Automated astatination of biomolecules--a stepping stone towards multicenter clinical trials

Production, isolation, and shipment of clinically relevant quantities of astatine-211: A simple and efficient approach to increasing supply

The alpha emitter astatine-211 (211At) is a promising candidate for cancer treatment based on Targeted Alpha (α) Therapy (TAT). A small number of facilities, distributed across the United States, are capable of accelerating α-particle beams to produce 211At. However, challenges remain regarding strategic methods for shipping 211At in a form adaptable to advanced radiochemistry reactions and other uses of the radioisotope.

PURPOSE

Our method allows shipment of 211At in various quantities in a form convenient for further radiochemistry.

PROCEDURES

For this study, a 3-octanone impregnated Amberchrom CG300M resin bed in a column cartridge was used to separate 211At from the bismuth matrix on site at the production accelerator (Texas A&M) in preparation for shipping. Aliquots of 6 M HNO3 containing up to ≈2.22 GBq of 211At from the dissolved target were successfully loaded and retained on columns. Exempt packages (<370 MBq) were shipped to a destination radiochemistry facility, University of Texas MD Anderson Cancer Center, in the form of a convenient air-dried column. Type A packages have been shipped overnight to University of Alabama at Birmingham.

MAIN FINDINGS

Air-dried column hold times of various lengths did not inhibit simple and efficient recovery of 211At. Solution eluted from the column was sufficiently high in specific activity to successfully radiolabel a model compound, 4-(4,4,5,5-tetramethyl-1,3,2-dioxaborolan-2-yl)aniline (1), with 211At. The method to prepare and ship 211At described in this manuscript has also been used to ship larger quantities of 211At a greater distance to University of Alabama at Birmingham.

PRINCIPAL CONCLUSIONS

The successful proof of this method paves the way for the distribution of 211At from Texas A&M University to research institutions and clinical oncology centers in Texas and elsewhere. Use of this simple method at other facilities has the potential increase the overall availability of 211At for preclinical and clinical studies.

Astatine-211 based radionuclide therapy: Current clinical trial landscape

Astatine-211 (²¹¹At) has physical properties that make it one of the top candidates for use as a radiation source for alpha particle-based radionuclide therapy, also referred to as targeted alpha therapy (TAT). Here, we summarize the main results of the completed clinical trials, further describe ongoing trials, and discuss future prospects.

The role of chemistry in accelerator-based production and separation of radionuclides as basis for radiolabelled compounds for medical applications

Radiochemical separations used in large scale routine production of diagnostic and therapeutic radionuclides at a particle accelerator for patient care are briefly outlined. The role of chemistry at various stages of development of a production route of a novel radionuclide, namely nuclear data measurement, high-current targetry, chemical processing and quality control of the product, is discussed in detail. Special attention is paid to production of non-standard positron emitters (e.g. 44gSc, 64Cu, 68Ga, etc.) at a cyclotron and novel therapeutic radionuclides (e.g. 67Cu, 225Ac, etc.) at an accelerator. Some typical examples of radiochemical methods involved are presented.

Recent Achievements about Targeted Alpha Therapy-Based Targeting Vectors and Chelating Agents

One of the most rapidly growing options in the management of cancer therapy is Targeted Alpha Therapy (TAT) through which lethal α-emitting radionuclides conjugated to tumor-targeting vectors selectively deliver high amount of radiation to cancer cells.²²⁵Ac, ²¹²Bi, ²¹¹At, ²¹³Bi, and ²²³Ra have been investigated by plenty of clinical trials and preclinical researches for the treatment of smaller tumor burdens, micro-metastatic disease, and post-surgery residual disease. In order to send maximum radiation to tumor cells while minimizing toxicity in normal cells, a high affinity of targeting vectors to cancer tissue is essential. Besides that, the stable and specific complex between chelating agent and α-emitters was found as a crucial parameter. The present review was planned to highlight recent achievements about TAT-based targeting vectors and chelating agents and provide further insight for future researches.

