1
|
Meher N, Ashley GW, Bobba KN, Wadhwa A, Bidkar AP, Dasari C, Mu C, Sankaranarayanan RA, Serrano JAC, Raveendran A, Bulkley DP, Aggarwal R, Greenland NY, Oskowitz A, Wilson DM, Seo Y, Santi DV, VanBrocklin HF, Flavell RR. Prostate-Specific Membrane Antigen Targeted StarPEG Nanocarrier for Imaging and Therapy of Prostate Cancer. Adv Healthc Mater 2024:e2304618. [PMID: 38700450 DOI: 10.1002/adhm.202304618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND The uptake of large (>10 nm) non-targeted nanocarriers by bulk tumors is thought to be dominated by passive extravasation through porous tumor vessels and limited lymphatic drainage, the enhanced permeability and retention (EPR) effect. Prior studies demonstrated radiolabeled tumor-targeted and non-targeted 4-arm 40 kDa star polyethylene glycol (StarPEG) polymers for cancer imaging. By adding small molecule ligands targeting prostate-specific membrane antigen (PSMA) to the StarPEG polymer, marked increase in tumor uptake, penetration and retention in the tumor core was observed. These prior studies support the application of imaging surrogates for the evaluation of targeted delivery of chemotherapeutic nanomedicines and the potential for therapy using analogous β-emitting radiopharmaceuticals. METHODS To evaluate the delivery and therapeutic efficacy of PSMA-targeted StarPEG nanocarriers, StarPEG nanodrugs with or without three copies of PSMA-targeting, ACUPA, ligands were designed and synthesized. One copy of the radiometal chelator, DOTA, was conjugated to each nanocarrier for labelling with b-emitting 177Lu, providing non-targeted [177Lu]PEG-(DOTA)1 and PSMA targeting [177Lu]PEG-(DOTA)1(ACUPA)3, for SPECT imaging and therapy. The radiolabeled nanodrugs were evaluated in vitro and in vivo using PSMA+ PC3-Pip and/or PSMA- PC3-Flu cell lines, subcutaneous xenografts and disseminated metastatic models. RESULTS The nanocarriers PEG-(DOTA)1 and PEG-(DOTA)1(ACUPA)3 were efficiently radiolabeled with 177Lu with molar activities of 10.8-15.8 MBq/nmol. Along with excellent in vitro PSMA binding affinity (kD = 51.7 nM in PC3-Pip cells), the targeted nanocarrier [177Lu]PEG-(DOTA)1(ACUPA)3 demonstrated excellent in vivo single-photon emission computed tomography (SPECT) imaging contrast with 21.3% ID/g uptake in PC3-Pip tumors at 192 h post injection. Single doses of 18.5 MBq [177Lu]PEG-(DOTA)1(ACUPA)3 showed complete resolution of the PC3-Pip xenografts, without any regrowth up to 138 days. CONCLUSIONS AND FUTURE DIRECTIONS The StarPEG nanocarriers demonstrated high PSMA-targeted delivery of the therapeutic isotope 177Lu with excellent imaging contrast. The targeted nanocarrier eliminated subcutaneous and metastatic PC3-Pip tumors. Overall, these preclinical results demonstrated high treatment efficacy of the PSMA-targeted nanocarrier [177Lu]PEG-(DOTA)1(ACUPA)3 for prostate cancer, with potential for clinical translation. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Niranjan Meher
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143, USA
- National Institute of Pharmaceutical Education and Research, Raebareli, Lucknow, UP, 226002, India
| | | | - Kondapa Naidu Bobba
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143, USA
| | - Anju Wadhwa
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143, USA
| | - Anil P Bidkar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143, USA
| | - Chandrashekhar Dasari
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, 94143-0981, USA
| | - Changhua Mu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143, USA
| | | | - Juan A Camara Serrano
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, 94143-0957, USA
| | - Athira Raveendran
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143, USA
| | - David P Bulkley
- Department of Pathology, University of California, San Francisco, CA, 94143, USA
| | - Rahul Aggarwal
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, 94143-0957, USA
| | - Nancy Y Greenland
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, 94158-2517, USA
| | - Adam Oskowitz
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, 94143-0981, USA
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143, USA
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, 94143-0957, USA
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143, USA
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, 94143-0957, USA
| | | | - Henry F VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143, USA
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, 94143-0957, USA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143, USA
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, 94143-0957, USA
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, 94158, USA
| |
Collapse
|
2
|
Kline B, Yadav S, Seo Y, Ippisch RC, Castillo J, Aggarwal RR, Kelley RK, Behr SC, Flavell RR, Lawhn-Heath C, Melisko M, Rugo HS, Wang V, Yom SS, Ha P, Jiang F, Hope TA. 68Ga-FAP-2286 PET of Solid Tumors: Biodistribution, Dosimetry, and Comparison with 18F-FDG. J Nucl Med 2024:jnumed.123.267281. [PMID: 38697672 DOI: 10.2967/jnumed.123.267281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Fibroblast activation protein (FAP), expressed in the tumor microenvironment of a variety of cancers, has become a target of novel PET tracers. The purpose of this report is to evaluate the imaging characteristics of 68Ga-FAP-2286, present the first-to our knowledge-dosimetry analysis to date, and compare the agent with 18F-FDG and FAPI compounds. Methods: Patients were administered 219 ± 43 MBq of 68Ga-FAP-2286 and scanned after 60 min. Uptake was measured in up to 5 lesions per patient and within the kidneys, spleen, liver, and mediastinum (blood pool). Absorbed doses were evaluated using MIM Encore and OLINDA/EXM version 1.1 using the International Commission on Radiological Protection publication 103 tissue weighting factor. Results: Forty-six patients were imaged with 68Ga-FAP-2286 PET. The highest average uptake was seen in sarcoma, cholangiocarcinoma, and colon cancer. The lowest uptake was found in lung cancer and testicular cancer. The average SUVmax was significantly higher on 68Ga-FAP-2286 PET than on 18F-FDG PET in cholangiocarcinoma (18.2 ± 6.4 vs. 9.1 ± 5.0, P = 0.007), breast cancer (11.1 ± 6.8 vs. 4.1 ± 2.2, P < 0.001), colon cancer (13.8 ± 2.2 vs. 7.6 ± 1.7, P = 0.001), hepatocellular carcinoma (9.3 ± 3.5 vs. 4.7 ± 1.3, P = 0.01), head and neck cancer (11.3 ± 3.5 vs. 7.6 ± 5.5, P = 0.04), and pancreatic adenocarcinoma (7.4 ± 1.8 vs. 3.7 ± 1.0, P = 0.01). The total-body effective dose was estimated at 1.16E-02 mSv/MBq, with the greatest absorbed organ dose in the urinary bladder wall (9.98E-02 mGy/MBq). Conclusion: 68Ga-FAP-2286 biodistribution, dosimetry, and tumor uptake were similar to those of previously reported FAPI compounds. Additionally,68Ga-FAP-2286 PET had consistently higher uptake than 18F-FDG PET. These results are especially promising in the setting of small-volume disease and differentiating tumor from inflammatory uptake.
Collapse
Affiliation(s)
- Brad Kline
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Surekha Yadav
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Robin Cumming Ippisch
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Jessa Castillo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Rahul R Aggarwal
- Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Robin Kate Kelley
- Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
- Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Courtney Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Michelle Melisko
- Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Hope S Rugo
- Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Victoria Wang
- Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Patrick Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California; and
| | - Fei Jiang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California;
| |
Collapse
|
3
|
Alanizi AA, Sorlin AM, Parker MFL, López-Álvarez M, Qin H, Lee SH, Blecha J, Rosenberg OS, Engel J, Ohliger MA, Flavell RR, Wilson DM. Bioorthogonal Radiolabeling of Azide-Modified Bacteria Using [ 18F]FB-sulfo-DBCO. Bioconjug Chem 2024; 35:517-527. [PMID: 38482815 PMCID: PMC11036355 DOI: 10.1021/acs.bioconjchem.4c00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 04/18/2024]
Abstract
Purpose: This study was motivated by the need for better positron emission tomography (PET)-compatible tools to image bacterial infection. Our previous efforts have targeted bacteria-specific metabolism via assimilation of carbon-11 labeled d-amino acids into the bacterial cell wall. Since the chemical determinants of this incorporation are not fully understood, we sought a high-throughput method to label d-amino acid derived structures with fluorine-18. Our strategy employed a chemical biology approach, whereby an azide (-N3) bearing d-amino acid is incorporated into peptidoglycan muropeptides, with subsequent "click" cycloaddition with an 18F-labeled strained cyclooctyne partner. Procedures: A water-soluble, 18F-labeled and dibenzocyclooctyne (DBCO)-derived radiotracer ([18F]FB-sulfo-DBCO) was synthesized. This tracer was incubated with pathogenic bacteria treated with azide-bearing d-amino acids, and incorporated 18F was determined via gamma counting. In vitro uptake in bacteria previously treated with azide-modified d-amino acids was compared to that in cultures treated with amino acid controls. The biodistribution of [18F]FB-sulfo-DBCO was studied in a cohort of healthy mice with implications for future in vivo imaging. Results: The new strain-promoted azide-alkyne cycloaddition (SPAAC) radiotracer [18F]FB-sulfo-DBCO was synthesized with high radiochemical yield and purity via N-succinimidyl 4-[18F]fluorobenzoate ([18F]SFB). Accumulation of [18F]FB-sulfo-DBCO was significantly higher in several bacteria treated with azide-modified d-amino acids than in controls; for example, we observed 7 times greater [18F]FB-sulfo-DBCO ligation in Staphylococcus aureus cultures incubated with 3-azido-d-alanine versus those incubated with d-alanine. Conclusions: The SPAAC radiotracer [18F]FB-sulfo-DBCO was validated in vitro via metabolic labeling of azide-bearing peptidoglycan muropeptides. d-Amino acid-derived PET radiotracers may be more efficiently screened via [18F]FB-sulfo-DBCO modification.
Collapse
Affiliation(s)
- Aryn A. Alanizi
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Alexandre M. Sorlin
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Matthew F. L. Parker
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
- Department
of Psychiatry, Renaissance School of Medicine
at Stony Brook University, Stony
Brook, New York 11794, United States
| | - Marina López-Álvarez
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Hecong Qin
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Sang Hee Lee
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Joseph Blecha
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Oren S. Rosenberg
- Department
of Medicine, University of California, San
Francisco, San Francisco, California 94158, United States
| | - Joanne Engel
- Department
of Medicine, University of California, San
Francisco, San Francisco, California 94158, United States
| | - Michael A. Ohliger
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
- Department
of Radiology, Zuckerberg San Francisco General
Hospital, San Francisco, California 94110, United States
| | - Robert R. Flavell
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - David M. Wilson
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| |
Collapse
|
4
|
Sorlin A, López-Álvarez M, Biboy J, Gray J, Rabbitt SJ, Rahim JU, Lee SH, Bobba KN, Blecha J, Parker MF, Flavell RR, Engel J, Ohliger M, Vollmer W, Wilson DM. Peptidoglycan-Targeted [ 18F]3,3,3-Trifluoro-d-alanine Tracer for Imaging Bacterial Infection. JACS Au 2024; 4:1039-1047. [PMID: 38559735 PMCID: PMC10976610 DOI: 10.1021/jacsau.3c00776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 04/04/2024]
Abstract
Imaging is increasingly used to detect and monitor bacterial infection. Both anatomic (X-rays, computed tomography, ultrasound, and MRI) and nuclear medicine ([111In]-WBC SPECT, [18F]FDG PET) techniques are used in clinical practice but lack specificity for the causative microorganisms themselves. To meet this challenge, many groups have developed imaging methods that target pathogen-specific metabolism, including PET tracers integrated into the bacterial cell wall. We have previously reported the d-amino acid derived PET radiotracers d-methyl-[11C]-methionine, d-[3-11C]-alanine, and d-[3-11C]-alanine-d-alanine, which showed robust bacterial accumulation in vitro and in vivo. Given the clinical importance of radionuclide half-life, in the current study, we developed [18F]3,3,3-trifluoro-d-alanine (d-[18F]-CF3-ala), a fluorine-18 labeled tracer. We tested the hypothesis that d-[18F]-CF3-ala would be incorporated into bacterial peptidoglycan given its structural similarity to d-alanine itself. NMR analysis showed that the fluorine-19 parent amino acid d-[19F]-CF3-ala was stable in human and mouse serum. d-[19F]-CF3-ala was also a poor substrate for d-amino acid oxidase, the enzyme largely responsible for mammalian d-amino acid metabolism and a likely contributor to background signals using d-amino acid derived PET tracers. In addition, d-[19F]-CF3-ala showed robust incorporation into Escherichia coli peptidoglycan, as detected by HPLC/mass spectrometry. Based on these promising results, we developed a radiosynthesis of d-[18F]-CF3-ala via displacement of a bromo-precursor with [18F]fluoride followed by chiral stationary phase HPLC. Unexpectedly, the accumulation of d-[18F]-CF3-ala by bacteria in vitro was highest for Gram-negative pathogens in particular E. coli. In a murine model of acute bacterial infection, d-[18F]-CF3-ala could distinguish live from heat-killed E. coli, with low background signals. These results indicate the viability of [18F]-modified d-amino acids for infection imaging and indicate that improved specificity for bacterial metabolism can improve tracer performance.
Collapse
Affiliation(s)
- Alexandre
M. Sorlin
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Marina López-Álvarez
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Jacob Biboy
- The
Centre for Bacterial Cell Biology, Newcastle
University Newcastle, Newcastle
upon Tyne NE2 4AX, United Kingdom
| | - Joe Gray
- The
Centre for Bacterial Cell Biology, Newcastle
University Newcastle, Newcastle
upon Tyne NE2 4AX, United Kingdom
| | - Sarah J. Rabbitt
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Junaid Ur Rahim
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Sang Hee Lee
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Kondapa Naidu Bobba
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Joseph Blecha
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Mathew F.L. Parker
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
- Department
of Psychiatry, Renaissance School of Medicine
at Stony Brook University, Stony Brook, New York 11794, United States
| | - Robert R. Flavell
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
- UCSF
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California 94158, United States
- Department
of Pharmaceutical Chemistry, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Joanne Engel
- Department
of Medicine, University of California, San
Francisco, San Francisco, California 94158, United States
- Department
of Microbiology and Immunology, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Michael Ohliger
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
- Department
of Radiology, Zuckerberg San Francisco General
Hospital, San Francisco, California 94110, United States
| | - Waldemar Vollmer
- The
Centre for Bacterial Cell Biology, Newcastle
University Newcastle, Newcastle
upon Tyne NE2 4AX, United Kingdom
- Institute
for Molecular Bioscience, The University
of Queensland, Brisbane 4072, Australia
| | - David M. Wilson
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| |
Collapse
|
5
|
Caravaca J, Bobba KN, Du S, Peter R, Gullberg GT, Bidkar AP, Flavell RR, Seo Y. A technique to quantify very low activities in regions of interest with a collimatorless detector. IEEE Trans Med Imaging 2024; PP:1-1. [PMID: 38478457 DOI: 10.1109/tmi.2024.3377142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
We present a new method to measure sub-microcurie activities of photon-emitting radionuclides in organs and lesions of small animals in vivo. Our technique, named the collimator-less likelihood fit, combines a very high sensitivity collimatorless detector with a Monte Carlo-based likelihood fit in order to estimate the activities in previously segmented regions of interest along with their uncertainties. This is done directly from the photon projections in our collimatorless detector and from the region of interest segmentation provided by an x-ray computed tomography scan. We have extensively validated our approach with 225Ac experimentally in spherical phantoms and mouse phantoms, and also numerically with simulations of a realistic mouse anatomy. Our method yields statistically unbiased results with uncertainties smaller than 20% for activities as low as ~111 Bq (3 nCi) and for exposures under 30 minutes. We demonstrate that our method yields more robust recovery coefficients when compared to SPECT imaging with a commercial pre-clinical scanner, specially at very low activities. Thus, our technique is complementary to traditional SPECT/CT imaging since it provides a more accurate and precise organ and tumor dosimetry, with a more limited spatial information. Finally, our technique is specially significant in extremely low-activity scenarios when SPECT/CT imaging is simply not viable.
Collapse
|
6
|
Wadhwa A, Wang S, Patiño-Escobar B, Bidkar AP, Bobba KN, Chan E, Meher N, Bidlingmaier S, Su Y, Dhrona S, Geng H, Sarin V, VanBrocklin HF, Wilson DM, He J, Zhang L, Steri V, Wong SW, Martin TG, Seo Y, Liu B, Wiita AP, Flavell RR. CD46-Targeted Theranostics for PET and 225Ac-Radiopharmaceutical Therapy of Multiple Myeloma. Clin Cancer Res 2024; 30:1009-1021. [PMID: 38109209 PMCID: PMC10905524 DOI: 10.1158/1078-0432.ccr-23-2130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/26/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE Multiple myeloma is a plasma cell malignancy with an unmet clinical need for improved imaging methods and therapeutics. Recently, we identified CD46 as an overexpressed therapeutic target in multiple myeloma and developed the antibody YS5, which targets a cancer-specific epitope on this protein. We further developed the CD46-targeting PET probe [89Zr]Zr-DFO-YS5 for imaging and [225Ac]Ac-DOTA-YS5 for radiopharmaceutical therapy of prostate cancer. These prior studies suggested the feasibility of the CD46 antigen as a theranostic target in multiple myeloma. Herein, we validate [89Zr]Zr-DFO-YS5 for immunoPET imaging and [225Ac]Ac-DOTA-YS5 for radiopharmaceutical therapy of multiple myeloma in murine models. EXPERIMENTAL DESIGN In vitro saturation binding was performed using the CD46 expressing MM.1S multiple myeloma cell line. ImmunoPET imaging using [89Zr]Zr-DFO-YS5 was performed in immunodeficient (NSG) mice bearing subcutaneous and systemic multiple myeloma xenografts. For radioligand therapy, [225Ac]Ac-DOTA-YS5 was prepared, and both dose escalation and fractionated dose treatment studies were performed in mice bearing MM1.S-Luc systemic xenografts. Tumor burden was analyzed using BLI, and body weight and overall survival were recorded to assess antitumor effect and toxicity. RESULTS [89Zr]Zr-DFO-YS5 demonstrated high affinity for CD46 expressing MM.1S multiple myeloma cells (Kd = 16.3 nmol/L). In vitro assays in multiple myeloma cell lines demonstrated high binding, and bioinformatics analysis of human multiple myeloma samples revealed high CD46 expression. [89Zr]Zr-DFO-YS5 PET/CT specifically detected multiple myeloma lesions in a variety of models, with low uptake in controls, including CD46 knockout (KO) mice or multiple myeloma mice using a nontargeted antibody. In the MM.1S systemic model, localization of uptake on PET imaging correlated well with the luciferase expression from tumor cells. A treatment study using [225Ac]Ac-DOTA-YS5 in the MM.1S systemic model demonstrated a clear tumor volume and survival benefit in the treated groups. CONCLUSIONS Our study showed that the CD46-targeted probe [89Zr]Zr-DFO-YS5 can successfully image CD46-expressing multiple myeloma xenografts in murine models, and [225Ac]Ac-DOTA-YS5 can effectively inhibit the growth of multiple myeloma. These results demonstrate that CD46 is a promising theranostic target for multiple myeloma, with the potential for clinical translation.
