Imaging with radiolabelled bisphosphonates

Synthesis and Biological Evaluation of 131I-Risedronate with Bone Targeting Activity

Current radiopharmaceuticals for treating bone metastatic tumors have various limitations. We focus on developing a universal, economical, efficient, and safe novel radiopharmaceutical for bone metastasis treatment. 131I is a well-established medical radionuclide commonly used for both treatment and diagnosis. Risedronate exhibits strong bone-targeting properties with moderate bone retention. This study explored the combination of these two components and evaluated its biological properties in animal experiments. Based on the experimental results, 131I-risedronate demonstrated high bone-targeting efficiency, low uptake in nontarget organs, and rapid clearance. Notably, at 3 days postadministration, significant bone retention was observed, indicating its potential for sustained therapeutic effects. Additionally, its biodistribution and therapeutic effect can be effectively monitored by SPECT/CT imaging.

Radiomics based on multiple machine learning methods for diagnosing early bone metastases not visible on CT images

OBJECTIVES

This study utilizes [99mTc]-methylene diphosphate (MDP) single photon emission computed tomography (SPECT) images as a reference standard to evaluate whether the integration of radiomics features from computed tomography (CT) and machine learning algorithms can identify microscopic early bone metastases. Additionally, we also determine the optimal machine learning approach.

MATERIALS AND METHODS

We retrospectively studied 63 patients with early bone metastasis from July 2020 to March 2023. The ITK-SNAP software was used to delineate early bone metastases and normal bone tissue in SPECT images of each patient, which were then registered onto CT images to outline the volume of interest (VOI). The VOI includes 63 early bone metastasis volumes and 63 normal bone tissue volumes. 126 VOIs were randomly distributed in a 7:3 ratio between the training and testing groups, and 944 radiomics features were extracted from every VOI. We established 20 machine learning models using 5 feature selection algorithms and 4 classification methods. Evaluate the performance of the model using the area under the receiver operating characteristic curve (AUC).

RESULTS

Most machine learning models demonstrated outstanding discriminative capacity, with AUCs higher than 0.70. Notably, the K-Nearest Neighbors (KNN) classifier exhibited significant performance improvement compared to the other four classifiers. Specifically, the model constructed utilizing eXtreme Gradient Boosting (XGBoost) feature selection method integrated with KNN classifier achieved the maximum AUC, which is 0.989 in the training set and 0.975 in the testing set.

CONCLUSIONS

Radiomics features integrated with machine learning methods can identify early bone metastases that are not visible on CT images. In our analysis, KNN is considered the optimal classification method.

SPECT/CT, PET/CT, and PET/MRI for Response Assessment of Bone Metastases

Recent developments in hybrid SPECT/CT systems and the use of cadmium-zinc-telluride (CZT) detectors have improved the diagnostic accuracy of bone scintigraphy. These advancements have paved the way for novel quantitative approaches to accurate and reproducible treatment monitoring of bone metastases. PET/CT imaging using [18F]F-FDG and [18F]F-NaF have shown promising clinical utility in bone metastases assessment and monitoring response to therapy and prediction of treatment response in a broad range of malignancies. Additionally, specific tumor-targeting tracers like [99mTc]Tc-PSMA, [68Ga]Ga-PSMA, or [11C]C- or [18F]F-Choline revealed high diagnostic performance for early assessment and prognostication of bone metastases, particularly in prostate cancer. PET/MRI appears highly accurate imaging modality, but has associated limitations notably, limited availability, more complex logistics and high installation costs. Advances in artificial intelligence (Al) seem to improve the accuracy of imaging modalities and provide an assistant role in the evaluation of treatment response of bone metastases.

68Ga-bisphosphonates for the imaging of extraosseous calcification by positron emission tomography

Radiolabelled bisphosphonates (BPs) and [18F]NaF (18F-fluoride) are the two types of radiotracers available to image calcium mineral (e.g. bone), yet only [18F]NaF has been widely explored for the non-invasive molecular imaging of extraosseous calcification (EC) using positron emission tomography (PET) imaging. These two radiotracers bind calcium mineral deposits via different mechanisms, with BPs chelating to calcium ions and thus being non-selective, and [18F]NaF being selective for hydroxyapatite (HAp) which is the main component of bone mineral. Considering that the composition of EC has been reported to include a diverse range of non-HAp calcium minerals, we hypothesised that BPs may be more sensitive for imaging EC due to their ability to bind to both HAp and non-HAp deposits. We report a comparison between the 68Ga-labelled BP tracer [68Ga]Ga-THP-Pam and [18F]NaF for PET imaging in a rat model of EC that develops macro- and microcalcifications in several organs. Macrocalcifications were identified using preclinical computed tomography (CT) and microcalcifications were identified using µCT-based 3D X-ray histology (XRH) on isolated organs ex vivo. The morphological and mineral analysis of individual calcified deposits was performed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). PET imaging and ex vivo analysis results demonstrated that while both radiotracers behave similarly for bone imaging, the BP-based radiotracer [68Ga]Ga-THP-Pam was able to detect EC more sensitively in several organs in which the mineral composition departs from that of HAp. Our results strongly suggest that BP-based PET radiotracers such as [68Ga]Ga-THP-Pam may have a particular advantage for the sensitive imaging and early detection of EC by being able to detect a wider array of relevant calcium minerals in vivo than [18F]NaF, and should be evaluated clinically for this purpose.