Production and supply of alpha particles emitting radionuclides for Targeted Alpha Therapy (TAT)

Encouraging results of Targeted Alpha Therapy (TAT) have created significant attention from academia and industry. However, the limited availability of suitable radionuclides has hampered widespread translation and application. In the present review, we discuss the most promising candidates for clinical application and the state of the art of their production and supply. Along with forthcoming another two reviews on chelation and clinical application of alpha-emitting radionuclides, JNM will provide a comprehensive assessment of the field.

Synthesis of [211At]4-astato-L-phenylalanine by dihydroxyboryl-astatine substitution reaction in aqueous solution

Astatine-211 (211At)-labeled phenylalanine is expected to be a promising agent for targeted alpha-particle therapy for the treatment of patients with glioma. The existing reactions to prepare the labeled compound usually require organic solvents and metals that are toxic and hazardous to the environment. In this study, we developed a novel method wherein astatination was realized via the substitution of 211At for a dihydroxyboryl group coupled to phenylalanine. [211At]4-astato-L-phenylalanine was obtained as the carrier-free product in aqueous medium in high radiochemical yields (98.1 ± 1.9%, n = 5). The crude reaction mixture was purified by solid-phase extraction, and the radiochemical purity of the product was 99.3 ± 0.7% (n = 5). The high yield and purity were attributed to the formation of [211At]AtI and AtI2- as the reactive intermediates in the astatination reaction. The reaction did not require any organic solvents or toxic reagents, suggesting that this method is suitable for clinical applications.

Production, purification and availability of 211At: Near term steps towards global access

The promising characteristics of the 7.2-h radiohalogen ²¹¹At have long been recognized; including having chemical properties suitable for labeling targeting vectors ranging from small organic molecules to proteins, and the emission of only one α-particle per decay, providing greater control over off-target effects. Unfortunately, the impact of ²¹¹At within the targeted α-particle therapy domain has been constrained by its limited availability. Paradoxically, the most commonly used production method - via the ²⁰⁹Bi(α,2n)²¹¹At reaction - utilizes a widely available natural material (bismuth) as the target and straightforward cyclotron irradiation methodology. On the other hand, the most significant impediment to widespread ²¹¹At availability is the need for an accelerator capable of generating ≥28 MeV α-particles with sufficient beam intensities to make clinically relevant levels of ²¹¹At. In this review, current methodologies for the production and purification of ²¹¹At - both by the direct production route noted above and via a ²¹¹Rn generator system - will be discussed. The capabilities of cyclotrons that currently produce ²¹¹At will be summarized and the characteristics of other accelerators that could be utilized for this purpose will be described. Finally, the logistics of networks, both academic and commercial, for facilitating ²¹¹At distribution to locations remote from production sites will be addressed.

Evaluation of therapeutic efficacy of 211At-labeled farletuzumab in an intraperitoneal mouse model of disseminated ovarian cancer

Introduction

Antibodies labeled with alpha-emitter astatine-211 have previously shown effective in intraperitoneal (i.p.) treatments of ovarian cancer. In the present work we explore the use of investigational farletuzumab, aimed at the folate receptor alpha. The aim was to evaluate the biodistribution and therapeutic effect of ²¹¹At-farletuzumab in in-vitro and in-vivo experiments and, using models for radiation dosimetry, to translate the findings to expected clinical result. The activity concentration used for therapy in mice (170 kBq/mL) was chosen to be in agreement with an activity concentration that is anticipated to be clinically relevant in patients (200 MBq/L).

Methods

For biodistribution, using intravenous injections and mice carrying subcutaneous (s.c.) tumors, the animals were administered either ²¹¹At-farletuzumab (n = 16); or with a combination of ¹²⁵I-farletuzumab and ²¹¹At-MX35 (n = 12). At 1, 3, 10 and 22 h, mice were euthanized and s.c.-tumors and organs weighted and measured for radioactivity. To evaluate therapeutic efficacy, mice were inoculated i.p. with 2 × 10⁶ NIH:OVCAR-3 cells. Twelve days later, the treatments were initiated by i.p.-administration. Specific treatment was given by ²¹¹At-labeled farletuzumab (group A; n = 22, 170 kBq/mL) which is specific for OVCAR-3 cells. Control treatments were given by either ²¹¹At-labeled rituximab which is unspecific for OVCAR-3 (group B; n = 22, 170 kBq/mL), non-radiolabeled farletuzumab (group C; n = 11) or PBS only (group D; n = 8).

