In vivo brain estrogen receptor density by neuroendocrine aging and relationships with cognition and symptomatology

17β-estradiol, the most biologically active estrogen, exerts wide-ranging effects in brain through its action on estrogen receptors (ERs), influencing higher-order cognitive function and neurobiological aging. However, our knowledge of ER expression and regulation by neuroendocrine aging in the living human brain is limited. This in vivo brain 18F-fluoroestradiol (18F-FES) Positron Emission Tomography (PET) study of healthy midlife women reveals progressively higher ER density over the menopause transition in estrogen-regulated networks. Effects were independent of age, plasma estradiol and sex hormone binding globulin, and were highly consistent, correctly classifying all women as being postmenopausal or premenopausal. Higher ER density in target regions was associated with poorer memory performance for both postmenopausal and perimenopausal groups, and predicted presence of self-reported mood and cognitive symptoms after menopause. These findings provide novel insights on brain ER density modulation by female neuroendocrine aging, with clinical implications for women's health.

State of the art procedures towards reactive [18F]fluoride in PET tracer synthesis

BACKGROUND

Positron emission tomography (PET) is a powerful, non-invasive preclinical and clinical nuclear imaging technique used in disease diagnosis and therapy assessment. Fluorine-18 is the predominant radionuclide used for PET tracer synthesis. An impressive variety of new 'late-stage' radiolabeling methodologies for the preparation of 18F-labeled tracers has appeared in order to improve the efficiency of the labeling reaction.

MAIN BODY

Despite these developments, one outstanding challenge into the early key steps of the process remains: the preparation of reactive [18F]fluoride from oxygen-18 enriched water ([18O]H2O). In the last decade, significant changes into the trapping, elution and drying stages have been introduced. This review provides an overview of the strategies and recent developments in the production of reactive [18F]fluoride and its use for radiolabeling.

CONCLUSION

Improved, modified or even completely new fluorine-18 work-up procedures have been developed in the last decade with widespread use in base-sensitive nucleophilic 18F-fluorination reactions. The many promising developments may lead to a few standardized drying methodologies for the routine production of a broad scale of PET tracers.

In vivo Brain Estrogen Receptor Expression By Neuroendocrine Aging And Relationships With Gray Matter Volume, Bio-Energetics, and Clinical Symptomatology

17β-estradiol,the most biologically active estrogen, exerts wide-ranging effects in brain through its action on estrogen receptors (ERs), influencing higher-order cognitive function and neurobiological aging. However, our knowledge of ER expression and regulation by neuroendocrine aging in the living human brain is limited. This in vivo multi-modality neuroimaging study of healthy midlife women reveals progressively higher ER density over the menopause transition in estrogen-regulated networks. Effects were independent of age and plasma estradiol levels, and were highly consistent, correctly classifying all women as being post-menopausal or not. Higher ER density was generally associated with lower gray matter volume and blood flow, and with higher mitochondria ATP production, possibly reflecting compensatory mechanisms. Additionally, ER density predicted changes in thermoregulation, mood, cognition, and libido. Our data provide evidence that ER density impacts brainstructure, perfusion and energy production during female endocrine aging, with clinical implications for women's health.

Radiosynthesis and validation of [18 F]Fluoroestradiol in a Synthra plus research platform for use in routine clinical practice

In this practitioner protocol, the optimization of the radiochemical synthesis of [¹⁸ F]fluoroestradiol (FES) on the Synthra RNplus research automated platform is described in detail and a QC summary of three validation productions is presented. In comparison to published synthesis methods developed on other platforms, the yield was considerably improved (40-45% ndc). The other important improvement is the reduction of the required concentration of H₂ SO₄ avoiding the production of high concentrations of acidic vapors that can deteriorate the module. Purification was achieved by solid phase extraction and the required adaptation of an external heating plate to the module to evaporate the ethanol is also described. The product was obtained with high radiochemical purity and fulfilled all the requirements of current Good Manufacturing Practice (cGMP). The final product is formulated as a sterile, pyrogen-free solution suitable for human injection. To the best of our knowledge this is the first report of FES production using this type of module.