Collapse
Affiliation(s)
- Anju Wadhwa
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Sinan Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Bonell Patiño-Escobar
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
- Department of Laboratory Medicine, University of California, San Francisco, California
| | - Anil P. Bidkar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Kondapa Naidu Bobba
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Emily Chan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
- Department of Laboratory Medicine, University of California, San Francisco, California
| | - Niranjan Meher
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Scott Bidlingmaier
- Department of Anesthesia, University of California, San Francisco, California
| | - Yang Su
- Department of Anesthesia, University of California, San Francisco, California
| | - Suchi Dhrona
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Huimin Geng
- Department of Laboratory Medicine, University of California, San Francisco, California
| | - Vishesh Sarin
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
- Department of Laboratory Medicine, University of California, San Francisco, California
| | - Henry F. VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - David M. Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Jiang He
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
| | - Li Zhang
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
- Department of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Veronica Steri
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Sandy W. Wong
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, California
| | - Thomas G. Martin
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, California
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Bin Liu
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
- Department of Anesthesia, University of California, San Francisco, California
| | - Arun P. Wiita
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
- Department of Laboratory Medicine, University of California, San Francisco, California
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California
- Chan Zuckerberg Biohub, San Francisco, California
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
- Department of Pharmaceutical Chemistry, University of California, San Francisco, California
| |
Collapse
|
7
|
Diwanji D, Onishi N, Hathi DK, Lawhn-Heath C, Kornak J, Li W, Guo R, Molina-Vega J, Seo Y, Flavell RR, Heditsian D, Brain S, Esserman LJ, Joe BN, Hylton NM, Jones EF, Ray KM. 18F-FDG Dedicated Breast PET Complementary to Breast MRI for Evaluating Early Response to Neoadjuvant Chemotherapy. Radiol Imaging Cancer 2024; 6:e230082. [PMID: 38551406 PMCID: PMC10988337 DOI: 10.1148/rycan.230082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/30/2023] [Accepted: 02/16/2024] [Indexed: 04/02/2024]
Abstract
Purpose To compare quantitative measures of tumor metabolism and perfusion using fluorine 18 (18F) fluorodeoxyglucose (FDG) dedicated breast PET (dbPET) and breast dynamic contrast-enhanced (DCE) MRI during early treatment with neoadjuvant chemotherapy (NAC). Materials and Methods Prospectively collected DCE MRI and 18F-FDG dbPET examinations were analyzed at baseline (T0) and after 3 weeks (T1) of NAC in 20 participants with 22 invasive breast cancers. FDG dbPET-derived standardized uptake value (SUV), metabolic tumor volume, and total lesion glycolysis (TLG) and MRI-derived percent enhancement (PE), signal enhancement ratio (SER), and functional tumor volume (FTV) were calculated at both time points. Differences between FDG dbPET and MRI parameters were evaluated after stratifying by receptor status, Ki-67 index, and residual cancer burden. Parameters were compared using Wilcoxon signed rank and Mann-Whitney U tests. Results High Ki-67 tumors had higher baseline SUVmean (difference, 5.1; P = .01) and SUVpeak (difference, 5.5; P = .04). At T1, decreases were observed in FDG dbPET measures (pseudo-median difference T0 minus T1 value [95% CI]) of SUVmax (-6.2 [-10.2, -2.6]; P < .001), SUVmean (-2.6 [-4.9, -1.3]; P < .001), SUVpeak (-4.2 [-6.9, -2.3]; P < .001), and TLG (-29.1 mL3 [-71.4, -6.8]; P = .005) and MRI measures of SERpeak (-1.0 [-1.3, -0.2]; P = .02) and FTV (-11.6 mL3 [-22.2, -1.7]; P = .009). Relative to nonresponsive tumors, responsive tumors showed a difference (95% CI) in percent change in SUVmax of -34.3% (-55.9%, 1.5%; P = .06) and in PEpeak of -42.4% (95% CI: -110.5%, 8.5%; P = .08). Conclusion 18F-FDG dbPET was sensitive to early changes during NAC and provided complementary information to DCE MRI that may be useful for treatment response evaluation. Keywords: Breast, PET, Dynamic Contrast-enhanced MRI Clinical trial registration no. NCT01042379 Supplemental material is available for this article. © RSNA, 2024.
Collapse
Affiliation(s)
- Devan Diwanji
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Natsuko Onishi
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Deep K. Hathi
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Courtney Lawhn-Heath
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - John Kornak
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Wen Li
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Ruby Guo
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Julissa Molina-Vega
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Youngho Seo
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Robert R. Flavell
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Diane Heditsian
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Susie Brain
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Laura J. Esserman
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Bonnie N. Joe
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Nola M. Hylton
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Ella F. Jones
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Kimberly M. Ray
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| |
Collapse
|
8
|
Bobba KN, Bidkar AP, Wadhwa A, Meher N, Drona S, Sorlin AM, Bidlingmaier S, Zhang L, Wilson DM, Chan E, Greenland NY, Aggarwal R, VanBrocklin HF, He J, Chou J, Seo Y, Liu B, Flavell RR. Development of CD46 targeted alpha theranostics in prostate cancer using 134Ce/ 225Ac-Macropa-PEG 4-YS5. Theranostics 2024; 14:1344-1360. [PMID: 38389832 PMCID: PMC10879874 DOI: 10.7150/thno.92742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Rationale: 225Ac, a long-lived α-emitter with a half-life of 9.92 days, has garnered significant attention as a therapeutic radionuclide when coupled with monoclonal antibodies and other targeting vectors. Nevertheless, its clinical utility has been hampered by potential off-target toxicity, a lack of optimized chelators for 225Ac, and limitations in radiolabeling methods. In a prior study evaluating the effectiveness of CD46-targeted radioimmunotherapy, we found great therapeutic efficacy but also significant toxicity at higher doses. To address these challenges, we have developed a radioimmunoconjugate called 225Ac-Macropa-PEG4-YS5, incorporating a stable PEGylated linker to maximize tumoral uptake and increase tumor-to-background ratios. Our research demonstrates that this conjugate exhibits greater anti-tumor efficacy while minimizing toxicity in prostate cancer 22Rv1 tumors. Methods: We synthesized Macropa.NCS and Macropa-PEG4/8-TFP esters and prepared Macropa-PEG0/4/8-YS5 (with nearly ~1:1 ratio of macropa chelator to antibody YS5) as well as DOTA-YS5 conjugates. These conjugates were then radiolabeled with 225Ac in a 2 M NH4OAc solution at 30 °C, followed by purification using YM30K centrifugal purification. Subsequently, we conducted biodistribution studies and evaluated antitumor activity in nude mice (nu/nu) bearing prostate 22Rv1 xenografts in both single-dose and fractionated dosing studies. Micro-PET imaging studies were performed with 134Ce-Macropa-PEG0/4/8-YS5 in 22Rv1 xenografts for 7 days. Toxicity studies were also performed in healthy athymic nude mice. Results: As expected, we achieved a >95% radiochemical yield when labeling Macropa-PEG0/4/8-YS5 with 225Ac, regardless of the chelator ratios (ranging from 1 to 7.76 per YS5 antibody). The isolated yield exceeded 60% after purification. Such high conversions were not observed with the DOTA-YS5 conjugate, even at a higher ratio of 8.5 chelators per antibody (RCY of 83%, an isolated yield of 40%). Biodistribution analysis at 7 days post-injection revealed higher tumor uptake for the 225Ac-Macropa-PEG4-YS5 (82.82 ± 38.27 %ID/g) compared to other conjugates, namely 225Ac-Macropa-PEG0/8-YS5 (38.2 ± 14.4/36.39 ± 12.4 %ID/g) and 225Ac-DOTA-YS5 (29.35 ± 7.76 %ID/g). The PET Imaging of 134Ce-Macropa-PEG0/4/8-YS5 conjugates resulted in a high tumor uptake, and tumor to background ratios. In terms of antitumor activity, 225Ac-Macropa-PEG4-YS5 exhibited a substantial response, leading to prolonged survival compared to 225Ac-DOTA-YS5, particularly when administered at 4.625 kBq doses, in single or fractionated dose regimens. Chronic toxicity studies observed mild to moderate renal toxicity at 4.625 and 9.25 kBq doses. Conclusions: Our study highlights the promise of 225Ac-Macropa-PEG4-YS5 for targeted alpha particle therapy. The 225Ac-Macropa-PEG4-YS5 conjugate demonstrates improved biodistribution, reduced off-target binding, and enhanced therapeutic efficacy, particularly at lower doses, compared to 225Ac-DOTA-YS5. Incorporating theranostic 134Ce PET imaging further enhances the versatility of macropa-PEG conjugates, offering a more effective and safer approach to cancer treatment. Overall, this methodology has a high potential for broader clinical applications.
Collapse
Affiliation(s)
- Kondapa Naidu Bobba
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143, United States
| | - Anil P. Bidkar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143, United States
| | - Anju Wadhwa
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143, United States
| | - Niranjan Meher
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143, United States
| | - Suchi Drona
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143, United States
| | - Alexandre M. Sorlin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143, United States
| | - Scott Bidlingmaier
- Department of Anesthesia, University of California, San Francisco, California 94110, United States
| | - Li Zhang
- Department of Medicine and the Department of Epidemiology and Biostatistics, University of California, Berkeley, California, United States
| | - David M. Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143, United States
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California 94143-0981, United States
| | - Emily Chan
- Department of Pathology, University of California, San Francisco, California 94110, United States
| | - Nancy Y. Greenland
- Department of Pathology, University of California, San Francisco, California 94110, United States
| | - Rahul Aggarwal
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California 94143-0981, United States
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, United States
| | - Henry F. VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143, United States
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California 94143-0981, United States
| | - Jiang He
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, 22908, United States
| | - Jonathan Chou
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California 94143-0981, United States
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, United States
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143, United States
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California 94143-0981, United States
| | - Bin Liu
- Department of Anesthesia, University of California, San Francisco, California 94110, United States
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California 94143-0981, United States
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143, United States
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California 94143-0981, United States
- Department of Pharmaceutical Chemistry, University of California, San Francisco, California 94158-2517, United States
| |
Collapse
|
9
|
Lee SH, Kim JM, López-Álvarez M, Wang C, Sorlin AM, Bobba KN, Pichardo-González PA, Blecha J, Seo Y, Flavell RR, Engel J, Ohliger MA, Wilson DM. Imaging the Bacterial Cell Wall Using N-Acetyl Muramic Acid-Derived Positron Emission Tomography Radiotracers. ACS Sens 2023; 8:4554-4565. [PMID: 37992233 PMCID: PMC10749472 DOI: 10.1021/acssensors.3c01477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/10/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
Imaging infections in patients is challenging using conventional methods, motivating the development of positron emission tomography (PET) radiotracers targeting bacteria-specific metabolic pathways. Numerous techniques have focused on the bacterial cell wall, although peptidoglycan-targeted PET tracers have been generally limited to the short-lived carbon-11 radioisotope (t1/2 = 20.4 min). In this article, we developed and tested new tools for infection imaging using an amino sugar component of peptidoglycan, namely, derivatives of N-acetyl muramic acid (NAM) labeled with the longer-lived fluorine-18 (t1/2 = 109.6 min) radioisotope. Muramic acid was reacted directly with 4-nitrophenyl 2-[18F]fluoropropionate ([18F]NFP) to afford the enantiomeric NAM derivatives (S)-[18F]FMA and (R)-[18F]FMA. Both diastereomers were easily isolated and showed robust accumulation by human pathogens in vitro and in vivo, including Staphylococcus aureus. These results form the basis for future clinical studies using fluorine-18-labeled NAM-derived PET radiotracers.
Collapse
Affiliation(s)
- Sang Hee Lee
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Jung Min Kim
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Marina López-Álvarez
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Chao Wang
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Alexandre M. Sorlin
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Kondapa Naidu Bobba
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Priamo A. Pichardo-González
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Joseph Blecha
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Youngho Seo
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Robert R. Flavell
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
- UCSF
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California 94158, United States
- Department
of Pharmaceutical Chemistry, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Joanne Engel
- Department
of Medicine, University of California, San
Francisco, San Francisco, California 94158, United States
- Department
of Microbiology and Immunology, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Michael A. Ohliger
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
- Department
of Radiology, Zuckerberg San Francisco General
Hospital, San Francisco, California 94110, United States
| | - David M. Wilson
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San
Francisco, California 94158, United States
| |
Collapse
|
10
|
Mu C, Liu X, Kim Y, Riselli A, Korenchan DE, Bok RA, Delos Santos R, Sriram R, Qin H, Nguyen H, Gordon JW, Slater J, Larson PEZ, Vigneron DB, Kurhanewicz J, Wilson DM, Flavell RR. Clinically Translatable Hyperpolarized 13C Bicarbonate pH Imaging Method for Use in Prostate Cancer. ACS Sens 2023; 8:4042-4054. [PMID: 37878761 PMCID: PMC10683509 DOI: 10.1021/acssensors.3c00851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
Solid tumors such as prostate cancer (PCa) commonly develop an acidic microenvironment with pH 6.5-7.2, owing to heterogeneous perfusion, high metabolic activity, and rapid cell proliferation. In preclinical prostate cancer models, disease progression is associated with a decrease in tumor extracellular pH, suggesting that pH imaging may reflect an imaging biomarker to detect aggressive and high-risk disease. Therefore, we developed a hyperpolarized carbon-13 MRI method to image the tumor extracellular pH (pHe) and prepared it for clinical translation for detection and risk stratification of PCa. This method relies on the rapid breakdown of hyperpolarized (HP) 1,2-glycerol carbonate (carbonyl-13C) via base-catalyzed hydrolysis to produce HP 13CO32-, which is neutralized and converted to HP H13CO3-. After injection, HP H13CO3- equilibrates with HP 13CO2 in vivo and enables the imaging of pHe. Using insights gleaned from mechanistic studies performed in the hyperpolarized state, we solved issues of polarization loss during preparation in a clinical polarizer system. We successfully customized a reaction apparatus suitable for clinical application, developed clinical standard operating procedures, and validated the radiofrequency pulse sequence and imaging data acquisition with a wide range of animal models. The results demonstrated that we can routinely produce a highly polarized and safe HP H13CO3- contrast agent suitable for human injection. Preclinical imaging studies validated the reliability and accuracy of measuring acidification in healthy kidney and prostate tumor tissue. These methods were used to support an Investigational New Drug application to the U.S. Food and Drug Administration. This methodology is now ready to be implemented in human trials, with the ultimate goal of improving the management of PCa.
Collapse
Affiliation(s)
- Changhua Mu
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - Xiaoxi Liu
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - Yaewon Kim
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - Andrew Riselli
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - David E. Korenchan
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - Robert A. Bok
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - Romelyn Delos Santos
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - Renuka Sriram
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - Hecong Qin
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - Hao Nguyen
- Department
of Urology, University of California, San Francisco, California 94143, United States
| | - Jeremy W. Gordon
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - James Slater
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - Peder E. Z. Larson
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - Daniel B. Vigneron
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - John Kurhanewicz
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - David M. Wilson
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
| | - Robert R. Flavell
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94107, United States
- Department
of Pharmaceutical Chemistry, University
of California, San Francisco, California 94158, United States
| |
Collapse
|
11
|
Parker MFL, López-Álvarez M, Alanizi AA, Luu JM, Polvoy I, Sorlin AM, Qin H, Lee S, Rabbitt SJ, Pichardo-González PA, Ordonez AA, Blecha J, Rosenberg OS, Flavell RR, Engel J, Jain SK, Ohliger MA, Wilson DM. Evaluating the Performance of Pathogen-Targeted Positron Emission Tomography Radiotracers in a Rat Model of Vertebral Discitis-Osteomyelitis. J Infect Dis 2023; 228:S281-S290. [PMID: 37788505 PMCID: PMC11009497 DOI: 10.1093/infdis/jiad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Vertebral discitis-osteomyelitis (VDO) is a devastating infection of the spine that is challenging to distinguish from noninfectious mimics using computed tomography and magnetic resonance imaging. We and others have developed novel metabolism-targeted positron emission tomography (PET) radiotracers for detecting living Staphylococcus aureus and other bacteria in vivo, but their head-to-head performance in a well-validated VDO animal model has not been reported. METHODS We compared the performance of several PET radiotracers in a rat model of VDO. [11C]PABA and [18F]FDS were assessed for their ability to distinguish S aureus, the most common non-tuberculous pathogen VDO, from Escherichia coli. RESULTS In the rat S aureus VDO model, [11C]PABA could detect as few as 103 bacteria and exhibited the highest signal-to-background ratio, with a 20-fold increased signal in VDO compared to uninfected tissues. In a proof-of-concept experiment, detection of bacterial infection and discrimination between S aureus and E coli was possible using a combination of [11C]PABA and [18F]FDS. CONCLUSIONS Our work reveals that several bacteria-targeted PET radiotracers had sufficient signal to background in a rat model of S aureus VDO to be potentially clinically useful. [11C]PABA was the most promising tracer investigated and warrants further investigation in human VDO.