Results

The biodistribution of ²¹¹At-farletuzumab was similar to that with ¹²⁵I as radiolabel, and also to that of ²¹¹At-labeled MX35 antibody. The tumor-free fraction (TFF) of the three control groups were all low (PBS 12%, unlabeled specific farletuzumab 9% and unspecific ²¹¹At-rituximab 14%). TFF following treatment with ²¹¹At-farletuzumab was 91%.

Conclusion

The current investigation of intraperitoneal therapy with ²¹¹At-farletuzumab, delivered at clinically relevant ²¹¹At-mAb radioactivity concentrations and specific activities, showed a 6 to 10-fold increase (treated versus controls) in antitumor efficacy. This observation warrants further clinical testing.

Realizing Clinical Trials with Astatine-211: The Chemistry Infrastructure

Despite the consensus around the clinical potential of the α-emitting radionuclide astatine-211 (211At), there are only a limited number of research facilities that work with this nuclide. There are three main reasons for this: (1) Scarce availability of the nuclide. Despite a relatively large number of globally existing cyclotrons capable of producing 211At, few cyclotron facilities produce the nuclide on a regular basis. (2) Lack of a chemical infrastructure, that is, isolation of 211At from irradiated targets and the subsequent synthesis of an astatinated product. At present, the research groups that work with 211At depend on custom systems for recovering 211At from the irradiated targets. Setting up and implementing such custom units require long lead times to provide a proper working system. (3) The chemistry of 211At. Compared with radiometals there are no well-established and generally accepted synthesis methods for forming sufficiently stable bonds between 211At and the tumor-specific vector to allow for systemic applications. Herein we present an overview of the infrastructure of producing 211At radiopharmaceuticals, from target to radiolabeled product including chemical strategies to overcome hurdles for advancement into clinical trials with 211At.

Astatine partitioning between nitric acid and conventional solvents: indication of covalency in ketone complexation of AtO. Chem Commun (Camb) 2020;56:9004-9007. [PMID: 32638758 DOI: 10.1039/d0cc03804k]

Astatine-211 has been produced at Texas A&M University on the K150 cyclotron, with a yield of 890 ± 80 MBq through the ²⁰⁹Bi(α,2n)²¹¹At reaction via an 8 h bombardment with a beam current of 4-8 μA and an α-particle beam energy of 28.8 MeV. The target was then dissolved in HNO₃ and the extraction of ²¹¹At was investigated into a variety of organic solvents in 1-3 M HNO₃. Extraction of ²¹¹At with distribution ratios as high as 11.3 ± 0.6, 12.3 ± 0.8, 42.2 ± 2.2, 69 ± 4, and 95 ± 6 were observed for diisopropyl ether, 1-decanol, 1-octanol, 3-octanone, and methyl isobutyl ketone, respectively, while the distribution ratios for ²⁰⁷Bi were ≤0.05 in all cases. The extraction of ²¹¹At into both methyl isobutyl ketone and 3-octanone showed a strong, linear dependence on the HNO₃ initial aqueous concentration and better extraction than other solvents. DFT calculations show stronger binding between the carbonyl oxygen of the ketone and the At metal center.

