In vivo kinetics of radiolabeled monoclonal anti-CEA antibodies in animal models

Studies were performed to determine the effect of the radiolabel and circulating carcinoembryonic antigen (CEA) on the pharmacodynamics of monoclonal anti-CEA antibodies (MoAbs). The studies were performed in normal BALB/c mice and in nude mice bearing human colon tumors. Three different tumors were used, each of which produced CEA levels characteristic of that particular tumor's secretory rate. The CEJ-326 MoAb labeled with either 111In or 125I was used in all studies. Circulating CEA induced the removal of 125I and 111In MoAbs from the vascular compartment. Liver concentrations of 111In increased and 125I levels decreased as the CEA secretory rate of the tumor rose. This indicates that circulating CEA complexes form in the vascular compartment which, in an animal model, are removed by the liver and spleen. This results in decreased tumor uptake of the labeled MoAb. The iodinated MoAb complexes are dehalogenated while the 111In is retained by the liver. This dehalogenation may account for the relatively low liver activity observed in radioimmunoimaging with intact radioiodinated anti-CEA MoAbs, provided the CEA complexes are similarly removed from the vascular compartment by the human liver.

Athymic mouse model of a human T-cell tumor

Because of the large number of different immunoconjugates which can be produced from monoclonal antibody-directed anti-cancer therapy, it would be useful to have in vivo tumor models to compare such preparations. Although historically human leukemias-lymphomas have been difficult to establish in athymic mice we have succeeded in establishing human T-cell tumors from primary MOLT-4 cultures in 290 of 353 animals and have successfully transferred tumors in 42 of 45 animals during ten serial passages. The potential utility of this model for testing immunoconjugates of murine monoclonal antibody T101 have been confirmed by: (a) in all 148 tumors sampled including all passaged tumors the human T-cell antigen, T65, was expressed in a manner identical to that of cultured cells; (b) 111In-T101 was concentrated preferentially in the tumor; and (c) T101 injected by both the i.p. and i.v. routes bound to tumor and induced antigenic modulation to the same extent as that observed previously in vitro and in human studies.

Radioimmunodetection of melanoma utilizing In-111 96.5 monoclonal antibody: a preliminary report

The murine 96.5 monoclonal antimelanoma antibody (MoAb) was labeled with In-111, and 1-20 mg were administered to 21 patients who had proved or suspected melanoma metastases. One patient was studied twice. In four patients, unlabeled 96.5 MoAb was administered prior to the radiopharmaceutical. All of the patients tolerated the procedure without toxicity regardless of the mass of MoAb administered. The scans were interpreted by two observers, one with full knowledge, the other with no knowledge of the cases. Increasing the MoAb mass or preinfusing unlabeled MoAb prior to the administration of In-111 MoAb resulted in a prolongation of the serum half time, and appeared to improve tumor detection. Lesions were best seen at 72 hours after infusion or later. In all patients who had metastatic disease, at least one tumor site was apparent. Fifty-six per cent of known lesions 1.5 cm or greater in size were detected by the physician who had knowledge of the cases when data from all doses were considered. There were eight lesions detected that were not suspected in the workup of the patient. When these are included, the detection rate rises to 61%. Forty-nine per cent were detected by the other physician. Subtraction techniques were not employed. Lesions were often better seen with single photon emission computed tomography than with planar imaging techniques. The 96.5 In-111 MoAb appears to have utility for the detection of metastatic melanoma. Further clinical evaluation of 96.5 In-111 MoAb is warranted.

Carcinoembryonic antigen production, secretion, and kinetics in BALB/c mice and a nude mouse-human tumor model