Collapse
Affiliation(s)
- Matthew F L Parker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, New York
| | - Marina López-Álvarez
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Aryn A Alanizi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Justin M Luu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Ilona Polvoy
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Alexandre M Sorlin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Hecong Qin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Sanghee Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Sarah J Rabbitt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | | | - Alvaro A Ordonez
- Center for Infection and Inflammation Imaging Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Blecha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | | | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Joanne Engel
- Department of Medicine, University of California, San Francisco
- UCSF Department of Microbiology and Immunology, San Francisco, California
| | - Sanjay K Jain
- Center for Infection and Inflammation Imaging Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| |
Collapse
|
12
|
Sorlin A, López-Álvarez M, Rabbitt SJ, Alanizi AA, Shuere R, Bobba KN, Blecha J, Sakhamuri S, Evans MJ, Bayles KW, Flavell RR, Rosenberg OS, Sriram R, Desmet T, Nidetzky B, Engel J, Ohliger MA, Fraser JS, Wilson DM. Chemoenzymatic Syntheses of Fluorine-18-Labeled Disaccharides from [ 18F] FDG Yield Potent Sensors of Living Bacteria In Vivo. J Am Chem Soc 2023; 145:17632-17642. [PMID: 37535945 PMCID: PMC10436271 DOI: 10.1021/jacs.3c03338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Indexed: 08/05/2023]
Abstract
Chemoenzymatic techniques have been applied extensively to pharmaceutical development, most effectively when routine synthetic methods fail. The regioselective and stereoselective construction of structurally complex glycans is an elegant application of this approach that is seldom applied to positron emission tomography (PET) tracers. We sought a method to dimerize 2-deoxy-[18F]-fluoro-d-glucose ([18F]FDG), the most common tracer used in clinical imaging, to form [18F]-labeled disaccharides for detecting microorganisms in vivo based on their bacteria-specific glycan incorporation. When [18F]FDG was reacted with β-d-glucose-1-phosphate in the presence of maltose phosphorylase, the α-1,4- and α-1,3-linked products 2-deoxy-[18F]-fluoro-maltose ([18F]FDM) and 2-deoxy-2-[18F]-fluoro-sakebiose ([18F]FSK) were obtained. This method was further extended with the use of trehalose (α,α-1,1), laminaribiose (β-1,3), and cellobiose (β-1,4) phosphorylases to synthesize 2-deoxy-2-[18F]fluoro-trehalose ([18F]FDT), 2-deoxy-2-[18F]fluoro-laminaribiose ([18F]FDL), and 2-deoxy-2-[18F]fluoro-cellobiose ([18F]FDC). We subsequently tested [18F]FDM and [18F]FSK in vitro, showing accumulation by several clinically relevant pathogens including Staphylococcus aureus and Acinetobacter baumannii, and demonstrated their specific uptake in vivo. Both [18F]FDM and [18F]FSK were stable in human serum with high accumulation in preclinical infection models. The synthetic ease and high sensitivity of [18F]FDM and [18F]FSK to S. aureus including methicillin-resistant (MRSA) strains strongly justify clinical translation of these tracers to infected patients. Furthermore, this work suggests that chemoenzymatic radiosyntheses of complex [18F]FDG-derived oligomers will afford a wide array of PET radiotracers for infectious and oncologic applications.
Collapse
Affiliation(s)
- Alexandre
M. Sorlin
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Marina López-Álvarez
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Sarah J. Rabbitt
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Aryn A. Alanizi
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Rebecca Shuere
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Kondapa Naidu Bobba
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Joseph Blecha
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Sasank Sakhamuri
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Michael J. Evans
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Kenneth W. Bayles
- Department
of Pathology and Microbiology, University
of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Robert R. Flavell
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| | - Oren S. Rosenberg
- Department
of Medicine University of California, San
Francisco, San Francisco, California 94158, United States
| | - Renuka Sriram
- Department
of Biotechnology, Ghent University, Gent B-9000, Belgium
| | - Tom Desmet
- Department
of Biotechnology, Ghent University, Gent B-9000, Belgium
| | - Bernd Nidetzky
- Institute
of Biotechnology and Biochemical Engineering, Graz University of Technology, Graz 8010, Austria
| | - Joanne Engel
- Department
of Biotechnology, Ghent University, Gent B-9000, Belgium
| | - Michael A. Ohliger
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
- Department
of Radiology Zuckerberg San Francisco General
Hospital, San Francisco, California 94110, United States
| | - James S. Fraser
- Department
of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California 94158, United States
| | - David M. Wilson
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California 94158, United States
| |
Collapse
|
13
|
Klauser PC, Chopra S, Cao L, Bobba KN, Yu B, Seo Y, Chan E, Flavell RR, Evans MJ, Wang L. Covalent Proteins as Targeted Radionuclide Therapies Enhance Antitumor Effects. ACS Cent Sci 2023; 9:1241-1251. [PMID: 37396859 PMCID: PMC10311652 DOI: 10.1021/acscentsci.3c00288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Indexed: 07/04/2023]
Abstract
Molecularly targeted radionuclide therapies (TRTs) struggle with balancing efficacy and safety, as current strategies to increase tumor absorption often alter drug pharmacokinetics to prolong circulation and normal tissue irradiation. Here we report the first covalent protein TRT, which, through reacting with the target irreversibly, increases radioactive dose to the tumor without altering the drug's pharmacokinetic profile or normal tissue biodistribution. Through genetic code expansion, we engineered a latent bioreactive amino acid into a nanobody, which binds to its target protein and forms a covalent linkage via the proximity-enabled reactivity, cross-linking the target irreversibly in vitro, on cancer cells, and on tumors in vivo. The radiolabeled covalent nanobody markedly increases radioisotope levels in tumors and extends tumor residence time while maintaining rapid systemic clearance. Furthermore, the covalent nanobody conjugated to the α-emitter actinium-225 inhibits tumor growth more effectively than the noncovalent nanobody without causing tissue toxicity. Shifting the protein-based TRT from noncovalent to covalent mode, this chemical strategy improves tumor responses to TRTs and can be readily scaled to diverse protein radiopharmaceuticals engaging broad tumor targets.
Collapse
Affiliation(s)
- Paul C. Klauser
- Department
of Pharmaceutical Chemistry and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, California 94158, United States
- Helen
Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94158, United States
| | - Shalini Chopra
- Department
of Pharmaceutical Chemistry and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, California 94158, United States
- Helen
Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94158, United States
- Department
of Radiology and Biomedical Imaging, University
of California San Francisco, San Francisco, California 94158, United States
| | - Li Cao
- Department
of Pharmaceutical Chemistry and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, California 94158, United States
- Helen
Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94158, United States
| | - Kondapa Naidu Bobba
- Department
of Radiology and Biomedical Imaging, University
of California San Francisco, San Francisco, California 94158, United States
| | - Bingchen Yu
- Department
of Pharmaceutical Chemistry and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, California 94158, United States
- Helen
Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94158, United States
| | - Youngho Seo
- Department
of Radiology and Biomedical Imaging, University
of California San Francisco, San Francisco, California 94158, United States
| | - Emily Chan
- Department
of Pathology, University of California San
Francisco, San Francisco, California 94158, United States
| | - Robert R. Flavell
- Department
of Pharmaceutical Chemistry and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, California 94158, United States
- Helen
Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94158, United States
- Department
of Radiology and Biomedical Imaging, University
of California San Francisco, San Francisco, California 94158, United States
| | - Michael J. Evans
- Department
of Pharmaceutical Chemistry and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, California 94158, United States
- Helen
Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94158, United States
- Department
of Radiology and Biomedical Imaging, University
of California San Francisco, San Francisco, California 94158, United States
| | - Lei Wang
- Department
of Pharmaceutical Chemistry and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, California 94158, United States
- Helen
Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94158, United States
| |
Collapse
|
14
|
Sorlin AM, López-Álvarez M, Rabbitt SJ, Alanizi AA, Shuere R, Bobba KN, Blecha J, Sakhamuri S, Evans MJ, Bayles KW, Flavell RR, Rosenberg OS, Sriram R, Desmet T, Nidetzky B, Engel J, Ohliger MA, Fraser JS, Wilson DM. Chemoenzymatic syntheses of fluorine-18-labeled disaccharides from [ 18 F]FDG yield potent sensors of living bacteria in vivo. bioRxiv 2023:2023.05.20.541529. [PMID: 37293043 PMCID: PMC10245702 DOI: 10.1101/2023.05.20.541529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Chemoenzymatic techniques have been applied extensively to pharmaceutical development, most effectively when routine synthetic methods fail. The regioselective and stereoselective construction of structurally complex glycans is an elegant application of this approach, that is seldom applied to positron emission tomography (PET) tracers. We sought a method to dimerize 2-deoxy-[ 18 F]-fluoro-D-glucose ([ 18 F]FDG), the most common tracer used in clinical imaging, to form [ 18 F]-labeled disaccharides for detecting microorganisms in vivo based on their bacteria-specific glycan incorporation. When [ 18 F]FDG was reacted with β-D-glucose-1-phosphate in the presence of maltose phosphorylase, both the α-1,4 and α-1,3-linked products 2-deoxy-[ 18 F]-fluoro-maltose ([ 18 F]FDM) and 2-deoxy-2-[ 18 F]-fluoro-sakebiose ([ 18 F]FSK) were obtained. This method was further extended with the use of trehalose (α,α-1,1), laminaribiose (β-1,3), and cellobiose (β-1,4) phosphorylases to synthesize 2-deoxy-2-[ 18 F]fluoro-trehalose ([ 18 F]FDT), 2-deoxy-2-[ 18 F]fluoro-laminaribiose ([ 18 F]FDL), and 2-deoxy-2-[ 18 F]fluoro-cellobiose ([ 18 F]FDC). We subsequently tested [ 18 F]FDM and [ 18 F]FSK in vitro, showing accumulation by several clinically relevant pathogens including Staphylococcus aureus and Acinetobacter baumannii, and demonstrated their specific uptake in vivo. The lead sakebiose-derived tracer [ 18 F]FSK was stable in human serum and showed high uptake in preclinical models of myositis and vertebral discitis-osteomyelitis. Both the synthetic ease, and high sensitivity of [ 18 F]FSK to S. aureus including methicillin-resistant (MRSA) strains strongly justify clinical translation of this tracer to infected patients. Furthermore, this work suggests that chemoenzymatic radiosyntheses of complex [ 18 F]FDG-derived oligomers will afford a wide array of PET radiotracers for infectious and oncologic applications.
Collapse
|
15
|
Bobba KN, Bidkar AP, Meher N, Fong C, Wadhwa A, Dhrona S, Sorlin A, Bidlingmaier S, Shuere B, He J, Wilson DM, Liu B, Seo Y, VanBrocklin HF, Flavell RR. Evaluation of 134Ce/ 134La as a PET Imaging Theranostic Pair for 225Ac α-Radiotherapeutics. J Nucl Med 2023:jnumed.122.265355. [PMID: 37201957 DOI: 10.2967/jnumed.122.265355] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/07/2023] [Indexed: 05/20/2023] Open
Abstract
225Ac-targeted α-radiotherapy is a promising approach to treating malignancies, including prostate cancer. However, α-emitting isotopes are difficult to image because of low administered activities and a low fraction of suitable γ-emissions. The in vivo generator 134Ce/134La has been proposed as a potential PET imaging surrogate for the therapeutic nuclides 225Ac and 227Th. In this report, we detail efficient radiolabeling methods using the 225Ac-chelators DOTA and MACROPA. These methods were applied to radiolabeling of prostate cancer imaging agents, including PSMA-617 and MACROPA-PEG4-YS5, for evaluation of their in vivo pharmacokinetic characteristics and comparison to the corresponding 225Ac analogs. Methods: Radiolabeling was performed by mixing DOTA/MACROPA chelates with 134Ce/134La in NH4OAc, pH 8.0, at room temperature, and radiochemical yields were monitored by radio-thin-layer chromatography. In vivo biodistributions of 134Ce-DOTA/MACROPA.NH2 complexes were assayed through dynamic small-animal PET/CT imaging and ex vivo biodistribution studies over 1 h in healthy C57BL/6 mice, compared with free 134CeCl3 In vivo, preclinical imaging of 134Ce-PSMA-617 and 134Ce-MACROPA-PEG4-YS5 was performed on 22Rv1 tumor-bearing male nu/nu-mice. Ex vivo biodistribution was performed for 134Ce/225Ac-MACROPA-PEG4-YS5 conjugates. Results: 134Ce-MACROPA.NH2 demonstrated near-quantitative labeling with 1:1 ligand-to-metal ratios at room temperature, whereas a 10:1 ligand-to-metal ratio and elevated temperatures were required for DOTA. Rapid urinary excretion and low liver and bone uptake were seen for 134Ce/225Ac-DOTA/MACROPA. NH2 conjugates in comparison to free 134CeCl3 confirmed high in vivo stability. An interesting observation during the radiolabeling of tumor-targeting vectors PSMA-617 and MACROPA-PEG4-YS5-that the daughter 134La was expelled from the chelate after the decay of parent 134Ce-was confirmed through radio-thin-layer chromatography and reverse-phase high-performance liquid chromatography. Both conjugates, 134Ce-PSMA-617 and 134Ce-MACROPA-PEG4-YS5, displayed tumor uptake in 22Rv1 tumor-bearing mice. The ex vivo biodistribution of 134Ce-MACROPA.NH2, 134Ce-DOTA and 134Ce-MACROPA-PEG4-YS5 corroborated well with the respective 225Ac-conjugates. Conclusion: These results demonstrate the PET imaging potential for 134Ce/134La-labeled small-molecule and antibody agents. The similar 225Ac and 134Ce/134La-chemical and pharmacokinetic characteristics suggest that the 134Ce/134La pair may act as a PET imaging surrogate for 225Ac-based radioligand therapies.
Collapse
Affiliation(s)
- Kondapa Naidu Bobba
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Anil P Bidkar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Niranjan Meher
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Cyril Fong
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Anju Wadhwa
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Suchi Dhrona
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Alex Sorlin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Scott Bidlingmaier
- Department of Anesthesia, University of California, San Francisco, San Francisco, California
| | - Becka Shuere
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Jiang He
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia;
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Bin Liu
- Department of Anesthesia, University of California, San Francisco, San Francisco, California
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California; and
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Henry F VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California;
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California; and
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California;
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California; and
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California
| |
Collapse
|
16
|
Bidkar AP, Wang S, Bobba KN, Chan E, Bidlingmaier S, Egusa EA, Peter R, Ali U, Meher N, Wadhwa A, Dhrona S, Dasari C, Beckford-Vera D, Su Y, Tang R, Zhang L, He J, Wilson DM, Aggarwal R, VanBrocklin HF, Seo Y, Chou J, Liu B, Flavell RR. Treatment of prostate cancer with CD46 targeted 225Ac alpha particle radioimmunotherapy. Clin Cancer Res 2023; 29:1916-1928. [PMID: 36917693 PMCID: PMC10183825 DOI: 10.1158/1078-0432.ccr-22-3291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE Radiopharmaceutical therapy is changing the standard of care in prostate cancer (PCa) and other malignancies. We previously reported high CD46 expression in PCa and developed an antibody-drug conjugate and immunoPET agent based on the YS5 antibody, which targets a tumor-selective CD46 epitope. Here, we present the preparation, preclinical efficacy, and toxicity evaluation of [225Ac]DOTA-YS5, a radioimmunotherapy agent based on the YS5 antibody. EXPERIMENTAL DESIGN [225Ac]DOTA-YS5 was developed, and its therapeutic efficiency was tested on cell derived (22Rv1, DU145), and patient derived (LTL-545, LTL484) PCa xenograft models. Biodistribution studies were carried out on 22Rv1 tumor xenograft models to confirm the targeting efficacy. Toxicity analysis of the [225Ac]DOTA-YS5 was carried out on nu/nu mice to study short-term (acute) and long-term (chronic) toxicity. RESULTS Biodistribution study shows that [225Ac]DOTA-YS5 agent delivers high levels of radiation to the tumor tissue (11.64±1.37 %ID/g, 28.58±10.88 %ID/g, 29.35±7.76%ID/g, and 31.78±5.89 %ID/g at 24 h, 96 h, 168 h, and 408 h, respectively), compared to the healthy organs. [225Ac]DOTA-YS5 suppressed tumor size and prolonged survival in cell line and patient derived xenograft models. Toxicity analysis revealed that the 0.5 µCi activity levels showed toxicity to the kidneys, likely due to redistribution of daughter isotope 213Bi. CONCLUSIONS [225Ac]DOTA-YS5 suppressed the growth of cell-derived and patient-derived xenografts, including PSMA-positive and deficient models. Overall, this preclinical study confirms that [225Ac]DOTA-YS5 is a highly effective treatment and suggests feasibility for clinical translation of CD46 targeted radioligand therapy in PCa.
Collapse
Affiliation(s)
- Anil P Bidkar
- University of California, San Francisco, San Francisco, CA, United States
| | - Sinan Wang
- University of California, San Francisco, San Francisco, California, China
| | | | - Emily Chan
- University of California, San Francisco, San Franciso, United States
| | - Scott Bidlingmaier
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, United States
| | - Emily A Egusa
- University of California, San Francisco, San Francisco, CA, United States
| | - Robin Peter
- University of California, Berkeley, CA, USA, United States
| | - Umama Ali
- University of California, San Francisco, San Francisco, CA, United States
| | - Niranjan Meher
- University of California, San Francisco, San Francisco, CA, United States
| | - Anju Wadhwa
- University of California, San Francisco, San Francisco, CA, United States
| | - Suchi Dhrona
- University of California, San Francisco, San Francisco, CA, United States
| | | | | | - Yang Su
- University of California, San Francisco, San Francisco, CA, United States
| | - Ryan Tang
- University of South Florida, Tampa, FL, United States
| | - Li Zhang
- University of California, San Francisco, San Franciso, United States
| | - Jiang He
- University of Virginia, Charlottesville, VA, United States
| | - David M Wilson
- University of California, San Francisco, San Francisco, CA, United States
| | - Rahul Aggarwal
- University of California, San Francisco, San Francisco, CA, United States
| | | | - Youngho Seo
- University of California, San Francisco, San Francisco, CA, United States
| | - Jonathan Chou
- University of California, San Francisco, San Francisco, CA, United States
| | - Bin Liu
- University of California, San Francisco, San Francisco, CA, United States
| | - Robert R Flavell
- University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
17
|
Li J, Huang T, Hua J, Wang Q, Su Y, Chen P, Bidlingmaier S, Li A, Xie Z, Bidkar AP, Shen S, Shi W, Seo Y, Flavell RR, Gioeli D, Dreicer R, Li H, Liu B, He J. CD46 targeted 212Pb alpha particle radioimmunotherapy for prostate cancer treatment. J Exp Clin Cancer Res 2023; 42:61. [PMID: 36906664 PMCID: PMC10007843 DOI: 10.1186/s13046-023-02636-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/01/2023] [Indexed: 03/13/2023] Open
Abstract
We recently identified CD46 as a novel prostate cancer cell surface antigen that shows lineage independent expression in both adenocarcinoma and small cell neuroendocrine subtypes of metastatic castration resistant prostate cancer (mCRPC), discovered an internalizing human monoclonal antibody YS5 that binds to a tumor selective CD46 epitope, and developed a microtubule inhibitor-based antibody drug conjugate that is in a multi-center phase I trial for mCRPC (NCT03575819). Here we report the development of a novel CD46-targeted alpha therapy based on YS5. We conjugated 212Pb, an in vivo generator of alpha-emitting 212Bi and 212Po, to YS5 through the chelator TCMC to create the radioimmunoconjugate, 212Pb-TCMC-YS5. We characterized 212Pb-TCMC-YS5 in vitro and established a safe dose in vivo. We next studied therapeutic efficacy of a single dose of 212Pb-TCMC-YS5 using three prostate cancer small animal models: a subcutaneous mCRPC cell line-derived xenograft (CDX) model (subcu-CDX), an orthotopically grafted mCRPC CDX model (ortho-CDX), and a prostate cancer patient-derived xenograft model (PDX). In all three models, a single dose of 0.74 MBq (20 µCi) 212Pb-TCMC-YS5 was well tolerated and caused potent and sustained inhibition of established tumors, with significant increases of survival in treated animals. A lower dose (0.37 MBq or 10 µCi 212Pb-TCMC-YS5) was also studied on the PDX model, which also showed a significant effect on tumor growth inhibition and prolongation of animal survival. These results demonstrate that 212Pb-TCMC-YS5 has an excellent therapeutic window in preclinical models including PDXs, opening a direct path for clinical translation of this novel CD46-targeted alpha radioimmunotherapy for mCRPC treatment.
