesis of [18F]fluoromisonidazole using a conventional [18F]FDG module. Nucl Med Biol 2005; 32:899-905. [PMID: 16253816 DOI: 10.1016/j.nucmedbio.2005.06.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Revised: 05/30/2005] [Accepted: 06/14/2005] [Indexed: 11/23/2022]
Abstract
We developed a new fully automated method for the synthesis of [18F]fluoromisonidazole ([18F]FMISO) by modifying a commercial FDG synthesizer and its disposable fluid pathway. A three-step procedure was used to prepare the tosylate precursor, 1-(2'-nitro-1'-imidazolyl)-2-O-tetrahydrofuranyl-3-O-toluenesulfonylpropanediol. Using glycerol as the starting material, the precursor was synthesized with a yield of 21%. The optimal labeling conditions for the automated synthesis of [18F]FMISO was 10 mg of precursor in acetonitrile (2 ml heated at 105 degrees C for 360 s, followed by heating at 75 degrees C for 280 s and hydrolysis with 1 N HCl at 105 degrees C for 300 s. Using 3.7 GBq of [18F]F- as a starting activity, [18F]FMISO was obtained with high end-of-synthesis (EOS) radiochemical yields of 58.5+/-3.5% for 60.0+/-5.2 min with high-performance liquid chromatography (HPLC) purification. When solid-phase purification steps were added, the EOS radiochemical yields were 54.5+/-2.8% (337+/-25 GBq/micromol) for 70.0+/-3.8 min (n=10 for each group, decay-corrected). With a high starting radioactivity of 37.0 GBq, we obtained radiochemical yields of 54.4+/-2.9% and 52.8+/-4.2%, respectively (n=3). The solid-phase purification removed unreacted [18F]fluoride and polar impurities before the HPLC procedure. Long-term tests showed a good stability of 98.2+/-1.5%. This new automated synthesis procedure combines high and reproducible yields with the advantage of using a disposable cassette system.
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Affiliation(s)
- Seung Jun Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, South Korea.
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Tang G, Wang M, Tang X, Gan M, Luo L. Fully automated one-pot synthesis of [18F]fluoromisonidazole. Nucl Med Biol 2005; 32:553-8. [PMID: 15982586 DOI: 10.1016/j.nucmedbio.2005.03.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Accepted: 03/24/2005] [Indexed: 10/25/2022]
Abstract
A (18)F-labeled fluoromisonidazole (1H-1-(3-[(18)F]fluoro-2-hydroxypropyl)-2-nitroimidazole, [(18)F]FMISO) was prepared via a one-pot, two-step synthesis procedure using a modified commercial Tracerlab FX(F-N) synthesis module. Nucleophilic fluorination of the precursor molecule 1-(2'-nitro-1'-imidazolyl)-2-O-tetrahydropyranyl-3-O-toluenesulphonylpropanediol using no-carrier-added [(18)F]fluoride, followed by hydrolysis of the protecting group with 1 mol/L HCl and purification with Sep-Paks instead of HPLC, gave [(18)F]FMISO. The overall radiochemical yield with no decay correction was greater than 40%, the whole synthesis time was less than 40 min and the radiochemical purity was greater than 95%. The new automated synthesis procedure can be applied to the fully automated synthesis of [(18)F]FMISO using a commercial FDG synthesis module.
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Affiliation(s)
- Ganghua Tang
- Nan Fang PET Center, Nan Fang Hospital, Southern Medical University, Guangzhou, China.
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