Carcinoembryonic antigen (CEA) is currently being used as a target antigen in the radioimmunodetection of cancer. Circulating CEA may adversely affect the outcome of such studies by formation of intravascular immune complexes. The following studies were undertaken to expand our knowledge of the production, secretion, and pharmacokinetics of CEA, since these factors should have a direct bearing on the serum levels of CEA encountered in radioimmunodetection. The production of CEA was assessed in nude mice given implants of the T-380 CEA secreting human colon tumor. Serum CEA rose linearly as the tumors enlarged; however, the concentration of CEA per g of extracted tumor remained constant throughout the weight range studied. The secretory rate of the T-380 tumor was determined by surgically removing all blood flow to the liver and gastrointestinal tract of the nude mouse model. This procedure removes the known sites of CEA degradation. Serum CEA levels rose progressively following surgery, the values being directly related to the tumor size. The secretory rate was also proportional to tumor size but was a constant 13.8 +/- 3.6 (S.D.) ng/g tumor/hr when expressed on a per g tumor basis. To determine if the serum levels of CEA observed in patients could be due to unique differences in the clearance rates of each patient's CEA, serum from three patients with CEA levels of 2150, 709, and 58 ng/ml was administered i.v. to groups of mice at the original and diluted concentrations. The kinetics of all samples followed a single exponential clearance pattern with a half-time of about 2.5 hr. This was dramatically different from the kinetics of tumor-extracted CEA which exhibited a multiexponential pattern, the first component having a half-time of 3 min. These data suggest that CEA secreted by a tumor is in some way different from that adhering to the tumor. If the secreted CEA truly has a monoexponential clearance with a fixed rate as the experiments suggest, the absolute values of serum CEA are either entirely a function of the tumor secretory rate, or else the product having the short half-time is not measured in serum samples obtained from patients.

In-111-leukocyte scintigraphy for detection of infection associated with peritoneal dialysis catheters

In-111-labeled leukocytes were administered to 13 patients on continuous ambulatory peritoneal dialysis in order to locate catheter-associated infections. Using a marker to indicate the catheter exit site, infections of the catheter tunnel were correctly identified prior to surgery in 4 patients with relapsing peritonitis and infections of the exit site were diagnosed in 5 out of 7 patients. There were no false positives or negatives as documented by surgery or follow-up. The authors conclude that In-111-leukocyte scintigraphy appears to be accurate in diagnosing peritoneal infections of the dialysis catheter tunnel.

Lack of radioimmunodetection and complications associated with monoclonal anticarcinoembryonic antigen antibody cross-reactivity with an antigen on circulating cells

Characterization of several high-affinity murine monoclonal anticarcinoembryonic antigen (CEA) antibodies suggested good specificity except for cross-reactivity with an antigen on granulocytes and erythrocytes which was different from the previously described normal cross-reacting antigen of granulocytes. In vivo studies in athymic mice using an indium conjugate of an anti-CEA monoclonal antibody (MoAb) revealed excellent specific uptake in colorectal carcinoma xenografts. Studies were conducted in humans to determine the limitations produced by the cross-reactivity with granulocytes and erythrocytes. Patients with metastatic colorectal cancer received 3 to 6 mg of anti-CEA MoAb over 10 min or 2 hr. In five of six trials, the MoAb infusion was associated with a 40 to 90% decrease in circulating granulocytes and systemic toxicity including fever, rigors, and emesis. One patient had no change in cell count and had no toxicity. Radionuclide scans with 111In-anti-CEA MoAb showed marked uptake in the spleen when cells were eliminated, and in the liver, especially when pretreatment CEA levels were high. Metastatic tumor sites failed to concentrate the isotope. This study emphasizes the potential limitations for radioimmunodetection and/or radioimmunotherapy imposed by reactivity with circulating cells, and suggests that certain toxic reactions associated with MoAb infusions are related to destruction of circulating cells rather than allergic reactions to mouse protein. It also emphasizes how variables such as dose and binding affinity of antibody, radioisotope used, and assessment at different observation points can obscure lack of antibody specificity.

Single photon emission computed tomograms of the liver: normal vascular intrahepatic structures

Because of the high target-to-background contrast obtained with single photon emission computed tomography (SPECT), normal intrahepatic vessels approximately 2 cm in diameter may appear as distinct focal defects in tomographic sections throughout the liver even though normal vessels rarely cause such defects on planar images. To assess this problem, five subjects without evidence of liver disease underwent tomography of the liver with Tc-99m sulfur colloid (TSC) and on a separate occasion tomography of the intrahepatic blood pool with Tc-99m autologous red blood cells (RBC). In each case, well demarcated defects were obvious in contiguous TSC liver tomograms in various planes. Direct comparison with RBC tomograms showed that all of these defects corresponded to intrahepatic veins, typically the right portal vein, its posterior branch, and the left portal vein. Knowledge of the intrahepatic vascular anatomy in a variety of tomographic planes, with examination of each defect in multiple orthogonal planes is necessary to avoid false positive interpretations. In some instances a study with RBC may also be required for more conclusive evaluation of defects seen on TSC liver tomograms.