Collapse
Affiliation(s)
- Jun Li
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, 22903, USA.,Department of Nuclear Medicine, Peking University Shenzhen Hospital, Guangdong, 518036, China
| | - Tao Huang
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, 22903, USA
| | - Jun Hua
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, 22903, USA.,Department of Nuclear Medicine, Chongqing Cancer Hospital, Chongqing University, Chongqing, China
| | - Qiong Wang
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.,Department of Pathology, University of Virginia, Charlottesville, VA, 22903, USA
| | - Yang Su
- Department of Anesthesia, University of California, San Francisco, CA, 94110, USA
| | - Ping Chen
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, 22903, USA.,Department of Nuclear Medicine, Peking University Shenzhen Hospital, Guangdong, 518036, China
| | - Scott Bidlingmaier
- Department of Anesthesia, University of California, San Francisco, CA, 94110, USA
| | - Allan Li
- Department of Anesthesia, University of California, San Francisco, CA, 94110, USA
| | - Zhongqiu Xie
- Department of Pathology, University of Virginia, Charlottesville, VA, 22903, USA
| | - Anil P Bidkar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94110, USA
| | - Sui Shen
- Department of Radiation Oncology, University of Alabama, Birmingham, AL, 35233, USA
| | - Weibin Shi
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, 22903, USA
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94110, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94110, USA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94110, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94110, USA
| | - Daniel Gioeli
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia, Charlottesville, VA, 22903, USA.,UVA Comprehensive Cancer Center, University of Virginia, Charlottesville, VA, 22903, USA
| | - Robert Dreicer
- UVA Comprehensive Cancer Center, University of Virginia, Charlottesville, VA, 22903, USA.,Department of Medicine, University of Virginia, Charlottesville, VA, 22903, USA
| | - Hui Li
- Department of Pathology, University of Virginia, Charlottesville, VA, 22903, USA.,UVA Comprehensive Cancer Center, University of Virginia, Charlottesville, VA, 22903, USA
| | - Bin Liu
- Department of Anesthesia, University of California, San Francisco, CA, 94110, USA. .,UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94110, USA.
| | - Jiang He
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, 22903, USA. .,UVA Comprehensive Cancer Center, University of Virginia, Charlottesville, VA, 22903, USA.
| |
Collapse
|
18
|
Meher N, VanBrocklin HF, Wilson DM, Flavell RR. PSMA-Targeted Nanotheranostics for Imaging and Radiotherapy of Prostate Cancer. Pharmaceuticals (Basel) 2023; 16:315. [PMID: 37259457 PMCID: PMC9964110 DOI: 10.3390/ph16020315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/11/2023] [Accepted: 02/12/2023] [Indexed: 08/26/2023] Open
Abstract
Targeted nanotheranostic systems offer significant benefits due to the integration of diagnostic and therapeutic functionality, promoting personalized medicine. In recent years, prostate-specific membrane antigen (PSMA) has emerged as an ideal theranostic target, fueling multiple new drug approvals and changing the standard of care in prostate cancer (PCa). PSMA-targeted nanosystems such as self-assembled nanoparticles (NPs), liposomal structures, water-soluble polymers, dendrimers, and other macromolecules are under development for PCa theranostics due to their multifunctional sensing and therapeutic capabilities. Herein, we discuss the significance and up-to-date development of "PSMA-targeted nanocarrier systems for radioligand imaging and therapy of PCa". The review also highlights critical parameters for designing nanostructured radiopharmaceuticals for PCa, including radionuclides and their chelators, PSMA-targeting ligands, and the EPR effect. Finally, prospects and potential for clinical translation is discussed.
Collapse
Affiliation(s)
- Niranjan Meher
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Henry F. VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, USA
| | - David M. Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, USA
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA 94158, USA
| |
Collapse
|
19
|
Li Y, Flavell RR, Juarez R, Chow M, Wu C, Tsai K, Daud A, Behr SC. Retrospective study of the incidence of sarcoidosis-like reaction in patients treated with immunotherapy. Clin Radiol 2023; 78:e131-e136. [PMID: 36344282 DOI: 10.1016/j.crad.2022.09.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
AIM To assess the frequency of radiographically evident drug-induced sarcoidosis-like reaction (DISR) in patients treated with anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) therapy, anti-programmed cell death protein 1 (PD-1) therapy, or a combination of both in a single centre. MATERIALS AND METHODS The images and medical records of 457 patients with metastatic melanoma or head and neck cancer treated with either anti-CTLA-4 therapy, anti-PD-1 therapy, or a combination of both at University of California medical centre were reviewed retrospectively and the incidence of radiological manifestations of DISR was assessed among these treatment groups. RESULTS Radiological manifestations of DISR were found in 19/457 patients (4.1%). The mean interval from the initiation of immunotherapy to development of DISR was 5.5 months (range 2.3-13.5 months). Mean interval from radiological detection of DISR to imaging evidence of resolution was 5.8 months (range 1.6-18.3 months). Three patients out of 81 (3.7%), 11/297 (3.7%), and 5/79 (6.3%) developed sarcoidosis-like reaction after treatment with anti-CTLA-4 antibody, anti-PD-1 antibody, and a combination of both, respectively. Most patients with DISR were asymptomatic and did not require systemic therapy. Most patients did not demonstrate concomitant increased maximum standardised uptake value (SUVmax) in other organs on their integrated 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT). CONCLUSIONS In the present retrospective study of patients treated with immune checkpoint inhibitors (ICIs), DISR occurred in approximately 3.7% of patients treated with either anti-CTLA-4 or anti-PD-1 antibody and 6.3% of patients treated with a combination of both.
Collapse
Affiliation(s)
- Y Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA
| | - R R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA
| | - R Juarez
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA
| | - M Chow
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - C Wu
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - K Tsai
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - A Daud
- Department of Medicine, University of California, San Francisco, 1825 5(th) St, San Francisco, CA 94143, USA
| | - S C Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA.
| |
Collapse
|
20
|
Chou J, Egusa EA, Wang S, Badura ML, Lee F, Bidkar AP, Zhu J, Shenoy T, Trepka K, Robinson TM, Steri V, Huang J, Wang Y, Small EJ, Chan E, Stohr BA, Ashworth A, Delafontaine B, Rottey S, Cooke KS, Hashemi Sadraei N, Yu B, Salvati M, Bailis JM, Feng FY, Flavell RR, Aggarwal R. Immunotherapeutic Targeting and PET Imaging of DLL3 in Small-Cell Neuroendocrine Prostate Cancer. Cancer Res 2023; 83:301-315. [PMID: 36351060 DOI: 10.1158/0008-5472.can-22-1433] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/06/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Abstract
Effective treatments for de novo and treatment-emergent small-cell/neuroendocrine (t-SCNC) prostate cancer represent an unmet need for this disease. Using metastatic biopsies from patients with advanced cancer, we demonstrate that delta-like ligand 3 (DLL3) is expressed in de novo and t-SCNC and is associated with reduced survival. We develop a PET agent, [89Zr]-DFO-DLL3-scFv, that detects DLL3 levels in mouse SCNC models. In multiple patient-derived xenograft models, AMG 757 (tarlatamab), a half-life-extended bispecific T-cell engager (BiTE) immunotherapy that redirects CD3-positive T cells to kill DLL3-expressing cells, exhibited potent and durable antitumor activity. Late relapsing tumors after AMG 757 treatment exhibited lower DLL3 levels, suggesting antigen loss as a resistance mechanism, particularly in tumors with heterogeneous DLL3 expression. These findings have been translated into an ongoing clinical trial of AMG 757 in de novo and t-SCNC, with a confirmed objective partial response in a patient with histologically confirmed SCNC. Overall, these results identify DLL3 as a therapeutic target in SCNC and demonstrate that DLL3-targeted BiTE immunotherapy has significant antitumor activity in this aggressive prostate cancer subtype. SIGNIFICANCE The preclinical and clinical evaluation of DLL3-directed immunotherapy, AMG 757, and development of a PET radiotracer for noninvasive DLL3 detection demonstrate the potential of targeting DLL3 in SCNC prostate cancer.
Collapse
Affiliation(s)
- Jonathan Chou
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Emily A Egusa
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.,Department of Radiation Oncology and Urology, University of California, San Francisco, California
| | - Sinan Wang
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Michelle L Badura
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.,Department of Radiation Oncology and Urology, University of California, San Francisco, California.,Department of Biology, Santa Clara University, Santa Clara, California
| | - Fei Lee
- Oncology Research, Amgen Research, Amgen, South San Francisco, California
| | - Anil P Bidkar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Jun Zhu
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.,Department of Radiation Oncology and Urology, University of California, San Francisco, California
| | - Tanushree Shenoy
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Kai Trepka
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.,Department of Radiation Oncology and Urology, University of California, San Francisco, California.,Medical Scientist Training Program, University of California, San Francisco, California
| | - Troy M Robinson
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.,Department of Radiation Oncology and Urology, University of California, San Francisco, California
| | - Veronica Steri
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Jiaoti Huang
- Department of Pathology, Duke University, Durham, North Carolina
| | - Yuzhuo Wang
- Department of Experimental Therapeutics, BC Cancer, Vancouver, British Columbia.,Vancouver Prostate Centre, Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric J Small
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Emily Chan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.,Department of Pathology, University of California, San Francisco, California
| | - Bradley A Stohr
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.,Department of Pathology, University of California, San Francisco, California
| | - Alan Ashworth
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | | | | | - Keegan S Cooke
- Oncology Research, Amgen Research, Amgen, Thousand Oaks, California
| | | | - Brian Yu
- Global Development, Amgen, Thousand Oaks, California
| | - Mark Salvati
- Global Development, Amgen, Thousand Oaks, California
| | - Julie M Bailis
- Oncology Research, Amgen Research, Amgen, South San Francisco, California
| | - Felix Y Feng
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.,Department of Radiation Oncology and Urology, University of California, San Francisco, California
| | - Robert R Flavell
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Rahul Aggarwal
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| |
Collapse
|
21
|
Shin J, Parker MFL, Zhu I, Alanizi A, Rodriguez CI, Liu R, Watchmaker PB, Kalita M, Blecha J, Luu J, Wright B, Lapi SE, Flavell RR, Okada H, Tlsty TD, Roybal KT, Wilson DM. Antigen-Dependent Inducible T-Cell Reporter System for PET Imaging of Breast Cancer and Glioblastoma. J Nucl Med 2023; 64:137-144. [PMID: 35981900 PMCID: PMC9841254 DOI: 10.2967/jnumed.122.264284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 01/28/2023] Open
Abstract
For the past several decades, chimeric antigen receptor T-cell therapies have shown promise in the treatment of cancers. These treatments would greatly benefit from companion imaging biomarkers to follow the trafficking of T cells in vivo. Methods: Using synthetic biology, we engineered T cells with a chimeric receptor synthetic intramembrane proteolysis receptor (SNIPR) that induces overexpression of an exogenous reporter gene cassette on recognition of specific tumor markers. We then applied a SNIPR-based PET reporter system to 2 cancer-relevant antigens, human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor variant III (EGFRvIII), commonly expressed in breast and glial tumors, respectively. Results: Antigen-specific reporter induction of the SNIPR PET T cells was confirmed in vitro using green fluorescent protein fluorescence, luciferase luminescence, and the HSV-TK PET reporter with 9-(4-18F-fluoro-3-[hydroxymethyl]butyl)guanine ([18F]FHBG). T cells associated with their target antigens were successfully imaged using PET in dual-xenograft HER2+/HER2- and EGFRvIII+/EGFRvIII- animal models, with more than 10-fold higher [18F]FHBG signals seen in antigen-expressing tumors versus the corresponding controls. Conclusion: The main innovation found in this work was PET detection of T cells via specific antigen-induced signals, in contrast to reporter systems relying on constitutive gene expression.
Collapse
Affiliation(s)
- Jaehoon Shin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Matthew F L Parker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Iowis Zhu
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, California
- Parker Institute for Cancer Immunotherapy, San Francisco, California
| | - Aryn Alanizi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Carlos I Rodriguez
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Raymond Liu
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, California
- Parker Institute for Cancer Immunotherapy, San Francisco, California
| | - Payal B Watchmaker
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Mausam Kalita
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Joseph Blecha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Justin Luu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Brian Wright
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne E Lapi
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
- Helen Diller Cancer Center, University of California, San Francisco, San Francisco, California
| | - Hideho Okada
- Parker Institute for Cancer Immunotherapy, San Francisco, California
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Helen Diller Cancer Center, University of California, San Francisco, San Francisco, California
| | - Thea D Tlsty
- Department of Pathology, University of California, San Francisco, San Francisco, California;
| | - Kole T Roybal
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, California;
- Parker Institute for Cancer Immunotherapy, San Francisco, California
- Helen Diller Cancer Center, University of California, San Francisco, San Francisco, California
- Chan Zuckerberg Biohub, San Francisco, California
- Gladstone UCSF Institute for Genetic Immunology, San Francisco, California; and
- UCSF Cell Design Institute, San Francisco, California
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California;
| |
Collapse
|
22
|
Meher N, Ashley GW, Bidkar AP, Dhrona S, Fong C, Fontaine SD, Beckford Vera DR, Wilson DM, Seo Y, Santi DV, VanBrocklin HF, Flavell RR. Prostate-Specific Membrane Antigen Targeted Deep Tumor Penetration of Polymer Nanocarriers. ACS Appl Mater Interfaces 2022; 14:50569-50582. [PMID: 36318757 PMCID: PMC9673064 DOI: 10.1021/acsami.2c15095] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/24/2022] [Indexed: 05/05/2023]
Abstract
Tumoral uptake of large-size nanoparticles is mediated by the enhanced permeability and retention (EPR) effect, with variable accumulation and heterogenous tumor tissue penetration depending on the tumor phenotype. The performance of nanocarriers via specific targeting has the potential to improve imaging contrast and therapeutic efficacy in vivo with increased deep tissue penetration. To address this hypothesis, we designed and synthesized prostate cancer-targeting starPEG nanocarriers (40 kDa, 15 nm), [89Zr]PEG-(DFB)3(ACUPA)1 and [89Zr]PEG-(DFB)1(ACUPA)3, with one or three prostate-specific membrane antigen (PSMA)-targeting ACUPA ligands. The in vitro PSMA binding affinity and in vivo pharmacokinetics of the targeted nanocarriers were compared with a nontargeted starPEG, [89Zr]PEG-(DFB)4, in PSMA+ PC3-Pip and PSMA- PC3-Flu cells, and xenografts. Increasing the number of ACUPA ligands improved the in vitro binding affinity of PEG-derived polymers to PC3-Pip cells. While both PSMA-targeted nanocarriers significantly improved tissue penetration in PC3-Pip tumors, the multivalent [89Zr]PEG-(DFB)1(ACUPA)3 showed a remarkably higher PC3-Pip/blood ratio and background clearance. In contrast, the nontargeted [89Zr]PEG-(DFB)4 showed low EPR-mediated accumulation with poor tumor tissue penetration. Overall, ACUPA conjugated targeted starPEGs significantly improve tumor retention with deep tumor tissue penetration in low EPR PC3-Pip xenografts. These data suggest that PSMA targeting with multivalent ACUPA ligands may be a generally applicable strategy to increase nanocarrier delivery to prostate cancer. These targeted multivalent nanocarriers with high tumor binding and low healthy tissue retention could be employed in imaging and therapeutic applications.