An Exposition of 11C and 18F Radiotracers Synthesis for PET Imaging

The development of new radiolabeled Positron emission tomography tracers has been extensively utilized to access the increasing diversity in the research process and to facilitate the development in research methodology, clinical usage of drug discovery and patient care. Recent advances in radiochemistry, as well as the latest techniques in automated radio-synthesizer, have encouraged and challenged the radiochemists to produce the routinely developed radiotracers. Various radionuclides like 18F, 11C, 15O, 13N 99mTc, 131I, 124I and 64Cu are used for incorporating into different chemical scaffolds; among them, 18F and 11C tagged radiotracers are mostly explored such as 11C-Methionine, 11C-Choline, 18F-FDG, 18F-FLT, and 18F-FES. This review is focused on the development of radiochemistry routes to synthesize different radiotracers of 11C and 18F for clinical studies.

Automated synthesis of the 16α-[18F]fluoroestradiol ([18F]FES): minimization of precursor amount and resulting benefits

The 16α-[18F]Fluoroestradiol ([18F]FES) is an established PET radiotracer for estrogen positive (ER+) breast cancer. Although the radiosynthesis is well-described, the majority of the published methods suffer from modest or irreproducible yields and time-intensive purification procedures. In view of the considerable clinical applications, development of a more efficient and faster synthesis of [18F]FES still remains a task of a significant practical importance. [18F]FES was produced by a direct nucleophilic radiofluorination of 3-O-methoxymethyl-16,17-O-sulfuryl-16-epiestriol (MMSE), followed by acidic hydrolysis using HCl/CH3CN. [18F]Fluoride retained on a QMA carb cartridge (46 mg) was eluted by solution of 1.2 mg of tetrabutylammonium tosylate (TBAOTs) in EtOH. After fluorination reaction (0.3 mg MMSE, 1 ml of CH3CN/100 °C, 5 min) [18F]FES was isolated by single-cartridge SPE purification using OASIS WAX 3cc, elution accomplished with aqueous ethanol of different concentrations. On а GE TRACERlab FX N Pro automated module [18F]FES (formulated in normal saline with 5% EtOH) was obtained in 33 ± 3% yield (n = 5, non-decay corrected) within 32 min. Reduction of precursor amount, exclusion of azeotropic drying step and simplification of purification make the suggested method readily adaptable to various automated synthesizers and offers significant cost decrease.

Quick Automatic Synthesis of Solvent-Free 16α-[18F] Fluoroestradiol: Comparison of Kryptofix 222 and Tetrabutylammonium Bicarbonate

Estrogen receptor (ER) expression level of human breast cancer often reflects the stage of disease and is usually monitored by immunohistochemical staining in vitro. The preferable non-invasive and real-time diagnosis in vivo is more accessible by PET scan using 16α-[¹⁸F]FES. The objective of this study was to develop a quick automatic method for synthesis of solvent-free 16α-[¹⁸F]FES using a CFN-MPS-200 synthesis system and compare the catalytic efficiency of two phase transfer catalysts, Kryptofix 222/K₂CO₃ (K222/K₂CO₃) and tetrabutylammonium hydrogen carbonate (TBA·HCO₃). In this method, phase transfer catalysts K222/K₂CO₃ and TBA·HCO₃ were used, respectively. The intermediate products were both hydrolyzed with hydrochloric acid and neutralized with sodium bicarbonate. The crude product was purified with semi-preparative HPLC, and the solvent was removed by rotary evaporation. The effects of radiofluorination temperature and time on the synthesis were also investigated. Radiochemical purity of solvent-free product was above 99% and the decay-corrected radiochemical yield of 16α-[¹⁸F]FES was obtained in 48.7 ± 0.95% (catalyzed by K222/K₂CO₃, n = 4) and 46.7 ± 0.77% (catalyzed by TBA·HCO₃, n = 4, respectively). The solvent-free 16α-[¹⁸F]FES was studied in clinically diagnosed breast cancer patients, and FES-PET results were compared with pathology diagnosis results to validate the diagnosis value of 16α-[¹⁸F]FES. The new method was more reliable, efficient, and time-saving. There was no significant difference in catalytic activity between K222/K₂CO₃ and TBA·HCO₃.