Labeling Monoclonal Antibody with α-emitting 211At at High Activity Levels via a Tin Precursor

Background: In a previous clinical study, the authors evaluated the potential of antitenascin C monoclonal antibody (mAb) 81C6 labeled with ²¹¹At via the prosthetic agent N-succinimidyl 3-[²¹¹At]astatobenzoate (SAB) for the treatment of primary brain tumors. Although encouraging results were obtained, labeling chemistry failed while attempting to escalate the dose to 370 MBq. The goal of the current study was to develop a revised procedure less susceptible to radiolysis-mediated effects on ²¹¹At labeling that would be suitable for use at higher activity levels of this α-emitter. Materials and Methods: Addition of N-chlorosuccinimide to the methanol used to remove the ²¹¹At from the cryotrap after bismuth target distillation was done to thwart radiolytic decomposition of reactive ²¹¹At and the tin precursor. A series of 11 reactions were performed to produce SAB at initial ²¹¹At activity levels of 0.31-2.74 GBq from 50 μg of N-succinimidyl 3-trimethylstannylbenzoate (Me-STB), which was then reacted with murine 81C6 mAb without purification of the SAB intermediate. Radiochemical purity, immunoreactive fraction, sterility, and apyrogenicity of the ²¹¹At-labeled 81C6 preparations were evaluated. Results: Murine 81C6 mAb was successfully labeled with ²¹¹At using these revised procedures with improved radiochemical yields and decreased overall synthesis time compared with the original clinical labeling procedure. Conclusions: With 2.74 GBq of ²¹¹At, it was possible to produce 1.0 GBq of ²¹¹At-labeled 81C6 with an immunoreactive fraction of 92%. These revised procedures permit production of ²¹¹At-labeled mAbs suitable for use at clinically relevant activity levels.

Development of an autonomous solvent extraction system to isolate astatine-211 from dissolved cyclotron bombarded bismuth targets

Cyclotron-produced astatine-211 (²¹¹At) shows tremendous promise in targeted alpha therapy (TAT) applications due to its attractive half-life and its 100% α-emission from nearly simultaneous branched alpha decay. Astatine-211 is produced by alpha beam bombardment of naturally monoisotopic bismuth metal (²⁰⁹Bi) via the (α, 2n) reaction. In order to isolate the small mass of ²¹¹At (specific activity = 76 GBq·µg⁻¹) from several grams of acid-dissolved Bi metal, a manual milliliter-scale solvent extraction process using diisopropyl ether (DIPE) is routinely performed at the University of Washington. As this process is complex and time consuming, we have developed a fluidic workstation that can perform the method autonomously. The workstation employs two pumps to concurrently deliver the aqueous and organic phases to a mixing tee and in-line phase mixer. The mixed phases are routed to a phase settling reservoir, where they gravity settle. Finally, each respective phase is withdrawn into its respective pump. However, development of a phase boundary sensor, placed in tandem with the phase settling reservoir, was necessary to communicate to the system when withdrawal of the denser aqueous phase was complete (i.e., the intersection of the two phases was located). The development and optimization of the autonomous solvent extraction system is described, and the ²¹¹At yields from several ~1.1 GBq-level ²¹¹At processing runs are reported.

Towards elucidating the radiochemistry of astatine - Behavior in chloroform

Targeted alpha therapy of disseminated cancer is an emerging technique where astatine-211 is one of the most promising candidate nuclides. Although astatine has been known for over 70 years, its chemistry is still largely unexplored, mainly due to the lack of stable or long-lived isotopes. However, substantial amounts of astatine-211 can be produced in cyclotrons by the bombardment of natural bismuth. The astatine can be recovered from the resulting irradiated target material through either wet extraction or dry-distillation. Chloroform has become an important intermediate solvent for the recovery of astatine after production, especially following dry distillation. In this work, the radiochemistry of astatine in chloroform was investigated using evaporation, solvent extraction, chromatographic methods and molecular modeling. The extraction of astatine in chloroform led to the formation of multiple astatine species, allowing for evaporation of the solvent to dryness without any loss of activity. Radiolysis products of chloroform were shown to play an important role in the speciation of astatine forming both reactive and kinetically stable compounds. It was hypothesized that reactions with chlorine, as well as trichloromethyl hydroperoxide, forming polar astatine compounds are important reactions under the current experimental conditions.