Collapse
Affiliation(s)
- Niranjan Meher
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, California 94143, United States
| | - Gary W. Ashley
- ProLynx
Inc., San Francisco, California 94158, United States
| | - Anil P. Bidkar
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, California 94143, United States
| | - Suchi Dhrona
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, California 94143, United States
| | - Cyril Fong
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, California 94143, United States
| | | | - Denis R. Beckford Vera
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, California 94143, United States
| | - David M. Wilson
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, California 94143, United States
- Helen
Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94143-0981, United States
| | - Youngho Seo
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, California 94143, United States
- Helen
Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94143-0981, United States
| | - Daniel V. Santi
- ProLynx
Inc., San Francisco, California 94158, United States
| | - Henry F. VanBrocklin
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, California 94143, United States
- Helen
Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94143-0981, United States
| | - Robert R. Flavell
- Department
of Radiology and Biomedical Imaging, University
of California, San Francisco, California 94143, United States
- Helen
Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94143-0981, United States
- Department
of Pharmaceutical Chemistry, University
of California, San Francisco, California 94158-2517, United States
| |
Collapse
|
23
|
Polvoy I, Seo Y, Parker M, Stewart M, Siddiqua K, Manacsa HS, Ravanfar V, Blecha J, Hope TA, Vanbrocklin H, Flavell RR, Barry J, Hansen E, Villanueva-Meyer JE, Engel J, Rosenberg OS, Wilson DM, Ohliger MA. Imaging joint infections using D-methyl- 11C-methionine PET/MRI: initial experience in humans. Eur J Nucl Med Mol Imaging 2022; 49:3761-3771. [PMID: 35732972 PMCID: PMC9399217 DOI: 10.1007/s00259-022-05858-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/30/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE Non-invasive imaging is a key clinical tool for detection and treatment monitoring of infections. Existing clinical imaging techniques are frequently unable to distinguish infection from tumors or sterile inflammation. This challenge is well-illustrated by prosthetic joint infections that often complicate joint replacements. D-methyl-11C-methionine (D-11C-Met) is a new bacteria-specific PET radiotracer, based on an amino acid D-enantiomer, that is rapidly incorporated into the bacterial cell wall. In this manuscript, we describe the biodistribution, radiation dosimetry, and initial human experience using D-11C-Met in patients with suspected prosthetic joint infections. METHODS 614.5 ± 100.2 MBq of D-11C-Met was synthesized using an automated in-loop radiosynthesis method and administered to six healthy volunteers and five patients with suspected prosthetic joint infection, who were studied by PET/MRI. Time-activity curves were used to calculate residence times for each source organ. Absorbed doses to each organ and body effective doses were calculated using OLINDA/EXM 1.1 with both ICRP 60 and ICRP 103 tissue weighting factors. SUVmax and SUVpeak were calculated for volumes of interest (VOIs) in joints with suspected infection, the unaffected contralateral joint, blood pool, and soft tissue background. A two-tissue compartment model was used for kinetic modeling. RESULTS D-11C-Met was well tolerated in all subjects. The tracer showed clearance from both urinary (rapid) and hepatobiliary (slow) pathways as well as low effective doses. Moreover, minimal background was observed in both organs with resident micro-flora and target organs, such as the spine and musculoskeletal system. Additionally, D-11C-Met showed increased focal uptake in areas of suspected infection, demonstrated by a significantly higher SUVmax and SUVpeak calculated from VOIs of joints with suspected infections compared to the contralateral joints, blood pool, and background (P < 0.01). Furthermore, higher distribution volume and binding potential were observed in suspected infections compared to the unaffected joints. CONCLUSION D-11C-Met has a favorable radiation profile, minimal background uptake, and fast urinary extraction. Furthermore, D-11C-Met showed increased uptake in areas of suspected infection, making this a promising approach. Validation in larger clinical trials with a rigorous gold standard is still required.
Collapse
Affiliation(s)
- Ilona Polvoy
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
- Department of Nuclear Engineering, University of California, Berkeley, CA USA
| | - Matthew Parker
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Megan Stewart
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Khadija Siddiqua
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Harrison S. Manacsa
- Department of Orthopedic Surgery, University of California, San Francisco, CA USA
| | - Vahid Ravanfar
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Joseph Blecha
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Thomas A. Hope
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Henry Vanbrocklin
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Jeffrey Barry
- Department of Orthopedic Surgery, University of California, San Francisco, CA USA
| | - Erik Hansen
- Department of Orthopedic Surgery, University of California, San Francisco, CA USA
| | - Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Joanne Engel
- Department of Medicine, University of California, San Francisco, CA USA
- Departments of Medicine and Microbiology and Immunology, University of California, San Francisco, CA USA
| | - Oren S. Rosenberg
- Department of Medicine, University of California, San Francisco, CA USA
- Chan Zuckerberg Biohub, San Francisco, CA USA
| | - David M. Wilson
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave., San Francisco, CA 94143 USA
| | - Michael A. Ohliger
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA USA
- Department of Radiology and Biomedical Imaging, University of California, 1001 Potrero Ave. 1x55D, San Francisco, CA 94110 USA
| |
Collapse
|
24
|
Liu X, Tang S, Mu C, Qin H, Cu D, Lai YC, Riselli AM, Delos Santos R, Carvajal L, Gebrezgiabhier D, Bok RA, Chen HY, Flavell RR, Gordon JW, Vigneron DB, Kurhanewicz J, Larson PE. Development of specialized magnetic resonance acquisition techniques for human hyperpolarized [ 13 C, 15 N 2 ]urea + [1- 13 C]pyruvate simultaneous perfusion and metabolic imaging. Magn Reson Med 2022; 88:1039-1054. [PMID: 35526263 PMCID: PMC9810116 DOI: 10.1002/mrm.29266] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE This study aimed to develop and demonstrate the in vivo feasibility of a 3D stack-of-spiral balanced steady-state free precession(3D-bSSFP) urea sequence, interleaved with a metabolite-specific gradient echo (GRE) sequence for pyruvate and metabolic products, for improving the SNR and spatial resolution of the first hyperpolarized 13 C-MRI human study with injection of co-hyperpolarized [1-13 C]pyruvate and [13 C,15 N2 ]urea. METHODS A metabolite-specific bSSFP urea imaging sequence was designed using a urea-specific excitation pulse, optimized TR, and 3D stack-of-spiral readouts. Simulations and phantom studies were performed to validate the spectral response of the sequence. The image quality of urea data acquired by the 3D-bSSFP sequence and the 2D-GRE sequence was evaluated with 2 identical injections of co-hyperpolarized [1-13 C]pyruvate and [13 C,15 N2 ]urea formula in a rat. Subsequently, the feasibility of the acquisition strategy was validated in a prostate cancer patient. RESULTS Simulations and phantom studies demonstrated that 3D-bSSFP sequence achieved urea-only excitation, while minimally perturbing other metabolites (<1%). An animal study demonstrated that compared to GRE, bSSFP sequence provided an ∼2.5-fold improvement in SNR without perturbing urea or pyruvate kinetics, and bSSFP approach with a shorter spiral readout reduced blurring artifacts caused by J-coupling of [13 C,15 N2 ]urea. The human study demonstrated the in vivo feasibility and data quality of the acquisition strategy. CONCLUSION The 3D-bSSFP urea sequence with a stack-of-spiral acquisition demonstrated significantly increased SNR and image quality for [13 C,15 N2 ]urea in co-hyperpolarized [1-13 C]pyruvate and [13 C,15 N2 ]urea imaging studies. This work lays the foundation for future human studies to achieve high-quality and high-SNR metabolism and perfusion images.
Collapse
Affiliation(s)
- Xiaoxi Liu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Shuyu Tang
- HeartVista Inc., Los Altos, California, USA
| | - Changhua Mu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Hecong Qin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Di Cu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Ying-Chieh Lai
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Andrew M. Riselli
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Romelyn Delos Santos
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Lucas Carvajal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Daniel Gebrezgiabhier
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Robert A. Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Hsin-Yu Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Jeremy W. Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Daniel B. Vigneron
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, San Francisco, California, USA
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, San Francisco, California, USA
| | - Peder E.Z. Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, San Francisco, California, USA
| |
Collapse
|
25
|
Soe MH, Chiang JM, Flavell RR, Khanafshar E, Mendoza L, Kang H, Liu C. Non-Iodine-Avid Disease Is Highly Prevalent in Distant Metastatic Differentiated Thyroid Cancer With Papillary Histology. J Clin Endocrinol Metab 2022; 107:e3206-e3216. [PMID: 35556126 PMCID: PMC9282362 DOI: 10.1210/clinem/dgac305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Patients with radioactive iodine (RAI) refractory metastatic differentiated thyroid cancer (DTC) have poor prognosis. Early identification of RAI refractoriness may improve care. OBJECTIVE This work aimed to characterize DTC patients with distant metastases (DM) at diagnosis who presented with non-iodine-avid disease. METHODS Retrospective analyses of DTC patients with DM at diagnosis who presented between 2012 and 2020 were performed. Iodine uptake in DM was correlated with tumor histology and mutational profile. The difference in uptake between BRAFV600E-like (BVL) and RAS-like (RL) cancers based on insights from The Cancer Genome Atlas was evaluated. RESULTS Among 78 patients, 48.7% had negative uptake in DM on the first posttherapy scan. Negative scans were highly prevalent in papillary thyroid carcinoma (PTC) with papillary architecture, PTC with BRAFV600E mutation, and PTC with both BRAFV600E and TERT promoter mutations (71.1%, 80.9%, and 100%, respectively). BVL and RL tumors exhibited distinct uptake patterns with negative scan prevalence of 76.9% and 14.3% (P = .005). Multivariate logistical regression confirmed high odds of negative uptake in BVL tumors with either BVL mutations or papillary architecture, 19.8 (95% CI, 2.72-144), and low odds of negative uptake in RL tumors with either RL mutations or follicular architecture, 0.048 (95% CI, 0.006-0.344), after adjusting for age, sex, race, RAI preparation method, bone metastases, and RAI dose. Patients with negative scans were significantly older (62.4 vs 47.0 years, P = .03). CONCLUSION Among DTC patients with DM at diagnosis, non-iodine-avid disease is highly prevalent in patients with BVL cancers, particularly with BRAFV600E and TERT promoter mutations, and is associated with an older age. Better strategies are needed to improve RAI treatment response for these patients.
Collapse
Affiliation(s)
| | | | - Robert R Flavell
- Molecular Imaging and Therapeutics Clinical Section, Department of Radiology and Biomedical Imaging, University of California, and Department of Pharmaceutical Chemistry, San Francisco, California 94143, USA
| | - Elham Khanafshar
- Division of Cytopathology, Department of Pathology, University of California, San Francisco, San Francisco, California 94143, USA
| | - Laura Mendoza
- College of Osteopathic Medicine, Touro University, Henderson, Nevada 89014, USA
| | - Hyunseok Kang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California 94143, USA
| | - Chienying Liu
- Correspondence: Chienying Liu, MD, Division of Endocrinology, Department of Medicine, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, USA.
| |
Collapse
|
26
|
Hope TA, Aggarwal RR, Dhawan MS, Kelley RK, Flavell RR, Lawhn Heath C, Li Y, Porten SP, Rugo HS, Yom SS, Ippisch R, Koshkin VS. Imaging of solid tumors using 68Ga-FAP-2286. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3059 Background: Fibroblast Activation Protein (FAP) is a transmembrane protein overexpressed on cancer associated fibroblasts (CAFs), and is abundantly present in many epithelial cancers, suggesting FAP is an attractive imaging and therapeutic target. FAP-2286 is a cyclic peptide that binds to FAP and is currently being evaluated as a radioligand therapy to treat patients (pts) with FAP-positive solid tumors. The role of 68Ga-FAP-2286 as a diagnostic agent is unknown. We present an interim analysis of the ability of 68Ga-FAP-2286 to detect metastatic disease across multiple cancer types. Methods: This is a first in human Phase I/II study of 68Ga-FAP-2286 (NCT04621435) with a planned total enrollment of 65 pts across 3 cohorts: dosimetry cohort (n = 5), cohort with RECIST measurable disease (n = 30) and a cohort at risk for metastases without measurable disease (n = 30). By the cutoff date of February 12, 2022, 27 pts were enrolled (3 in cohort 1, 15 in cohort 2 and 9 in cohort 3). For each pt, the five largest lesions were included for analysis, and for each lesion, the maximum standardized uptake value (SUVmax) of the 68Ga-FAP-2286 and the size (short axis for lymph nodes) were documented. In pts who had an available FDG PET performed within 8 weeks of 68Ga-FAP-2286 PET, uptake on the two scans was compared. Results: Of the 27 enrolled pts, 9 had bladder cancer, 5 sarcoma, 4 head and neck squamous cell cancer (HNSCCA), 3 breast cancer (BC), and 3 castration resistant prostate cancer (CRPC). Most pts (89%, 24/27) had tumors positive for uptake on 68Ga-FAP-2286 PET, including 30 lesions < 1.5 cm, and 17 less than 1.0 cm. 16 pts had a paired FDG PET. In these pts, the average SUVmax on 68Ga-FAP-2286 PET was 244% higher than on FDG PET. Only two pts had higher uptake on FDG PET than on 68Ga-FAP-2286 PET (HNSCCA and DSRCT). The highest relative uptake was seen in 2 pts with BC (both 3.4 times higher on 68Ga-FAP-2286 PET); the average SUVmax in BC was 16.6. The lowest uptake on 68Ga-FAP-2286 PET was CRPC with an average SUVmax of 7.0. Sarcoma had variable uptake with one pt having an SUVmax of 4.5 (Ewing’s), while two pts had an SUVmax over 30 (both undifferentiated pleomorphic). Although sarcoma had high uptake on 68Ga-FAP-2286 PET, it was similar to FDG PET uptake across the 5 pts (ratio to FDG PET = 1.0). Conclusions: 68Ga-FAP-2286 is a promising imaging agent across cancers, although its benefit is not seen equally. BC had the highest absolute uptake and highest relative uptake compared to FDG PET; prostate cancer had the lowest uptake. Further work should be undertaken to define the settings where 68Ga-FAP-2286 PET may inform clinical decision making, and which pts may benefit from FAP-targeted radioligand therapy. Clinical trial information: NCT04621435.
Collapse
Affiliation(s)
- Thomas A. Hope
- University of California, San Francisco, San Francisco, CA
| | | | - Mallika Sachdev Dhawan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | - Robert R. Flavell
- Departments of Radiology and Biomedical Imaging and Pharmaceutical Chemistry, University of California San Francisco, San Francisco, CA
| | | | - Yan Li
- University of California-San Francisco, San Francisco, CA
| | - Sima P. Porten
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Hope S. Rugo
- Department of Medicine, University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Sue S. Yom
- University of California-San Francisco, San Francisco, CA
| | - Robin Ippisch
- University of California-San Francisco, San Francisco, CA
| | | |
Collapse
|
27
|
Beckford-Vera DR, Flavell RR, Seo Y, Martinez-Ortiz E, Aslam M, Thanh C, Fehrman E, Pardons M, Kumar S, Deitchman AN, Ravanfar V, Schulte B, Wu IWK, Pan T, Reeves JD, Nixon CC, Iyer NS, Torres L, Munter SE, Hyunh T, Petropoulos CJ, Hoh R, Franc BL, Gama L, Koup RA, Mascola JR, Chomont N, Deeks SG, VanBrocklin HF, Henrich TJ. First-in-human immunoPET imaging of HIV-1 infection using 89Zr-labeled VRC01 broadly neutralizing antibody. Nat Commun 2022; 13:1219. [PMID: 35264559 PMCID: PMC8907355 DOI: 10.1038/s41467-022-28727-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 02/01/2022] [Indexed: 11/09/2022] Open
Abstract
A major obstacle to achieving long-term antiretroviral (ART) free remission or functional cure of HIV infection is the presence of persistently infected cells that establish a long-lived viral reservoir. HIV largely resides in anatomical regions that are inaccessible to routine sampling, however, and non-invasive methods to understand the longitudinal tissue-wide burden of HIV persistence are urgently needed. Positron emission tomography (PET) imaging is a promising strategy to identify and characterize the tissue-wide burden of HIV. Here, we assess the efficacy of using immunoPET imaging to characterize HIV reservoirs and identify anatomical foci of persistent viral transcriptional activity using a radiolabeled HIV Env-specific broadly neutralizing antibody, 89Zr-VRC01, in HIV-infected individuals with detectable viremia and on suppressive ART compared to uninfected controls (NCT03729752). We also assess the relationship between PET tracer uptake in tissues and timing of ART initiation and direct HIV protein expression in CD4 T cells obtained from lymph node biopsies. We observe significant increases in 89Zr-VRC01 uptake in various tissues (including lymph nodes and gut) in HIV-infected individuals with detectable viremia (N = 5) and on suppressive ART (N = 5) compared to uninfected controls (N = 5). Importantly, PET tracer uptake in inguinal lymph nodes in viremic and ART-suppressed participants significantly and positively correlates with HIV protein expression measured directly in tissue. Our strategy may allow non-invasive longitudinal characterization of residual HIV infection and lays the framework for the development of immunoPET imaging in a variety of other infectious diseases.
Collapse
Affiliation(s)
- Denis R Beckford-Vera
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Enrique Martinez-Ortiz
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Maya Aslam
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Cassandra Thanh
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Emily Fehrman
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Marion Pardons
- Department of Microbiology, Infectiology and Immunology, Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada
| | - Shreya Kumar
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Amelia N Deitchman
- Department of Clinical Pharmacy, University of California, San Francisco, USA
| | - Vahid Ravanfar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Brailee Schulte
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - I-Wei Katherine Wu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Tony Pan
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jacqueline D Reeves
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Christopher C Nixon
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nikita S Iyer
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Leonel Torres
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sadie E Munter
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Tony Hyunh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Christos J Petropoulos
- Monogram Biosciences, Inc., Laboratory Corporation of America, South San Francisco, San Francisco, USA
| | - Rebecca Hoh
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin L Franc
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Lucio Gama
- Vaccine Research Center, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Richard A Koup
- Vaccine Research Center, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - John R Mascola
- Vaccine Research Center, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Nicolas Chomont
- Department of Microbiology, Infectiology and Immunology, Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada
| | - Steven G Deeks
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Henry F VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Timothy J Henrich
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA.
| |
Collapse
|
28
|
Miyahira AK, Zarif JC, Coombs CC, Flavell RR, Russo JW, Zaidi S, Zhao D, Zhao SG, Pienta KJ, Soule HR. Prostate cancer research in the 21st century; report from the 2021 Coffey-Holden prostate cancer academy meeting. Prostate 2022; 82:169-181. [PMID: 34734426 PMCID: PMC8688282 DOI: 10.1002/pros.24262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The 2021 Coffey-Holden Prostate Cancer Academy (CHPCA) Meeting, "Prostate Cancer Research in the 21st Century," was held virtually, from June 24-25, 2021. METHODS The CHPCA Meeting is organized by the Prostate Cancer Foundation as a unique discussion-oriented meeting focusing on critical topics in prostate cancer research envisioned to bridge the next major advances in prostate cancer biology and treatment. The 2021 CHPCA Meeting was virtually attended by 89 investigators and included 31 talks over nine sessions. RESULTS Major topic areas discussed at the meeting included: cancer genomics and sequencing, functional genomic approaches to studying mediators of plasticity, emerging signaling pathways in metastatic castration resistant prostate cancer, Wnt signaling biology and the challenges of targeted therapy, clonal hematopoiesis, neuroendocrine cell plasticity and antitumor immunity, cancer immunotherapy and its synergizers, and imaging the tumor microenvironment and metabolism. DISCUSSION This meeting report summarizes the research presented at the 2021 CHPCA Meeting. We hope that publication of this knowledge will accelerate new understandings and the development of new biomarkers and treatments for prostate cancer.