Head-to-Head Evaluation of 18F-FES and 18F-FDG PET/CT in Metastatic Invasive Lobular Breast Cancer

Invasive lobular carcinoma (ILC) demonstrates lower conspicuity on ¹⁸F-FDG PET than the more common invasive ductal carcinoma. Other molecular imaging methods may be needed for evaluation of this malignancy. As ILC is nearly always (95%) estrogen receptor (ER)-positive, ER-targeting PET tracers such as 16α-¹⁸F-fluoroestradiol (¹⁸F-FES) may have value. We reviewed prospective trials at Memorial Sloan Kettering Cancer Center using ¹⁸F-FES PET/CT to evaluate metastatic ILC patients with synchronous ¹⁸F-FDG and ¹⁸F-FES PET/CT imaging, which allowed a head-to-head comparison of these 2 PET tracers. Methods: Six prospective clinical trials using ¹⁸F-FES PET/CT in patients with metastatic breast cancer were performed at Memorial Sloan Kettering Cancer Center from 2008 to 2019. These trials included 92 patients, of whom 14 (15%) were of ILC histology. Seven of 14 patients with ILC had ¹⁸F-FDG PET/CT performed within 5 wk of the research ¹⁸F-FES PET/CT and no intervening change in management. For these 7 patients, the ¹⁸F-FES and ¹⁸F-FDG PET/CT studies were analyzed to determine the total number of tracer-avid lesions, organ systems of involvement, and SUV_max of each organ system for both tracers. Results: In the 7 comparable pairs of scans, there were a total of 254 ¹⁸F-FES-avid lesions (SUV_max, 2.6-17.9) and 111 ¹⁸F-FDG-avid lesions (SUV_max, 3.3-9.9) suggestive of malignancy. For 5 of 7 (71%) ILC patients, ¹⁸F-FES PET/CT detected more metastatic lesions than ¹⁸F-FDG PET/CT. In the same 5 of 7 patients, the SUV_max of ¹⁸F-FES-avid lesions was greater than the SUV_max of ¹⁸F-FDG-avid lesions. One patient had ¹⁸F-FES-avid metastases with no corresponding ¹⁸F-FDG-avid metastases. There were no patients with ¹⁸F-FDG-avid distant metastases without ¹⁸F-FES-avid distant metastases, although in one patient liver metastases were evident on ¹⁸F-FDG but not on ¹⁸F-FES PET. Conclusion: ¹⁸F-FES PET/CT compared favorably with ¹⁸F-FDG PET/CT for detection of metastases in patients with metastatic ILC. Larger prospective trials of ¹⁸F-FES PET/CT in ILC should be considered to evaluate ER-targeted imaging for clinical value in patients with this histology of breast cancer.

Ring opening of epoxides with [18F]FeF species to produce [18F]fluorohydrin PET imaging agents

A simple technique for the preparation of [18F]HF has been developed and applied to the generation of an [18F]FeF species for opening sterically hindered epoxides. This method has been successfully employed to prepare four drug-like molecules, including 5-[18F]fluoro-6-hydroxy-cholesterol, a potential adrenal/endocrine PET imaging agent. This easily automated one-pot procedure produces sterically hindered fluorohydrin PET imaging agents in good yields and high molar activities.

18F-Fluoroestradiol PET/CT Measurement of Estrogen Receptor Suppression during a Phase I Trial of the Novel Estrogen Receptor-Targeted Therapeutic GDC-0810: Using an Imaging Biomarker to Guide Drug Dosage in Subsequent Trials

Purpose: Evaluate ¹⁸F-fluoroestradiol (FES) PET/CT as a biomarker of estrogen receptor (ER) occupancy and/or downregulation during phase I dose escalation of the novel ER targeting therapeutic GDC-0810 and help select drug dosage for subsequent clinical trials.Experimental Design: In a phase I clinical trial of GDC-0810, patients with ER-positive metastatic breast cancer underwent FES PET/CT before beginning therapy and at cycle 2, day 3 of GDC-0810 therapy. Up to five target lesions were selected per patient, and FES standardized uptake value (SUV) corrected for background was recorded for each lesion pretherapy and on-therapy. Complete ER downregulation was defined as ≥90% decrease in FES SUV. The effect of prior tamoxifen and fulvestrant therapy on FES SUV was assessed.Results: Of 30 patients who underwent paired FES-PET scans, 24 (80%) achieved ≥90% decrease in FES avidity, including 1 of 3 patients receiving 200 mg/day, 2 of 4 patients receiving 400 mg/day, 14 of 16 patients receiving 600 mg/day, and 7 of 7 patients receiving 800 mg/day. Withdrawal of tamoxifen 2 months prior to FES PET/CT and withdrawal of fulvestrant 6 months prior to FES PET/CT both appeared sufficient to prevent effects on FES SUV. A dosage of 600 mg GDC-0810 per day was selected for phase II in part due to decreases in FES SUV achieved in phase I.Conclusions: FES PET/CT was a useful biomarker of ER occupancy and/or downregulation in a phase I dose escalation trial of GDC-0810 and helped select the dosage of the ER antagonist/degrader for phase II trials. Clin Cancer Res; 23(12); 3053-60. ©2016 AACR.