Improved production of 76Br, 77Br and 80mBr via CoSe cyclotron targets and vertical dry distillation

INTRODUCTION

The radioisotopes of bromine are uniquely suitable radiolabels for small molecule theranostic radiopharmaceuticals but are of limited availability due to production challenges. Significantly improved methods were developed for the production and radiochemical isolation of clinical quality ⁷⁶Br, ⁷⁷Br, and ^80mBr. The radiochemical quality of the radiobromine produced using these methods was tested through the synthesis of a novel ⁷⁷Br-labeled inhibitor of poly (ADP-ribose) polymerase-1 (PARP-1), a DNA damage response protein.

METHODS

⁷⁶Br, ⁷⁷Br, and ^80mBr were produced in high radionuclidic purity via the proton irradiation of novel isotopically-enriched Co⁷⁶Se, Co⁷⁷Se, and Co⁸⁰Se intermetallic targets, respectively. Radiobromine was isolated through thermal chromatographic distillation in a vertical furnace assembly. The ⁷⁷Br-labeled PARP inhibitor was synthesized via copper-mediated aryl boronic ester radiobromination.

RESULTS

Cyclotron production yields were 103 ± 10 MBq∙μA^-1∙h^-1 for ⁷⁶Br, 88 ± 10 MBq∙μA^-1∙h^-1 for ^80mBr at 16 MeV and 17 ± 1 MBq∙μA^-1∙h^-1 for ⁷⁷Br at 13 MeV. Radiobromide isolation yields were 76 ± 11% in a small volume of aqueous solution. The synthesized ⁷⁷Br-labeled PARP-1 inhibitor had a measured apparent molar activity up to 700 GBq/μmol at end of synthesis.

CONCLUSIONS

A novel selenium alloy target enabled clinical-scale production of ⁷⁶Br, ⁷⁷Br, and ^80mBr with high apparent molar activities, which was used to for the production of a new ⁷⁷Br-labeled inhibitor of PARP-1.

ADVANCES IN KNOWLEDGE

New methods for the cyclotron production and isolation of radiobromine improved the production capacity of ⁷⁷Br by a factor of three and ⁷⁶Br by a factor of six compared with previous methods.

IMPLICATIONS FOR PATIENT CARE

Preclinical translational research of ⁷⁷Br-based Auger electron radiotherapeutics, such as those targeting PARP-1, will require the production of GBq-scale ⁷⁷Br, which necessitates next-generation, high-yielding, isotopically-enriched cyclotron targets, such as the novel intermetallic Co⁷⁷Se.

Multifunctional Clickable Reagents for Rapid Bioorthogonal Astatination and Radio-Crosslinking

In the past decade, several developments have expanded the chemical toolbox for astatination and the preparation of 211At-labeled radiopharmaceuticals. However, there is still a need for advanced methods for the synthesis of astatinated (bio)molecules to address challenges such as limited in vivo stability. Herein, we report the development of multifunctional 211At-labeled reagents that can be prepared by applying a modular and versatile click approach for rapid assembly. The introduction of tetrazines as bioorthogonal tags enables rapid radiolabeling and radio-crosslinking, which is demonstrated by steric shielding of 211At to significantly increase label stability in human blood plasma.

Radiochemical aspects of alpha emitting radionuclides for medical application

The use of α-emitting radionuclides in targeted alpha therapy (TAT) holds great potential for treatment of human diseases, such as cancer, due to the short pathlength and high potency of the α particle, which can localize damage to targeted cells while minimizing effects to healthy surrounding tissues. In this review several potential α-emitting radionuclides having emission properties applicable to TAT are discussed from a radiochemical point of view. Overviews of production, radiochemical separation and chelation aspects relative to developing TAT radiopharmaceuticals are provided for the α-emitting radionuclides (and their generator systems) 211At, 224Ra/212Pb/212Bi, 225Ac/213Bi, 227Th/223Ra, 230U/226Th, 149Tb and 255Fm.