Collapse
Affiliation(s)
| | - Jelani C. Zarif
- Department of Oncology, Johns Hopkins University School of Medicine and The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Catherine C. Coombs
- Department of Medicine, Division of Hematology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA
| | - Joshua W. Russo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Samir Zaidi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Di Zhao
- Department of Experimental Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Shuang G. Zhao
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Kenneth J. Pienta
- The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD
| | | |
Collapse
|
29
|
Meher N, Seo K, Wang S, Bidkar AP, Fogarty M, Dhrona S, Huang X, Tang R, Blaha C, Evans MJ, Raleigh DR, Jun YW, VanBrocklin HF, Desai TA, Wilson DM, Ozawa T, Flavell RR. Synthesis and Preliminary Biological Assessment of Carborane-Loaded Theranostic Nanoparticles to Target Prostate-Specific Membrane Antigen. ACS Appl Mater Interfaces 2021; 13:54739-54752. [PMID: 34752058 DOI: 10.1021/acsami.1c16383] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Boron neutron capture therapy (BNCT) is an encouraging therapeutic modality for cancer treatment. Prostate-specific membrane antigen (PSMA) is a cell membrane protein that is abundantly overexpressed in prostate cancer and can be targeted with radioligand therapies to stimulate clinical responses in patients. In principle, a spatially targeted neutron beam together with specifically targeted PSMA ligands could enable prostate cancer-targeted BNCT. Thus, we developed and tested PSMA-targeted poly(lactide-co-glycolide)-block-poly(ethylene glycol) (PLGA-b-PEG) nanoparticles (NPs) loaded with carborane and tethered to the radiometal chelator deferoxamine B (DFB) for simultaneous positron emission tomography (PET) imaging and selective delivery of boron to prostate cancer. Monomeric PLGA-b-PEGs were covalently functionalized with either DFB or the PSMA ligand ACUPA. Different nanoparticle formulations were generated by nanoemulsification of the corresponding unmodified and DFB- or ACUPA-modified monomers in varying percent fractions. The nanoparticles were efficiently labeled with 89Zr and were subjected to in vitro and in vivo evaluation. The optimized DFB(25)ACUPA(75) NPs exhibited strong in vitro binding to PSMA in direct binding and competition radioligand binding assays in PSMA(+) PC3-Pip cells. [89Zr]DFB(25) NPs and [89Zr]DFB(25)ACUPA(75) NPs were injected to mice with bilateral PSMA(-) PC3-Flu and PSMA(+) PC3-Pip dual xenografts. The NPs demonstrated twofold superior accumulation in PC3-Pip tumors to that of PC3-Flu tumors with a tumor/blood ratio of 25; however, no substantial effect of the ACUPA ligands was detected. Moreover, fast release of carborane from the NPs was observed, resulting in a low boron delivery to tumors in vivo. In summary, these data demonstrate the synthesis, characterization, and initial biological assessment of PSMA-targeted, carborane-loaded PLGA-b-PEG nanoparticles and establish the foundation for future efforts to enable their best use in vivo.
Collapse
Affiliation(s)
- Niranjan Meher
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94143, United States
| | - Kyounghee Seo
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143, United States
| | - Sinan Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94143, United States
| | - Anil P Bidkar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94143, United States
| | - Miko Fogarty
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143, United States
| | - Suchi Dhrona
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94143, United States
| | - Xiao Huang
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California 94158, United States
| | - Ryan Tang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94143, United States
| | - Charles Blaha
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California 94158, United States
| | - Michael J Evans
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94143, United States
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94143-0981, United States
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California 94158-2517, United States
| | - David R Raleigh
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143, United States
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California 94143, United States
| | - Young-Wook Jun
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94143-0981, United States
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California 94158-2517, United States
- Department of Otolaryngology, University of California, San Francisco, San Francisco, California 94158, United States
| | - Henry F VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94143, United States
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94143-0981, United States
| | - Tejal A Desai
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California 94158, United States
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94143, United States
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94143-0981, United States
| | - Tomoko Ozawa
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143, United States
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94143, United States
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California 94143-0981, United States
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California 94158-2517, United States
| |
Collapse
|
30
|
Polvoy I, Qin H, Flavell RR, Gordon J, Viswanath P, Sriram R, Ohliger MA, Wilson DM. Deuterium Metabolic Imaging-Rediscovery of a Spectroscopic Tool. Metabolites 2021; 11:570. [PMID: 34564385 PMCID: PMC8470013 DOI: 10.3390/metabo11090570] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/18/2021] [Indexed: 01/31/2023] Open
Abstract
The growing demand for metabolism-specific imaging techniques has rekindled interest in Deuterium (2H) Metabolic Imaging (DMI), a robust method based on administration of a substrate (glucose, acetate, fumarate, etc.) labeled with the stable isotope of hydrogen and the observation of its metabolic fate in three-dimensions. This technique allows the investigation of multiple metabolic processes in both healthy and diseased states. Despite its low natural abundance, the short relaxation time of deuterium allows for rapid radiofrequency (RF) pulses without saturation and efficient image acquisition. In this review, we provide a comprehensive picture of the evolution of DMI over the course of recent decades, with a special focus on its potential clinical applications.
Collapse
Affiliation(s)
- Ilona Polvoy
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., San Francisco, CA 94158, USA; (I.P.); (H.Q.); (R.R.F.); (J.G.); (P.V.); (R.S.); (M.A.O.)
| | - Hecong Qin
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., San Francisco, CA 94158, USA; (I.P.); (H.Q.); (R.R.F.); (J.G.); (P.V.); (R.S.); (M.A.O.)
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., San Francisco, CA 94158, USA; (I.P.); (H.Q.); (R.R.F.); (J.G.); (P.V.); (R.S.); (M.A.O.)
| | - Jeremy Gordon
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., San Francisco, CA 94158, USA; (I.P.); (H.Q.); (R.R.F.); (J.G.); (P.V.); (R.S.); (M.A.O.)
| | - Pavithra Viswanath
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., San Francisco, CA 94158, USA; (I.P.); (H.Q.); (R.R.F.); (J.G.); (P.V.); (R.S.); (M.A.O.)
| | - Renuka Sriram
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., San Francisco, CA 94158, USA; (I.P.); (H.Q.); (R.R.F.); (J.G.); (P.V.); (R.S.); (M.A.O.)
| | - Michael A. Ohliger
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., San Francisco, CA 94158, USA; (I.P.); (H.Q.); (R.R.F.); (J.G.); (P.V.); (R.S.); (M.A.O.)
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - David M. Wilson
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., San Francisco, CA 94158, USA; (I.P.); (H.Q.); (R.R.F.); (J.G.); (P.V.); (R.S.); (M.A.O.)
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, San Francisco, CA 94143, USA
| |
Collapse
|
31
|
Heath CL, Esserman LJ, Flavell RR, Melisko ME. Authors' Reply: To the Letter to the Editor by Groheux et al. J Natl Compr Canc Netw 2021; 19:xxx-xxxii. [PMID: 34416710 DOI: 10.6004/jnccn.2021.7080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
32
|
|
33
|
Huang Y, Zhao N, Wang YH, Truillet C, Wei J, Parker MFL, Blecha JE, Drake CR, VanBrocklin HF, Garrido-Ruiz D, Jacobson MP, Aggarwal R, Behr SC, Flavell RR, Wilson DM, Seo Y, Evans MJ. The Synthesis and Structural Requirements for Measuring Glucocorticoid Receptor Expression In Vivo with (±)- 11C-YJH08 PET. J Nucl Med 2021; 62:723-731. [PMID: 32887758 DOI: 10.2967/jnumed.120.249755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022] Open
Abstract
Noninvasive methods to study glucocorticoid receptor (GR) signaling are urgently needed to elaborate the complexity of GR signaling in normal physiology and human disorders, as well as to identify selective GR modulators to treat diseases. Here, we report evidence supporting translational studies with (±)-11C-5-(4-fluorobenzyl)-10-methoxy-2,2,4-trimethyl-2,5-dihydro-1H-chromeno[3,4-f]-quinoline ((±)-11C-YJH08), a radioligand for PET that engages the ligand binding domain on GR. Methods: (±)-11C-YJH08 was synthesized by reacting the phenol precursor with 11C-methyl iodide. The biodistribution was studied in vivo. Specific binding was tested in vivo with adrenalectomy and ligand competition. A library of analogs was synthesized and studied in vitro and in vivo to understand the (±)-11C-YJH08 structure-activity relationship. Rodent dosimetry studies were performed to estimate the human-equivalent doses of (±)-11C-YJH08. Results: (±)-11C-YJH08 was synthesized by reaction of the phenolic precursor with 11C-methyl iodide, giving a radiochemical yield of 51.7% ± 4.7% (decay-corrected to starting 11C-methyl iodide). Specific binding was observed in many tissues, including the brain. An analysis of the (±)-YJH08 structure-activity relationship showed that (R)- and (S)-enantiomers are equally avid for GR by occupying discrete binding modes. A focused chemical screen revealed that the aryl fluoride motif on YJH08 is essential for high-affinity GR binding in vitro, high tissue uptake in vivo, and efficient passage across the blood-brain barrier. Lastly, we performed dosimetry studies on rodents, from which we estimated the human-equivalent doses of (±)-11C-YJH08 to be commensurate with the widely used 11C and 18F tracers. Conclusion: These studies reveal the molecular determinants of a high-affinity and high-selectivity ligand-receptor interaction and support the use of (±)-11C-YJH08 PET to make the first measurements of GR expression in human subjects.
Collapse
Affiliation(s)
- Yangjie Huang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Ning Zhao
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Yung-Hua Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Charles Truillet
- Imagerie Moleculaire in Vivo, INSERM, CEA, Université Paris Sud, CNRS, Universite Paris Saclay, CEA-Service Hospitalier Frederic Joliot, Orsay, France
| | - Junnian Wei
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Matthew F L Parker
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Joseph E Blecha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | | | - Henry F VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Diego Garrido-Ruiz
- Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, California; and
| | - Matthew P Jacobson
- Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, California; and
| | - Rahul Aggarwal
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.,Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Michael J Evans
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California .,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.,Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, California; and
| |
Collapse
|
34
|
Batsios G, Taglang C, Cao P, Gillespie AM, Najac C, Subramani E, Wilson DM, Flavell RR, Larson PEZ, Ronen SM, Viswanath P. Imaging 6-Phosphogluconolactonase Activity in Brain Tumors In Vivo Using Hyperpolarized δ-[1- 13C]gluconolactone. Front Oncol 2021; 11:589570. [PMID: 33937017 PMCID: PMC8082394 DOI: 10.3389/fonc.2021.589570] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The pentose phosphate pathway (PPP) is essential for NADPH generation and redox homeostasis in cancer, including glioblastomas. However, the precise contribution to redox and tumor proliferation of the second PPP enzyme 6-phosphogluconolactonase (PGLS), which converts 6-phospho-δ-gluconolactone to 6-phosphogluconate (6PG), remains unclear. Furthermore, non-invasive methods of assessing PGLS activity are lacking. The goal of this study was to examine the role of PGLS in glioblastomas and assess the utility of probing PGLS activity using hyperpolarized δ-[1-13C]gluconolactone for non-invasive imaging. METHODS To interrogate the function of PGLS in redox, PGLS expression was silenced in U87, U251 and GS2 glioblastoma cells by RNA interference and levels of NADPH and reduced glutathione (GSH) measured. Clonogenicity assays were used to assess the effect of PGLS silencing on glioblastoma proliferation. Hyperpolarized δ-[1-13C]gluconolactone metabolism to 6PG was assessed in live cells treated with the chemotherapeutic agent temozolomide (TMZ) or with vehicle control. 13C 2D echo-planar spectroscopic imaging (EPSI) studies of hyperpolarized δ-[1-13C]gluconolactone metabolism were performed on rats bearing orthotopic glioblastoma tumors or tumor-free controls on a 3T spectrometer. Longitudinal 2D EPSI studies of hyperpolarized δ-[1-13C]gluconolactone metabolism and T2-weighted magnetic resonance imaging (MRI) were performed in rats bearing orthotopic U251 tumors following treatment with TMZ to examine the ability of hyperpolarized δ-[1-13C]gluconolactone to report on treatment response. RESULTS PGLS knockdown downregulated NADPH and GSH, elevated oxidative stress and inhibited clonogenicity in all models. Conversely, PGLS expression and activity and steady-state NADPH and GSH were higher in tumor tissues from rats bearing orthotopic glioblastoma xenografts relative to contralateral brain and tumor-free brain. Importantly, [1-13C]6PG production from hyperpolarized δ-[1-13C]gluconolactone was observed in live glioblastoma cells and was significantly reduced by treatment with TMZ. Furthermore, hyperpolarized δ-[1-13C]gluconolactone metabolism to [1-13C]6PG could differentiate tumor from contralateral normal brain in vivo. Notably, TMZ significantly reduced 6PG production from hyperpolarized δ-[1-13C]gluconolactone at an early timepoint prior to volumetric alterations as assessed by anatomical imaging. CONCLUSIONS Collectively, we have, for the first time, identified a role for PGLS activity in glioblastoma proliferation and validated the utility of probing PGLS activity using hyperpolarized δ-[1-13C]gluconolactone for non-invasive in vivo imaging of glioblastomas and their response to therapy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sabrina M. Ronen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States
| | - Pavithra Viswanath
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States
| |
Collapse
|
35
|
Abstract
ABSTRACT We present a case of metastatic gastrointestinal stromal tumor incidentally detected on 18F-fluciclovine PET/CT. A 68-year-old man with history of intermediate-risk prostate cancer (Gleason score 4 + 3 = 7; pT2cN0M0) previously treated with retropubic radical prostatectomy, adjuvant whole pelvis radiation, and androgen deprivation therapy (leuprolide) presented with slowly rising serum prostate-specific antigen over 3 years, concerning for recurrent prostate cancer. To identify potential sites of recurrent disease, an 18F-fluciclovine PET/CT was obtained. Multiple tracer-avid mesenteric masses and enlarged lymph nodes were found throughout the abdomen and pelvis, later biopsy-proven to reflect metastatic gastrointestinal stromal tumor.
Collapse
Affiliation(s)
| | | | - Antonio C Westphalen
- Division of Abdominal Imaging, Department of Radiology, University of Washington, Seattle, WA
| | | |
Collapse
|
36
|
Parker MFL, Blecha J, Rosenberg O, Ohliger M, Flavell RR, Wilson DM. Cyclic 68Ga-Labeled Peptides for Specific Detection of Human Angiotensin-Converting Enzyme 2. J Nucl Med 2021; 62:1631-1637. [PMID: 33637588 PMCID: PMC8612341 DOI: 10.2967/jnumed.120.261768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/11/2021] [Indexed: 01/30/2023] Open
Abstract
In this study, we developed angiotensin-converting enzyme 2 (ACE2)–specific, peptide-derived 68Ga-labeled radiotracers, motivated by the hypotheses that ACE2 is an important determinant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) susceptibility and that modulation of ACE2 in coronavirus disease 2019 (COVID-19) drives severe organ injury. Methods: A series of NOTA-conjugated peptides derived from the known ACE2 inhibitor DX600 were synthesized, with variable linker identity. Since DX600 bears 2 cystine residues, both linear and cyclic peptides were studied. An ACE2 inhibition assay was used to identify lead compounds, which were labeled with 68Ga to generate peptide radiotracers (68Ga-NOTA-PEP). The aminocaproate-derived radiotracer 68Ga-NOTA-PEP4 was subsequently studied in a humanized ACE2 (hACE2) transgenic model. Results: Cyclic DX-600–derived peptides had markedly lower half-maximal inhibitory concentrations than their linear counterparts. The 3 cyclic peptides with triglycine, aminocaproate, and polyethylene glycol linkers had calculated half-maximal inhibitory concentrations similar to or lower than the parent DX600 molecule. Peptides were readily labeled with 68Ga, and the biodistribution of 68Ga-NOTA-PEP4 was determined in an hACE2 transgenic murine cohort. Pharmacologic concentrations of coadministered NOTA-PEP (blocking) showed a significant reduction of 68Ga-NOTA-PEP4 signals in the heart, liver, lungs, and small intestine. Ex vivo hACE2 activity in these organs was confirmed as a correlate to in vivo results. Conclusion: NOTA-conjugated cyclic peptides derived from the known ACE2 inhibitor DX600 retain their activity when N-conjugated for 68Ga chelation. In vivo studies in a transgenic hACE2 murine model using the lead tracer, 68Ga-NOTA-PEP4, showed specific binding in the heart, liver, lungs and intestine—organs known to be affected in SARS-CoV-2 infection. These results suggest that 68Ga-NOTA-PEP4 could be used to detect organ-specific suppression of ACE2 in SARS-CoV-2–infected murine models and COVID-19 patients.
Collapse
Affiliation(s)
- Matthew F L Parker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Joseph Blecha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Oren Rosenberg
- Department of Medicine, University of California, San Francisco, San Francisco, California; and
| | - Michael Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.,Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California;
| |
Collapse
|
37
|
Hathi DK, Jones EF, Li W, Newitt DC, Guo R, Seo Y, Flavell RR, Joe BN, Heditsian D, Brain S, Esserman LJ, Hylton NM. Abstract PS13-50: Relationship of dedicated breast PET and MRI features in breast cancer patients receiving neoadjuvant chemotherapy. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps13-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Dedicated breast positron emission tomography (dbPET) is an emerging imaging technique with the spatial resolution needed to assess functionality and intra-tumor heterogeneity in primary breast lesions. Breast cancer patients may benefit from dbPET imaging combined with molecularly targeted agents to non-invasively assess and predict response to targeted therapy in the neoadjuvant treatment setting. We have previously observed that [18F]-fluorodeoxyglucose (FDG) PET provides tumor metabolic information complementary to the angiogenic properties reflected by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for characterizing triple-negative breast cancers (TNBC) (1). In this study, we examined the relationship between FDG-dbPET and MRI features in a cohort of breast cancer patients receiving neoadjuvant chemotherapy (NAC).
Methods: With institutional review board approval, patients with biopsy-proven locally-advanced breast cancer were imaged with breast MRI and dbPET before (T0) and after three weeks (T1) of NAC. Standard DCE-MRI was obtained using a dedicated breast coil. Patients also underwent dbPET with 5 mCi of FDG at 45 minutes post-injection. Functional tumor volumes (FTV) were calculated from DCE-MRI by summing all voxels with an early percent enhancement (PE) exceeding 70% within a manually defined volume of interest (VOI). Maximum and mean PE (PEMax, PEMean) values within the VOI were also computed for analyses. Tumors were segmented in dbPET images using semi-automated threshold-driven methods. Body weight-corrected maximum and mean standardized uptake values (SUVMax, SUVMean), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) were calculated for FDG-dbPET. Percent change relative to T0 (Δ = 100*(T1 - T0)/T0) was calculated for each feature. Spearman’s correlation coefficient was used to evaluate the relationship between MRI and dbPET features.