Rapid synthesis of [18F]fluoroestradiol: remarkable advantage of microwaving over conventional heating

16α-[(18)F]fluoroestradiol ([(18)F]FES) is known as a clinically important tracer in nuclear medicine as an estrogen receptor ligand for investigating primary and metastatic breast cancers. Synthesizing [(18)F]FES is a two-step process associated with [(18)F]fluoride incorporation to the precursor (3-methoxymethyl 16β,17β-epiestriol-O-cyclic sulfone) and subsequent hydrolysis of the [(18)F]fluorinated intermediate with 2 N HCl. The impact of microwave (MW) heating on both fluorination and hydrolysis reactions was investigated. The duration and temperatures of the fluorination reaction were varied for both MW heating and conventional heating (CH) methods. Chemical and radiochemical purity and radiochemical yields were investigated for CH and compared with MW-assisted radiosyntheses. Quality control tests of MW-assisted [(18)F]FES were performed following US Pharmacopeia procedures for clinical-grade positron emission tomography pharmaceuticals. The results demonstrate that microwaving not only improves the (18)F-fluoride incorporation (~55% improvement at 110°C for 4 min) but also significantly reduces hydrolysis time (approximately sevenfold reduction at 120°C) in comparison with CH under similar conditions. The overall isolated radiochemical yield of purified [(18)F]FES was significantly higher (~90% improvement) with MW, and side products were notably fewer. Quality control test results demonstrated that [(18)F]FES produced by microwaving was suitable for human injection.

Alternative synthesis for the preparation of 16α-[(18) F]fluoroestradiol

We have developed a new precursor, 3,17β-O-bis(methoxymethyl)-16β-O-p-nitrobenzenesulfonylestriol (14c) of 16α-[(18) F]fluoroestradiol ([(18) F]FES). Although we could not selectively protect the C17 alcohol in the presence of the C16 alcohol, we were able to prepare and chromatographically isolate the desired C16 TBDMS, C17,C3-dimethoxymethyl (diMOM) protected estriol derivative and convert into the ultimate fluorination precursor. The MOM protective group proved to be more quickly removed than the cyclic sulfate group. The di-MOM protective precursor at the C3 and C17 alcohols instead of a cyclic sulfate group shortened hydrolysis time. We prepared three different sulfonate precursors at C16 alcohol. After checking their reactivity in the [(18) F]fluorination step and considering the stability of the precursors, we obtained the best results with nosylate precursor 14c.

Synthesis of Clinical-Grade [(18)F]-Fluoroestradiol as a Surrogate PET Biomarker for the Evaluation of Estrogen Receptor-Targeting Therapeutic Drug

16 α -[(18)F]-fluoroestradiol ([(18)F]FES), a steroid-based positron emission tomography (PET) tracer, has emerged as a dependable tracer for the evaluation and management of estrogen receptor-positive (ER+) breast cancer patients. We have developed a fully automatic, one-pot procedure for the synthesis of [(18)F]FES using the Eckert & Ziegler (E & Z) radiomodular system. After [(18)F]fluorination, the intermediate was hydrolyzed with 2.0 M HCl twice and neutralized with sodium bicarbonate. After high-performance liquid chromatography (HPLC) purification, the decay-corrected radiochemical yield and purity of [(18)F]FES were 40 ± 5.0% (n = 12) and >97%, respectively. The product was stable up to 10 h. Total synthesis time including HPLC purification was 80 min. This new, fully automated rapid synthetic procedure provided high and reproducible yields of [(18)F]FES. Quality control (QC) tests showed that the [(18)F]FES produced by this method met all specifications for human injection.