Stability, characterization, and kinetics of 111In-labeled monoclonal antitumor antibodies in normal animals and nude mouse-human tumor models

Monoclonal antibodies (MoAbs) against carcinoembryonic antigen were successfully radiolabeled with 111In, and the radiopharmaceutical was characterized in vitro and in normal and tumor-bearing mice. The 111In-MoAb proved to be stable in vitro and in vivo under normal conditions, although instability could be induced in vitro with large quantities of iron-free transferrin. Animal distribution studies with 111In-MoAb demonstrated tumor localization superior to 67Ga and pharmacokinetics that were highly similar to those of endogenously labeled 75Se-MoAb. The 111In-MoAb followed first-order kinetics and fit a two-compartmental model when studied in nude mice bearing human colon tumors known to express carcinoembryonic antigen. Significant quantities of radiolabel appeared in tissues other than tumor, with liver and skin having the highest concentrations. Sufficient tumor/background ratios were formed for scanning purposes. The data indicate that 111In-MoAb may prove to be effective as a radiopharmaceutical for tumor imaging.

The effect of certain variables on the tumor and tissue distribution of tracers: VI. False-carrier effect, Part III, Fe

Previous work has shown that Fe3+, when administered in the proper dose and time sequence, increases the tumor uptake of gallium-67 (67Ga) while decreasing its uptake by normal tissues. The purpose of this series of experiments was to examine further the postulate that the false carrier effect is mediated at the cellular as well as the vascular level, determine the lowest concentration of ionic Fe3+ that will induce near maximum tumor/background ratios (T/Bkg), determine the best technique for its administration, and decide whether Benadryl and dexamethasone could be used to offset side effects of the Fe3+ without altering tumor and tissue kinetics. Fe3+ altered tissue levels of 67Ga prior to changes in the blood. The threshold for initiation of the false-carrier effect varied to some extent from one organ to another. Tumor uptake of 67Ga was either enhanced or unaltered at 4 hours after injection; 0.3 mg Fe3+/kg administered 0.5 hour before and 2 hours after the 67Ga enhanced 4-hour T/Bkg by a factor of about ten. Twenty-four-hour ratios were improved (to a lesser extent than 4-hour), but decreased concentrations of 67Ga occurred in the tumor. Dexamethasone and Benadryl did not alter the outcome of the experiment. This technique should be useful for imaging with gallium-68 and the PET camera.

Limitations of renal function scanning in acute obstruction

This study was designed to determine if technetium-99m penicillamine (TPEN), could be used to predict recoverable function in dogs with acute obstruction. Renal accumulation of TPEN was measured in four control dogs, in four dogs with acute obstruction lasting 7-14 days, and in the same four dogs following a variable recovery period of 15-63 days. The relative renal uptake of TPEN in vivo showed good agreement with the relative uptake in vitro and both measurements correlated closely with the relative inulin clearances in the normal and in the post obstructed kidneys. The uptake of TPEN in the obstructed kidney following 7-14 days of obstruction averaged 6.8% of the total renal uptake. After relief of the obstruction and a variable recovery period the relative uptake of TPEN in the post obstructed kidney had increased to a mean of 29.5%. These results indicate that TPEN scans should not be used during acute obstruction to predict recoverable function. The observations noted in the study almost certainly apply to similar chelating agents such as dimercaptosuccinic acid (DMSA) and probably to other renal radiopharmaceuticals as well.

The effect of certain variables on the tumor and tissue distribution of tracers V: false carrier effect, II, Fe

The effect of Fe3+ citrate on carrier-free 67Ga and 59Fe kinetics was studied in a Buffalo rat-Morris 7777 hepatoma model. Two mg Fe3+ citrate/Kg were administered intravenously in a variety of time sequences, prior to and following the tracers, and the rats were killed at 4 or 24 hours. 67Ga concentrations could be increased in tumor and decreased in most normal tissues. Administering Fe3+ both one half hour before and 2 hours after the tracers produced 67Ga values equivalent to 72-hour carrier-free values after 4 hours, while simultaneously decreasing gut secretion and increasing urinary excretion. The 59Fe and 67Ga kinetics suggested that events at both vascular and cellular levels were responsible for these changes. This study demonstrated the potential utility of Fe3+ citrate for improving both conventional 67Ga and positron (68Ga) imaging of tumors.