Results: Of the 16 patients enrolled in this study, 13 patients (N = 15 unique tumors) with MRI and dbPET at T0 and T1 were included in the analysis. 46% (6/13) of the patients had TNBC. Our initial findings indicated that ΔPEMax and ΔSUVMax had the highest correlation (ρ = 0.59, p = 0.022). FTV and TLG at T1 were also correlated (ρ = 0.56, p = 0.032). Among all imaging features, ΔMTV showed the largest post-treatment difference between TNBC (-54.5%) and non-TNBC (-6.06%) groups. Among MRI features, ΔFTV exhibited the largest difference between the groups: -70.4% in TNBC and -43.1% in non-TNBC. ΔSUVMax and ΔTLG were additional dbPET features with large differences between TNBC and non-TNBC patients (Table 1).
Conclusion: This exploratory study suggests that post-treatment ΔSUVMax and TLG provide complementary metabolic information to angiogenic properties (ΔPEMax and FTV, respectively) reflected by MRI. Other dbPET features may provide independent information adjunct to MRI for describing primary breast tumors. Patients with TNBC exhibited larger reductions in FDG uptake values and metabolic volume than non-TNBC patients. These observed reductions may improve early treatment response in patients with TNBC, enabling more precise treatment guidance. Further studies in larger cohorts are needed to validate these initial observations.
1. Bolouri MS, et al. Triple-Negative and Non-Triple-Negative Invasive Breast Cancer: Association between MR and Fluorine 18 Fluorodeoxyglucose PET Imaging. Radiology 2013;269:354-61
Comparison of ΔMRI and ΔFDG-dbPET in TNBC vs non-TNBC patientsAll Tumors (N = 15 tumors) Median(IQR)TNBC (N = 6 tumors) Median(IQR)non-TNBC (N = 9 tumors) Median(IQR)DCE-MRIΔFTV (%)-66.1 (-77.6, -19.1)-70.4 (-79.0, -62.1)-43.1 (-72.5, -2.95)ΔPEMax (%)-9.91 (-31.5, 19.5)-10.3 (-26.3, 24.2)-9.91 (-31.8, 8.42)ΔPEMean (%)-10.7 (-22.4, 2.77)-9.57 (-12.8, 0.29)-17.0 (-26.0, 2.33)FDG-dbPETΔSUVMax (%)-31.6 (-53.9, -20.6)-47.3 (-55.7, -41.1)-23.1 (-31.6, 1.13)ΔSUVMean (%)-34.1 (-65.4, -14.2)-48.5 (-74.6, -9.74)-34.1 (-44.5, -14.8)ΔMTV (%)-6.18 (-57.0, 38.5)-54.5 (-75.4, 15.3)-6.06 (-47.2, 38.9)ΔTLG (%)-64.9 (-75.2, 23.3)-75.2 (-84.0, -60.0)-47.9 (-65.2, 31.1)
Citation Format: Deep K Hathi, Ella F Jones, Wen Li, David C Newitt, Ruby Guo, Youngho Seo, Robert R Flavell, Bonnie N Joe, Diane Heditsian, Susie Brain, ISPY-2 Imaging Working Group, ISPY-2 Consortium, Laura J Esserman, Nola M Hylton. Relationship of dedicated breast PET and MRI features in breast cancer patients receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS13-50.
Collapse
Affiliation(s)
- Deep K Hathi
- University of California, San Francisco, San Francisco, CA
| | - Ella F Jones
- University of California, San Francisco, San Francisco, CA
| | - Wen Li
- University of California, San Francisco, San Francisco, CA
| | - David C Newitt
- University of California, San Francisco, San Francisco, CA
| | - Ruby Guo
- University of California, San Francisco, San Francisco, CA
| | - Youngho Seo
- University of California, San Francisco, San Francisco, CA
| | | | - Bonnie N Joe
- University of California, San Francisco, San Francisco, CA
| | | | - Susie Brain
- University of California, San Francisco, San Francisco, CA
| | | | - Nola M Hylton
- University of California, San Francisco, San Francisco, CA
| | | |
Collapse
|
38
|
Seo Y, Khalighi MM, Wangerin KA, Deller TW, Wang YH, Jivan S, Kohi MP, Aggarwal R, Flavell RR, Behr SC, Evans MJ. Quantitative and Qualitative Improvement of Low-Count [ 68Ga]Citrate and [ 90Y]Microspheres PET Image Reconstructions Using Block Sequential Regularized Expectation Maximization Algorithm. Mol Imaging Biol 2021; 22:208-216. [PMID: 30993558 DOI: 10.1007/s11307-019-01347-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE There are several important positron emission tomography (PET) imaging scenarios that require imaging with very low photon statistics, for which both quantitative accuracy and visual quality should not be neglected. For example, PET imaging with the low photon statistics is closely related to active efforts to significantly reduce radiation exposure from radiopharmaceuticals. We investigated two examples of low-count PET imaging: (a) imaging [90Y]microsphere radioembolization that suffers the very small positron emission fraction of Y-90's decay processes, and (b) cancer imaging with [68Ga]citrate with uptake time of 3-4 half-lives, necessary for visualizing tumors. In particular, we investigated a type of penalized likelihood reconstruction algorithm, block sequential regularized expectation maximization (BSREM), for improving both image quality and quantitative accuracy of these low-count PET imaging cases. PROCEDURES The NEMA/IEC Body phantom filled with aqueous solution of Y-90 or Ga-68 was scanned to mimic the low-count scenarios of corresponding patient data acquisitions on a time-of-flight (TOF) PET/magnetic resonance imaging system. Contrast recovery, background variation, and signal-to-noise ratio were evaluated in different sets of count densities using both conventional TOF ordered subset expectation (TOF-OSEM) and TOF-BSREM algorithms. The regularization parameter, beta, in BSREM that controls the tradeoff between image noise and resolution was evaluated to find a value for improved confidence in image interpretation. Visual quality assessment of the images obtained from patients administered with [68Ga]citrate (n = 6) was performed. We also made preliminary visual image quality assessment for one patient with [90Y]microspheres. In Y-90 imaging, the effect of 511-keV energy window selection for minimizing the number of random events was also evaluated. RESULTS Quantitatively, phantom images reconstructed with TOF-BSREM showed improved contrast recovery, background variation, and signal-to-noise ratio values over images reconstructed with TOF-OSEM. Both phantom and patient studies of delayed imaging of [68Ga]citrate show that TOF-BSREM with beta = 500 gives the best tradeoff between image noise and image resolution based on visual assessment by the readers. The NEMA-IQ phantom study with [90Y]microspheres shows that the narrow energy window (460-562 keV) recovers activity concentrations in small spheres better than the regular energy window (425-650 keV) with the beta value of 2000 using the TOF-BSREM algorithm. For the images obtained from patients with [68Ga]citrate using TOF-BSREM with beta = 500, the visual analogue scale (VAS) was improved by 17 % and the Likert score was increased by 1 point on average, both in comparison to corresponding scores for images reconstructed using TOF-OSEM. CONCLUSION Our investigation shows that the TOF-BSREM algorithm improves the image quality and quantitative accuracy in low-count PET imaging scenarios. However, the beta value in this algorithm needed to be adjusted for each radiopharmaceutical and counting statistics at the time of scans.
Collapse
Affiliation(s)
- Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA. .,Department of Radiation Oncology, University of California, San Francisco, CA, USA. .,UC Berkeley - UCSF Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, California, CA, USA. .,Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
| | - Mohammad Mehdi Khalighi
- GE Healthcare, Waukesha, WI, USA.,Department of Radiology, Stanford University, Stanford, CA, USA
| | | | | | | | - Salma Jivan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA
| | - Rahul Aggarwal
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA.,Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, USA
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA
| | - Michael J Evans
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, 94143-0946, USA.,Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, USA
| |
Collapse
|
39
|
Wang S, Li J, Hua J, Su Y, Beckford-Vera DR, Zhao W, Jayaraman M, Huynh TL, Zhao N, Wang YH, Huang Y, Qin F, Shen S, Gioeli D, Dreicer R, Sriram R, Egusa EA, Chou J, Feng FY, Aggarwal R, Evans MJ, Seo Y, Liu B, Flavell RR, He J. Molecular Imaging of Prostate Cancer Targeting CD46 Using ImmunoPET. Clin Cancer Res 2020; 27:1305-1315. [PMID: 33293372 DOI: 10.1158/1078-0432.ccr-20-3310] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/19/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE We recently identified CD46 as a novel therapeutic target in prostate cancer. In this study, we developed a CD46-targeted PET radiopharmaceutical, [89Zr]DFO-YS5, and evaluated its performance for immunoPET imaging in murine prostate cancer models. EXPERIMENTAL DESIGN [89Zr]DFO-YS5 was prepared and its in vitro binding affinity for CD46 was measured. ImmunoPET imaging was conducted in male athymic nu/nu mice bearing DU145 [AR-, CD46+, prostate-specific membrane antigen-negative (PSMA-)] or 22Rv1 (AR+, CD46+, PSMA+) tumors, and in NOD/SCID gamma mice bearing patient-derived adenocarcinoma xenograft, LTL-331, and neuroendocrine prostate cancers, LTL-331R and LTL-545. RESULTS [89Zr]DFO-YS5 binds specifically to the CD46-positive human prostate cancer DU145 and 22Rv1 xenografts. In biodistribution studies, the tumor uptake of [89Zr]DFO-YS5 was 13.3 ± 3.9 and 11.2 ± 2.5 %ID/g, respectively, in DU145 and 22Rv1 xenografts, 4 days postinjection. Notably, [89Zr]DFO-YS5 demonstrated specific uptake in the PSMA- and AR-negative DU145 model. [89Zr]DFO-YS5 also showed uptake in the patient-derived LTL-331 and -331R models, with particularly high uptake in the LTL-545 neuroendocrine prostate cancer tumors (18.8 ± 5.3, 12.5 ± 1.8, and 32 ± 5.3 %ID/g in LTL-331, LTL-331R, and LTL-545, respectively, at 4 days postinjection). CONCLUSIONS [89Zr]DFO-YS5 is an excellent PET imaging agent across a panel of prostate cancer models, including in both adenocarcinoma and neuroendocrine prostate cancer, both cell line- and patient-derived xenografts, and both PSMA-positive and -negative tumors. It demonstrates potential for clinical translation as an imaging agent, theranostic platform, and companion biomarker in prostate cancer.
Collapse
Affiliation(s)
- Sinan Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Jun Li
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia.,Department of Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai, P.R. China
| | - Jun Hua
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia.,Department of Nuclear Medicine, Chongqing University Cancer Hospital, Chongqing, P.R. China
| | - Yang Su
- Department of Anesthesia, University of California, San Francisco, San Francisco, California
| | - Denis R Beckford-Vera
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Walter Zhao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Mayuri Jayaraman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Tony L Huynh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Ning Zhao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Yung-Hua Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Yangjie Huang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Fujun Qin
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Sui Shen
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel Gioeli
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia, Charlottesville, Virginia.,University of Virginia Cancer Center, Charlottesville, Virginia
| | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, Virginia.,Departments of Medicine and Urology, University of Virginia, Charlottesville, Virginia
| | - Renuka Sriram
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Emily A Egusa
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Jonathan Chou
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Felix Y Feng
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Rahul Aggarwal
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Division of Hematology and Oncology, University of California, San Francisco, San Francisco, California
| | - Michael J Evans
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Bin Liu
- Department of Anesthesia, University of California, San Francisco, San Francisco, California. .,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California. .,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California
| | - Jiang He
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia. .,University of Virginia Cancer Center, Charlottesville, Virginia
| |
Collapse
|
40
|
Waller J, Lawhn-Heath CA, Edmonds C, Wendorf C, Holmes B, White M, Pampaloni MH, Liu C, Flavell RR. Management of Challenging Radioiodine Treatment Protocols: A Case Series and Review of the Literature. J Nucl Med Technol 2020; 49:180-185. [PMID: 33219159 DOI: 10.2967/jnmt.120.255307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022] Open
Abstract
Radioactive iodine (RAI) therapy with 131I is the standard of care for treatment in many patients with differentiated thyroid cancer. Because 131I is typically administered as a pill, and much of its radioactivity is excreted via the urine, there can be challenges in patients who cannot swallow pills, absorb iodine via the gastrointestinal tract, or eliminate RAI via the urine (i.e., dialysis patients and patients with renal failure). In this article, we present 3 cases in which the standard 131I treatment protocol for thyroid cancer could not be used because of these challenges, and we discuss the strategies used to overcome them. Provider collaboration and treatment customization are critical in overcoming patient-specific challenges.
Collapse
Affiliation(s)
- Joseph Waller
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.,Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Courtney A Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Cathleen Edmonds
- Radiation Safety and UCOP, University of California San Francisco, San Francisco, California; and
| | - Chloee Wendorf
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Brandon Holmes
- Radiation Safety and UCOP, University of California San Francisco, San Francisco, California; and
| | - Michael White
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Miguel Hernandez Pampaloni
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Chienying Liu
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California;
| |
Collapse
|
41
|
Hyland CJ, Varghese F, Yau C, Beckwith H, Khoury K, Varnado W, Hirst GL, Flavell RR, Chien AJ, Yee D, Isaacs CJ, Forero-Torres A, Esserman LJ, Melisko ME. Use of 18F-FDG PET/CT as an Initial Staging Procedure for Stage II-III Breast Cancer: A Multicenter Value Analysis. J Natl Compr Canc Netw 2020; 18:1510-1517. [PMID: 33152704 DOI: 10.6004/jnccn.2020.7598] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Metastatic staging imaging is not recommended for asymptomatic patients with stage I-II breast cancer. Greater distant metastatic disease risk may warrant baseline imaging in patients with stage II-III with high-risk biologic subtypes. NCCN Guidelines recommend considering CT of the chest, abdomen, and pelvis (CT CAP) and bone scan in appropriate patients. CT CAP and bone scan are considered standard of care (SoC), although PET/CT is a patient-centered alternative. METHODS Data were available for 799 high-risk patients with clinical stage II-III disease who initiated screening for the I-SPY2 trial at 4 institutions. A total of 564 complete records were reviewed to compare PET/CT versus SoC. Costs were determined from the payer perspective using the national 2018 Medicare Physician Fee Schedule and representative reimbursements to the University of California, San Francisco (UCSF). Incremental cost-effectiveness ratio (ICER) measured cost of using PET/CT per percent of patients who avoided a false-positive (FP). RESULTS The de novo metastatic disease rate was 4.6%. Imaging varied across the 4 institutions (P<.0001). The FP rate was higher using SoC versus PET/CT (22.1% vs 11.1%; P=.0009). Mean time between incidental finding on baseline imaging to FP determination was 10.8 days. Mean time from diagnosis to chemotherapy initiation was 44.3 days with SoC versus 37.5 days with PET/CT (P=.0001). Mean cost per patient was $1,132 (SoC) versus $1,477 (PET/CT) using the Medicare Physician Fee Schedule, with an ICER of $31. Using representative reimbursements to UCSF, mean cost per patient was $1,236 (SoC) versus $1,073 (PET/CT) for Medicare, and $3,083 (SoC) versus $1,656 (PET/CT) for a private payer, with ICERs of -$15 and -$130, respectively. CONCLUSIONS Considerable variation exists in metastatic staging practices. PET/CT reduced FP risk by half and decreased workup of incidental findings, allowing for earlier treatment start. PET/CT may be cost-effective, and at one institution was shown to be cost-saving. Better alignment is needed between hospital pricing strategies and payer coverage policies to deliver high-value care.
Collapse
Affiliation(s)
- Colby J Hyland
- 1University of California, San Francisco, San Francisco, California
| | - Flora Varghese
- 1University of California, San Francisco, San Francisco, California
| | - Christina Yau
- 1University of California, San Francisco, San Francisco, California
| | | | | | - William Varnado
- 4University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Gillian L Hirst
- 1University of California, San Francisco, San Francisco, California
| | - Robert R Flavell
- 5Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - A Jo Chien
- 1University of California, San Francisco, San Francisco, California
| | - Douglas Yee
- 2University of Minnesota, Minneapolis, Minnesota
| | | | | | - Laura J Esserman
- 1University of California, San Francisco, San Francisco, California
| | | |
Collapse
|
42
|
Lawhn-Heath C, Yom SS, Liu C, Villanueva-Meyer JE, Aslam M, Smith R, Narwal M, Juarez R, Behr SC, Pampaloni MH, Chan JW, Glastonbury CM, Hope TA, Flavell RR. Gallium-68 prostate-specific membrane antigen ([ 68Ga]Ga-PSMA-11) PET for imaging of thyroid cancer: a feasibility study. EJNMMI Res 2020; 10:128. [PMID: 33090273 PMCID: PMC7581659 DOI: 10.1186/s13550-020-00720-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background Prostate-specific membrane antigen (PSMA) is expressed in the microvasculature of thyroid cancer. This suggests the potential use of PSMA as a diagnostic agent in patients with aggressive forms of thyroid cancer. The purpose of the current study was to determine the feasibility and utility of [68Ga]Ga-PSMA-11 PET/MRI in thyroid cancer patients. Methods Eligible patients for this prospective pilot study were adults with a history of pathology-proven thyroid cancer who had abnormal radiotracer uptake on an 2-[18F]FDG PET and/or 131I scintigraphy performed in the 12 months prior to study enrollment. Patients underwent a [68Ga]Ga-PSMA-11 PET/MRI, and comparison was made to the prior qualifying 2-[18F]FDG PET CT/MRI for lesion location and relative intensity. Results Twelve patients underwent [68Ga]Ga-PSMA-11 PET/MRI, one of which was excluded from analysis due to debulking surgery prior to the PSMA PET. Of the remaining patients, 7/11 had differentiated disease (3 papillary, 2 follicular, 2 Hurthle cell) and 4/11 had dedifferentiated disease (2 poorly differentiated papillary, 2 anaplastic). Out of 43 lesions, 41 were visually 2-[18F]FDG positive (uptake greater than background, detection rate 95.3%) and 28 were PSMA positive (uptake greater than background, detection rate 65.1%). Uptake was heterogeneous between patients, and in some cases within patients. 3/11 patients (1 poorly differentiated papillary, 2 follicular) had PSMA uptake which was greater than FDG uptake. For the remaining 8 patients, 2-[18F]FDG uptake was greater than PSMA. Using one eligibility guideline in the prostate cancer literature for PSMA radioligand therapy (RLT), 8/11 could be considered eligible for possible future PSMA RLT. This was not predictable based on thyroid cancer subtype. Conclusions [68Ga]Ga-PSMA-11 PET demonstrated lower detection rate when compared to 2-[18F]FDG PET for thyroid cancer lesion visualization. Thyroid cancer subtype alone may not be sufficient to predict PSMA uptake, and radiotracer uptake may vary between patients and even within patients.