A convenient and reproducible method for the synthesis of astatinated 4-[211At]astato-l-phenylalanine via electrophilic desilylation

The 211At-labeled compound, 4-[211At]astato-l-phenylalanine, is one of the most promising amino acid derivatives for use in targeted alpha therapy (TAT) for various cancers. Electrophilic demetallation of a stannyl precursor is the most widely used approach for labeling biomolecules with 211At. However, the low acid-resistance of the stannyl precursor necessitates the use of an N- and C-terminus-protected precursor, which results in a low overall radiochemical yield (RCY) due to the multiple synthetic steps involved. In this study, a deprotected organosilyl compound, 4-triethylsilyl-l-phenylalanine, was employed for the direct synthesis of astatinated phenylalanines. 211At was separately recovered from the irradiated 209Bi target using chloroform (CHCl3) and N-chlorosuccinimide-methanol (NCS-MeOH) solution. The RCYs of 4-[211At]astato-l-phenylalanine obtained from the triethylsilyl precursor with the use of 211At, isolated in CHCl3 and NCS-MeOH solution, were 75% and 64% respectively. In both cases, the retention time of the 4-[211At]astato-l-phenylalanine was found to be about 20 min, which showed reasonable correlation with the retention time of non-radioactive 4-halo-l-phenylalanines (4-chloro-, 4-bromo-, and 4-iodo-l-phenylalanine). The one-step reaction examined in this study involved mild reaction conditions (70 °C) and a short time (10 min) compared to the other currently reported procedures for astatination. Electrophilic desilylation was found to be very effective for the labeling of aromatic amino acids with 211At.

Rapid Cu-Catalyzed [211At]Astatination and [125I]Iodination of Boronic Esters at Room Temperature

Access to 211At- and 125I-radiolabeled compounds in excellent RCCs and RCYs was achieved in just 10 min at room temperature using a Cu catalyst. The reaction conditions are applicable to a broad class of aryl and heteroaryl boronic reagents with varying steric and electronic properties as well as late-stage astatination and iodination of anticancer PARP inhibitors. This protocol eliminates the traditional need for toxic organotin reagents, elevated temperatures, and extended reaction times, providing a more practical and environmentally friendly approach to developing α-emitting radiotherapeutics.

Targeted radionuclide therapy with astatine-211: Oxidative dehalogenation of astatobenzoate conjugates

²¹¹At is a most promising radionuclide for targeted alpha therapy. However, its limited availability and poorly known basic chemistry hamper its use. Based on the analogy with iodine, labelling is performed via astatobenzoate conjugates, but in vivo deastatination occurs, particularly when the conjugates are internalized in cells. Actually, the chemical or biological mechanism responsible for deastatination is unknown. In this work, we show that the C−At “organometalloid” bond can be cleaved by oxidative dehalogenation induced by oxidants such as permanganates, peroxides or hydroxyl radicals. Quantum mechanical calculations demonstrate that astatobenzoates are more sensitive to oxidation than iodobenzoates, and the oxidative deastatination rate is estimated to be about 6 × 10⁶ faster at 37 °C than the oxidative deiodination one. Therefore, we attribute the “internal” deastatination mechanism to oxidative dehalogenation in biological compartments, in particular lysosomes.

Targeted alpha therapy using short-lived alpha-particles and the promise of nanobodies as targeting vehicle

Introduction: The combination of a targeted biomolecule that specifically defines the target and a radionuclide that delivers a cytotoxic payload offers a specific way to destroy cancer cells. Targeted radionuclide therapy (TRNT) aims to deliver cytotoxic radiation to cancer cells and causes minimal toxicity to surrounding healthy tissues. Recent advances using α-particle radiation emphasizes their potential to generate radiation in a highly localized and toxic manner because of their high level of ionization and short range in tissue.

Areas covered: We review the importance of targeted alpha therapy (TAT) and focus on nanobodies as potential beneficial vehicles. In recent years, nanobodies have been evaluated intensively as unique antigen-specific vehicles for molecular imaging and TRNT.

Expert opinion: We expect that the efficient targeting capacity and fast clearance of nanobodies offer a high potential for TAT. More particularly, we argue that the nanobodies’ pharmacokinetic properties match perfectly with the interesting decay properties of the short-lived α-particle emitting radionuclides Astatine-211 and Bismuth-213 and offer an interesting treatment option particularly for micrometastatic cancer and residual disease.