The effect of certain variables on the tumor and tissue distribution of tracers. IV. False carriers: ferric citrate

The intravenous administration of Fe+3 -citrate (1.6 mg/kg body weight) was demonstrated to alter the concentration of carrier-free 67Ga and 54Mn in malignant and healthy tissues of the rat, Morris 7777 hepatoma model. When the Fe+3 was injected 2 hours before, simultaneously with, or 2 hours after 67Ga (and the rats sacrificed 4 hours after injection), the 67Ga in most normal tissues decreased, and the viable tumor concentrations increased by 135, 24, and 47%, respectively. Twenty-four hours after a simultaneous administration of Fe+3 and 67Ga, egress of 67Ga from the tumor was much less than from the healthy tissues. These changes resulted in significant improvements in viable tumor to background ratios, especially at 4 hours. These changes induced in the distribution of the two tracers by Fe+3 indicate that some kinetic characteristics are shared. This is discussed in the light of their response to carrier Ga and Mn. The use of Fe+3 shows promise as a means of improving tumor/background ratios for 68Ga and 52mMn, two short-lived positron emitters that can be used with positron scanners. Gallium-67 imaging may also be improved by these techniques. The Fe+3 increases excretion of 67Ga from the animal, and this could result in a lower radiation dose to a patient.

The effect of certain variables on the tumor and tissue distribution of tracers. III. Salicylates and vasoactive drugs

Attempts were made to increase the viable tumor concentration of 54Mn and 67Ga in a rat hepatoma model by administering rat angiotensin, tolazoline, and salicylates. Salicylates increased the tumor concentrations of 54Mn and improved 65Mn viable tumor/background ratios. 67Ga was not affected by the salicylates. The salicylate effect appeared to be mediated by intracellular mechanisms rather than alterations in plasma protein binding. Rat angiotensin slightly increased the concentrations of 67Ga in the tumors but not enough to suggest that it would be useful clinically. Tolazoline did not increase tumor uptake of the tracers.

The effect of parathyroid hormone on technetium-99m pyrophosphate distribution in rats

Sprague-Dawley rats were treated with varying quantities of parathyroid hormone for 1--3 days, then sacrificed at periods ranging from 1--6 h after administration of 99mTc-pyrophosphate. Very little increase in bone accumulation of tracer occurred with this treatment. A small, but obvious decrease occurred in the blood levels of 99mTc-pyrophosphate and a smaller and less consistent decrease was affected in the muscle levels of the radiopharmaceutical. The overall result was an improvement in the bone/blood and bone/muscle ratios. It is suggested that the basis of the "supernormal" bone scan of hyperparathyroidism is achieved by this mechanism and that the increased bone uptake of other ions in response to parathyroid hormone is not shared by 99mTc-pyrophosphate.

The effect of certain variables on the tumor and tissue distribution of tracers. II. Carrier effect: rapidity of onset and concentrations necessary for initiation and maximum response

The smallest quantity of carrier Ga and Mn necessary to initiate and maximize a carrier effect was studied in the Morris 7777 rat hepatoma model. The quantity needed for a maximum response did not appear to adversely effect the rats. Not all tissues were equally affected at the same plasma concentrations. If carrier Ga was administered 2 hours following 67Ga injection and the rats sacrificed 30 minutes later, a dramatic change occurred in background activity, which was more pronounced in healthy than malignant tissues. Early viable and nonviable tumor/background ratios were improved by this technique. The data suggest that the use of carrier Ga and Mn might improve early lesion/background ratios in patients. This could be of use if tumor imaging were undertaken with 68Ga or 52mMn with positron detector systems.

The effect of certain variables on the tumor and tissue distribution of tracers. Part 1; Carrier

Buffalo rats bearing thigh-implanted strain-7777 Morris hepatomas were used as a model for studying the effect of carrier material on the body distribution, tumor uptake, excretion, and tumor-to-background ratios of 67Ga and 54Mn. An effort was also made to observe the changes in 67Ga and 54Mn concentrations induced by carrier in viable tumor and skeletal muscle, relative to their interstitial fluid space. This value is referred to as the Tissue Distribution Index. Carrier manipulation resulted in striking changes in the distribution of the two ions from the carrier-free state. The data also indicated a difference in the pharmacodynamics of 67Ga and 54Mn in malignant and healthy tissues which could be of importance to nuclear medicine and oncology.