Collapse
Affiliation(s)
- Courtney Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, Lobby 6, Box 0946, San Francisco, CA, 94143, USA
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Chienying Liu
- Department of Medicine, Division of Endocrinology, University of California San Francisco, San Francisco, CA, USA
| | - Javier E Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, Lobby 6, Box 0946, San Francisco, CA, 94143, USA
| | - Maya Aslam
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, Lobby 6, Box 0946, San Francisco, CA, 94143, USA
| | - Raven Smith
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, Lobby 6, Box 0946, San Francisco, CA, 94143, USA
| | - Manpreet Narwal
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Roxanna Juarez
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, Lobby 6, Box 0946, San Francisco, CA, 94143, USA
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, Lobby 6, Box 0946, San Francisco, CA, 94143, USA
| | - Miguel Hernandez Pampaloni
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, Lobby 6, Box 0946, San Francisco, CA, 94143, USA
| | - Jason W Chan
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Christine M Glastonbury
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, Lobby 6, Box 0946, San Francisco, CA, 94143, USA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, Lobby 6, Box 0946, San Francisco, CA, 94143, USA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, Lobby 6, Box 0946, San Francisco, CA, 94143, USA. .,Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, CA, USA.
| |
Collapse
|
43
|
Flavell RR, Evans MJ, Villanueva-Meyer JE, Yom SS. Understanding Response to Immunotherapy Using Standard of Care and Experimental Imaging Approaches. Int J Radiat Oncol Biol Phys 2020; 108:242-257. [PMID: 32585333 DOI: 10.1016/j.ijrobp.2020.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/14/2020] [Accepted: 06/17/2020] [Indexed: 12/31/2022]
Abstract
Immunotherapy has emerged as a standard of care in the treatment of a wide variety of malignancies, and it may be used in combination with other treatments including surgery, radiation, and chemotherapy. However, a patient's imaging response to immunotherapy can be confounded by a variety of factors, including the appearance of pseudoprogression or the development of immune-related adverse events. In these situations, the immune response itself can mimic disease progression, potentially causing confusion in assessment and determination of further treatment. To address these challenges, a variety of approaches have been proposed to improve response assessment. First, revised definitions of response criteria, accounting for the appearance of pseudoprogression, can improve specificity of assessment. Second, advanced image processing including radiomics and machine learning analysis can be used to further analyze standard of care imaging data. In addition, new molecular imaging techniques can be used to directly interrogate immune cell activity or study aspects of the tumor microenvironment. These approaches have promise for improving the understanding of the response to immunotherapy and improving patient care.
Collapse
Affiliation(s)
- Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California; Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California.
| | - Michael J Evans
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California; Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, California
| | - Javier E Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| |
Collapse
|
44
|
Murthy V, Smith RL, Tao DH, Lawhn-Heath CA, Korenchan DE, Larson PEZ, Flavell RR, Hope TA. 68Ga-PSMA-11 PET/MRI: determining ideal acquisition times to reduce noise and increase image quality. EJNMMI Phys 2020; 7:54. [PMID: 32844310 PMCID: PMC7447708 DOI: 10.1186/s40658-020-00322-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background In this study, we investigate the impact of increased PET acquisition time per bed position on lesion detectability, standard uptake value, and image noise in 68Ga-PSMA-11 PET/MRI scans. Methods Scans of twenty patients were analyzed in this study. Patients were injected with 68Ga-PSMA-11 (mean, 5.50 ± 1.49 mCi) and imaged on a 3.0 T time-of-flight PET/MRI. PET images were retrospectively reconstructed using 0.5, 1, 2, 4, 7, and 10 min of PET data. Lesion detectability was evaluated on a 5-point Likert Scale for each lesion in each reconstruction. Quantitative analysis was performed measuring image noise and lesion uptake. Results A total of 55 lesions were identified, and lesion detectability increased from 2.07 ± 1.14 for 0.5 min to 4.93 ± 0.26 for 10 min (p < 0.001), with no significant difference detected between 7 and 10 min of scan time. Average SUVmax decreased from 9.89 ± 6.62 for 0.5 min to 8.64 ± 6.81 for 10 min. Noise decreased from 0.72 ± 0.22 for 0.5 min to 0.31 ± 0.12 for 10 min (p < 0.001) and were nearly equivalent between 7 and 10 min. Pairwise interaction terms between size, SUVmax, and scan time were all found to be significant, although the interaction term between SUVmax and scan time was found to be the most significant. Conclusions Increased acquisition duration improves image quality by increasing detectability and reducing noise. In patients with biochemical recurrence, increased acquisition time up to 7 min improves lesion detection.
Collapse
Affiliation(s)
- Vishnu Murthy
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Raven L Smith
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Dora H Tao
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Courtney A Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Dave E Korenchan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. .,UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA. .,Department of Radiology, San Francisco VA Medical Center, San Francisco, CA, USA.
| |
Collapse
|
45
|
Wei J, Wang YH, Lee CY, Truillet C, Oh DY, Xu Y, Ruggero D, Flavell RR, VanBrocklin HF, Seo Y, Craik CS, Fong L, Wang CI, Evans MJ. An Analysis of Isoclonal Antibody Formats Suggests a Role for Measuring PD-L1 with Low Molecular Weight PET Radiotracers. Mol Imaging Biol 2020; 22:1553-1561. [PMID: 32813112 DOI: 10.1007/s11307-020-01527-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE The swell of new and diverse radiotracers to predict or monitor tumor response to cancer immunotherapies invites the opportunity for comparative studies to identify optimal platforms. To probe the significance of antibody format on image quality for PD-L1 imaging, we developed and studied the biodistribution of a library of antibodies based on the anti-PD-L1 IgG1 clone C4. PROCEDURE A C4 minibody and scFv were cloned, expressed, and characterized. The antibodies were functionalized with desferrioxamine and radiolabeled with Zr-89 to enable a rigorous comparison with prior data collected using 89Zr-labeled C4 IgG1. The biodistribution of the radiotracers was evaluated in C57Bl6/J or nu/nu mice bearing B16F10 or H1975 tumors, respectively, which are models that represent high and low tumor autonomous PD-L1 expression. RESULTS The tumor uptake of the 89Zr-C4 minibody was higher than 89Zr-C4 scFv and equivalent to previous data collected using 89Zr-C4 IgG1. However, the peak tumors to normal tissue ratios were generally higher for 89Zr-C4 scFv compared with 89Zr-C4 minibody and 89Zr-IgG1. Moreover, an exploratory study showed that the rapid clearance of 89Zr-C4 scFv enabled detection of endogenous PD-L1 on a genetically engineered and orthotopic model of hepatocellular carcinoma. CONCLUSION In summary, these data support the use of low molecular weight constructs for PD-L1 imaging, especially for tumor types that manifest in abdominal organs that are obstructed by the clearance of high molecular weight radioligands.
Collapse
Affiliation(s)
- Junnian Wei
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Yung-Hua Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Chia Yin Lee
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove Immunos #03-06, Biopolis, Singapore, 138648, Singapore
| | - Charles Truillet
- Imagerie Moleculaire In Vivo, INSERM, CEA, Univ. Paris Sud, CNRS, Universite Paris Saclay, CEA-Service Hospitalier Frederic Joliot, 94100, Orsay, France
| | - David Y Oh
- Department of Medicine, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA, 94143, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Yichen Xu
- Department of Urology, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Davide Ruggero
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Department of Urology, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Henry F VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Charles S Craik
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.,Department of Pharmaceutical Chemistry, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Lawrence Fong
- Department of Medicine, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA, 94143, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Cheng-I Wang
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove Immunos #03-06, Biopolis, Singapore, 138648, Singapore
| | - Michael J Evans
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA. .,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA. .,Department of Pharmaceutical Chemistry, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
| |
Collapse
|
46
|
Abstract
Fluorine-18 (18F)-fluorodeoxyglucose (FDG) positron emission tomography fused with computed tomography (PET/CT) is a valuable tool in surgical planning for head and neck squamous cell carcinoma (HNSCC). If performed prior to biopsy or other surgical intervention, FDG-PET/CT has high sensitivity for the detection of the primary site in patients with cervical lymph node metastases from unknown primary origin and can be used to direct the surgical workup. FDG-PET/CT is superior to CT alone for detection of nodal metastases outside the expected pattern or distant metastases or second primary cancers and can greatly affect determination of appropriate management including surgical eligibility. Prior to the advent of PET/CT, many patients undergoing (chemo)radiation-based therapy had planned post-treatment neck dissection; FDG-PET/CT now has a proven role in the evaluation of recurrent or persistent disease amenable to salvage surgery and enables safe avoidance of planned postradiation neck dissection with a high negative predictive value. Specifically for this important application, two standardized reporting metrics may be used in the head and neck anatomic region: the "Hopkins criteria" and the "Neck Imaging Reporting and Data System"; both systems produce a formalized evaluation and recommendation based on PET/CT findings. The role of PET/CT as a replacement for elective neck dissection or examination under anesthesia remains controversial but deserves further study. FDG-PET/CT has a wide-ranging impact on the surgical management of patients with HNSCC and should be used routinely in patients with unknown primary nodal disease and those presenting with advanced-stage cancers at initial staging and to assess treatment response.
Collapse
Affiliation(s)
- Madeleine P Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA.
| |
Collapse
|
47
|
Polvoy I, Flavell RR, Rosenberg OS, Ohliger MA, Wilson DM. Nuclear Imaging of Bacterial Infection: The State of the Art and Future Directions. J Nucl Med 2020; 61:1708-1716. [PMID: 32764120 DOI: 10.2967/jnumed.120.244939] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022] Open
Abstract
Increased mortality rates from infectious diseases is a growing public health concern. Successful management of acute bacterial infections requires early diagnosis and treatment, which are not always easy to achieve. Structural imaging techniques such as CT and MRI are often applied to this problem. However, these methods generally rely on secondary inflammatory changes and are frequently not specific to infection. The use of nuclear medicine techniques can add crucial complementary information, allowing visualization of infectious pathophysiology beyond morphologic imaging. This review will discuss the current structural and functional imaging techniques used for the diagnosis of bacterial infection and their roles in different clinical scenarios. We will also present several new radiotracers in development, with an emphasis on probes targeting bacteria-specific metabolism. As highlighted by the current coronavirus disease 2019 epidemic, caused by the novel severe acute respiratory syndrome coronavirus 2, similar thinking may apply in imaging viral pathogens; for this case, prominent effects on host proteins, most notably angiotensin-converting enzyme 2, might also provide worthwhile imaging targets.
Collapse
Affiliation(s)
- Ilona Polvoy
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Oren S Rosenberg
- Department of Medicine, University of California, San Francisco, San Francisco, California; and
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.,Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| |
Collapse
|
48
|
Abstract
This review highlights recent efforts to detect bacteria using engineered small molecules that are processed and incorporated similarly to their natural counterparts. There are both scientific and clinical justifications for these endeavors. The use of detectable, cell-wall targeted chemical probes has elucidated microbial behavior, with several fluorescent labeling methods in widespread laboratory use. Furthermore, many existing efforts including ours, focus on developing new imaging tools to study infection in clinical practice. The bacterial cell wall, a remarkably rich and complex structure, is an outstanding target for bacteria-specific detection. Several cell wall components are found in bacteria but not mammals, especially peptidoglycan, lipopolysaccharide, and teichoic acids. As this review highlights, the development of laboratory tools for fluorescence microscopy has vastly outstripped related positron emission tomography (PET) or single photon emission computed tomography (SPECT) radiotracer development. However, there is great synergy between these chemical strategies, which both employ mimicry of endogenous substrates to incorporate detectable structures. As the field of bacteria-specific imaging grows, it will be important to understand the mechanisms involved in microbial incorporation of radionuclides. Additionally, we will highlight the clinical challenges motivating this imaging effort.
Collapse
Affiliation(s)
- Matthew F. L. Parker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Justin M. Luu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| | - Oren S. Rosenberg
- Department of Medicine, University of California, San Francisco, San Francisco, California 94158, United States
| | - Michael A. Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, California 94110, United States
| | - David M. Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California 94158, United States
| |
Collapse
|
49
|
Kalita M, Parker MFL, Luu JM, Stewart MN, Blecha JE, VanBrocklin HF, Evans MJ, Flavell RR, Rosenberg OS, Ohliger MA, Wilson DM. Arabinofuranose-derived positron-emission tomography radiotracers for detection of pathogenic microorganisms. J Labelled Comp Radiopharm 2020; 63:231-239. [PMID: 32222086 DOI: 10.1002/jlcr.3835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/06/2020] [Accepted: 02/26/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Detection of bacteria-specific metabolism via positron emission tomography (PET) is an emerging strategy to image human pathogens, with dramatic implications for clinical practice. In silico and in vitro screening tools have recently been applied to this problem, with several monosaccharides including l-arabinose showing rapid accumulation in Escherichia coli and other organisms. Our goal for this study was to evaluate several synthetically viable arabinofuranose-derived 18 F analogs for their incorporation into pathogenic bacteria. PROCEDURES We synthesized four radiolabeled arabinofuranose-derived sugars: 2-deoxy-2-[18 F]fluoro-arabinofuranoses (d-2-18 F-AF and l-2-18 F-AF) and 5-deoxy-5-[18 F]fluoro-arabinofuranoses (d-5-18 F-AF and l-5-18 F-AF). The arabinofuranoses were synthesized from 18 F- via triflated, peracetylated precursors analogous to the most common radiosynthesis of 2-deoxy-2-[18 F]fluoro-d-glucose ([18 F]FDG). These radiotracers were screened for their uptake into E. coli and Staphylococcus aureus. Subsequently, the sensitivity of d-2-18 F-AF and l-2-18 F-AF to key human pathogens was investigated in vitro. RESULTS All 18 F radiotracer targets were synthesized in high radiochemical purity. In the screening study, d-2-18 F-AF and l-2-18 F-AF showed greater accumulation in E. coli than in S. aureus. When evaluated in a panel of pathologic microorganisms, both d-2-18 F-AF and l-2-18 F-AF demonstrated sensitivity to most gram-positive and gram-negative bacteria. CONCLUSIONS Arabinofuranose-derived 18 F PET radiotracers can be synthesized with high radiochemical purity. Our study showed absence of bacterial accumulation for 5-substitued analogs, a finding that may have mechanistic implications for related tracers. Both d-2-18 F-AF and l-2-18 F-AF showed sensitivity to most gram-negative and gram-positive organisms. Future in vivo studies will evaluate the diagnostic accuracy of these radiotracers in animal models of infection.
Collapse
Affiliation(s)
- Mausam Kalita
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Matthew F L Parker
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Justin M Luu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Megan N Stewart
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Joseph E Blecha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Henry F VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Michael J Evans
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Oren S Rosenberg
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.,Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| |
Collapse
|
50
|
Fendler WP, Ferdinandus J, Czernin J, Eiber M, Flavell RR, Behr SC, Wu IWK, Lawhn-Heath C, Pampaloni MH, Reiter RE, Rettig MB, Gartmann J, Murthy V, Slavik R, Carroll PR, Herrmann K, Calais J, Hope TA. Impact of 68Ga-PSMA-11 PET on the Management of Recurrent Prostate Cancer in a Prospective Single-Arm Clinical Trial. J Nucl Med 2020; 61:1793-1799. [PMID: 32358094 DOI: 10.2967/jnumed.120.242180] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) ligand PET induces management changes in patients with prostate cancer. We aim to better characterize the impact of 68Ga-PSMA-11 PET (68Ga-PSMA PET) on management of recurrent prostate cancer in a large prospective cohort. Methods: We report management changes after 68Ga-PSMA PET, a secondary endpoint of a prospective multicenter trial in men with biochemical recurrence of prostate cancer. Pre-PET (Q1), post-PET (Q2), and posttreatment (Q3) questionnaires were sent to referring physicians recording site of recurrence and intended (Q1 to Q2 change) and implemented (Q3) therapeutic and diagnostic management. Results: Q1 and Q2 response was collected for 382 of 635 patients (60%, intended cohort), and Q1, Q2, and Q3 response was collected for 206 patients (32%, implemented cohort). An intended management change occurred in 260 of 382 (68%) patients. The intended change was considered major in 176 of 382 (46%) patients. Major changes occurred most often for patients with prostate-specific antigen of 0.5 to less than 2.0 ng/mL (81/147, 55%). By analysis of stage groups, management change was consistent with PET disease location, that is, a majority of major changes toward active surveillance (47%) for unknown disease site (103/382, 27%), toward local or focal therapy (56%) for locoregional disease (126/382, 33%), and toward systemic therapy (69% M1a; 43% M1b/c) for metastatic disease (153/382, 40%). According to Q3 responses, the intended management was implemented in 160 of 206 (78%) patients. In total, 150 intended diagnostic tests, mostly CT (n = 43, 29%) and bone scans or 18F-NaF PET (n = 52, 35%), were prevented by 68Ga-PSMA PET; 73 tests, mostly biopsies (n = 44, 60%) as requested by the study protocol, were triggered. Conclusion: According to referring physicians, sites of recurrence were clarified by 68Ga-PSMA PET, and disease localization translated into management changes in more than half of patients with biochemical recurrence of prostate cancer.
Collapse
Affiliation(s)
- Wolfgang P Fendler
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California.,Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Germany
| | - Justin Ferdinandus
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Germany
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Matthias Eiber
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California.,Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - I-Wei K Wu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Courtney Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Miguel H Pampaloni
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Robert E Reiter
- Department of Urology, UCLA Medical Center, UCLA, Los Angeles, California
| | - Matthew B Rettig
- Department of Urology, UCLA Medical Center, UCLA, Los Angeles, California.,Division of Hematology/Oncology, Department of Medicine, UCLA, and Division of Hematology/Oncology, Department of Medicine, VA Greater Los Angeles, Los Angeles, California; and
| | - Jeannine Gartmann
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Vishnu Murthy
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Roger Slavik
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Peter R Carroll
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Ken Herrmann
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California.,Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Germany
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| |
Collapse
|