A robust approach to make inorganic nanovectors biotraceable

Nuclear medicine imaging plays an important role in nanomedicine. However, it is still challenging to develop a versatile platform to make the nonviral nanovectors used in cancer therapy biotraceable. In the present study, a robust approach to radiolabel inorganic nanovectors for SPECT and PET imaging was developed. The approach was based on the bisphosphonates (BP) conjugated on the nanovector, mesoporous silicon (PSi) nanoparticles. BP served as an efficient chelator for various radionuclides. For both of the ^99mTc and ⁶⁸Ga radionuclides utilized, the radiochemical purity and radiochemical yield were ∼99% and ∼90%, respectively. Because of the short decay time of the radionuclides, an easy, fast and effective PEGylation method was developed to improve the residence time in systemic circulation. Both PEG-^99mTc-BP-PSi and PEG-⁶⁸Ga-BP-PSi NPs, where PEGylation was performed after the labeling, had excellent colloidal and radiochemical stability in vitro. The plain particles without PEGylation accumulated fast in the reticuloendothelial system organs upon intravenous administration, while PEGylation prolonged the residence time of the particles in systemic circulation. Overall, the developed approach proved to be applicable for labeling nonviral nanovectors with various radionuclides easily and robustly. Considering the nature of mesoporous nanoparticles, the approach does not hamper the addition of other functionalities on the vector, nor its capability to carry high payloads.

Synthesis of novel pyrazolo[3,4-b]quinolinebisphosphonic acids and an unexpected intramolecular cyclization and phosphonylation reaction

Novel pyrazolo[3,4-b]quinoline α-ketophosphonic and hydroxymethylenebisphosphonic acid compounds were synthesized using different methodologies, starting from 2-chloro-3-formylquinoline 1. New phosphonic acid compounds were obtained as N-1 derivatives with a side chain with 1 or 3 (n = 1 or 3) methylene groups. All phosphonic acid compounds and their corresponding ester and carboxylic acid precursors were fully characterized, and their structures elucidated by spectroscopic data, using NMR techniques and infrared and high-resolution mass spectroscopy. During the process to obtain the N-1 substituted derivative with two methylene groups (n = 2) in the side chain, an unexpected addition-cyclization cascade reaction was observed, involving the phosphonylation of an aromatic ring and the formation of a new six-member lactam ring to afford a tetracyclic ring system. This was an unexpected result since other pyrazolo[3,4-b]quinoline derivatives and all corresponding pyrazolo[3,4-b]pyridine derivatives already prepared, under similar experimental conditions, did not undergo this reaction. This domino reaction occurs with different phosphite reagents but only affords the six-member ring. The spectroscopic data allowed the identification of the new synthesized tetracyclic compounds and the X-ray diffraction data of compound 11 enabled the confirmation of the proposed structures.

Development and validation of a kit formulation of [68Ga]Ga-P15-041 as a bone imaging agent

One of the commonly performed studies in nuclear medicine are bone scans with [^99mTc]Tc-methylene diphosphonate (MDP) for detecting various bone lesions, including cancer metastasis. The recent emergence of commercially available ⁶⁸Ge/⁶⁸Ga radionuclide generators makes it possible to provide ⁶⁸Ga-labelled bisphosphonates as positron emission tomography (PET) tracers for bone imaging. Preliminary human studies suggested that [⁶⁸Ga]Ga-HBED-CC-BP ([⁶⁸Ga]Ga-P15-041) in conjunction with PET/computed tomography (CT) showed accumulation in known bone lesions, fast clearance from blood and soft tissue, and an ability to provide high contrast images. A simple and efficient lyophilized P15-041 kit formulation for the rapid production of [⁶⁸Ga]Ga-P15-041 with excellent radiochemical purity (RCP) under ambient temperature without the need for purification is described. It is demonstrated that clinical doses of [⁶⁸Ga]Ga-P15-041 can be prepared manually within minutes with an excellent purity (> 90%) and readily meet the dose release criteria. When [⁶⁸Ga]Ga-P15-041 was evaluated in a patient with cancer, the imaging agent clearly showed accumulations in multiple lesions. In conclusion, [⁶⁸Ga]Ga-P15-041, prepared by a lyophilized kit, might be an excellent bone imaging agent for widespread clinical application.