Distributions of 137Cs, 201Tl, 203Hg, 203Pb and 57Co in a rat hepatoma model. Comparison with 67Ga

The distribution of carrier-free 203Pb-acetate, 203HgCl2, 57 CoCl2, 137CsCl and 201TlCl was investigated in rats bearing thigh-implanted Morris 7777 hepatomas. Viable and nonviable tumor tissue was collected in order to determine the relative affinities of the radiopharmaceuticals for these tissues. The animals were sacrificed at 4, 24, 48, 72 and 96 hrs following intravenous injection. Washout of the radioisotope from the viable tumor tissue was rapid, the maximum concentration being reached on or before 4 hrs following injection. In contrast, residual activity within the nonviable tumor tissue decreased much more slowly and in some cases even increased with time. Viable tumor-to-muscle and nonviable tumor-to-muscle ratios for 203Pb, 203Hg and 57Co were comparable to the analogous ratios reported for 67Ga. However, none of these isotopes approached 67Ga as a potential tumor imaging agent because the large ratios were the result of low muscle uptake rather than high tumor uptake. Blood clearance of 67Ga was faster than any of the five cations, while viable and nonviable tumor affinity for 67Ga was greater than for any of the radiopharmaceuticals studied.

Comparison of viable and nonviable tumor uptake of Sc-46, Mn-54, Zn-65, In-111 and Au-195 with Ga-67 citrate in a hepatoma model

The tissue distribution of Sc-46, Mn-54, Zn-65, In-111 and Au-195 were studied in a rat hepatoma model at various time intervals over a 96 h period. The tumor localizing properties of these isotopes were evaluated by examining their incorporation and clearance from viable and nonviable tumor tissue and determining the critical tissue ratios formed with blood and muscle. In general, the results showed greater uptake in viable than nonviable tumor tissue at early time periods (4-24 h). By 96 h, however, the activity remaining in the nonviable tumor tissue exceeded the quantity in viable tumor tissue. This trend was previously noted for Ga-67. When compared with Ga-67, only Mn-54 among the isotopes studied showed remarkably higher viable tumor/blood ratios (4-24 h, 45:1-83:1 respectively). Manganese-54 also showed highly significant accumulation in cardiac muscle with a heart/blood ratio at 4 h superior to comparable values previously reported for Cs-137 and Tl-201. It is suggested that tumor and heart imaging may be feasible utilizing radioactive manganese (Mn-51 or Mn-52) with the new positron imaging systems.

Tissue distribution studies with radioactive manganese: a potential agent for myocardial imaging

Manganese, a trace metal, is known to localize in mitochondria. Because mitochondria are abundant in heart muscle, the possible utility of radioactive manganese as a myocardial imaging agent was examined in 25 rats and six dogs. Myocardial uptake of Mn-54 in rats was found to exceed that of thallium-201; myocardium-to-blood ratios averaged 306:1 versus 48:1 for Tl-201. In the dog, uptake of Mn-54 by ischemic myocardium was reduced by 17-75% compared with normal myocardium. Thus, radioactive manganese appears promising as an intravenous myocardial imaging agent, and might be useful in studying the function of myocardial mitochondria by external imaging.

99mTc-thiomalic acid complex: a nonstannous chelate for renal scanning

Thiomalic acid (monomercaptosuccinic acid) has been labeled with 99mTc without the use of an intermediary reducing agent. Tissue distribution studies in rats following the injection of 99mTc-tagged thiomalic acid (99mTc-TMA) showed 40-48% of the injected dose in the kidneys. Renal incorporation of this compound was influenced by various parameters such a pH, quantity of thiomalic acid, heating time, and the preparation-injection interval. Scintigrams of a midline kidney slice showed that the 99mTc activity concentrated mainly in the renal cortex. As a proposed renal-imaging agent 99mTc-TMA compared favorably with 99mTc-Sn-dimercaptosuccinate and 99mTc-penicillamine regarding the precent incorporation into the kidney and was superior in this respect to 99mTc-Sn-glucoheptonate and 99mTc-Sn-diethylenetriamine pentaacetic acid. The 99mTc-TMA was also shown to be highly stable through 24 hr. The reagent can be made available in kit form and is easily combined with 99mTc in two steps. Finally, the absence of stannous ion in the 99mTc-TMA complex should avoid the problem of interference with other procedures involving pertechnetate 99mTco4- as the imaging agent.