Uptake and release of two new Tc-99m labeled myocardial blood flow imaging agents in cultured cardiac cells

Synthesis of novel technetium-99m tricarbonyl-HBED-CC complexes and structural prediction in solution by density functional theory calculation

HBED-CC (N,N'-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylene diamine-N,N'-diacetic acid, L₁ ) is a common bifunctional chelating agent in preparation of ⁶⁸Ga-radiopharmaceuticals. Due to its high stability constant for the Ga³⁺ complex (logK_GaL = 38.5) and its acyclic structure, it is well known for a rapid and efficient radiolabelling at ambient temperature with Gallium-68 and its high in vivo stability. [^99mTc][Tc(CO)₃(H₂O)₃]⁺ is an excellent precursor for radiolabelling of biomolecules. The aim of this study was to develop a novel preparation method of ^99mTc-HBED-CC complexes. In this study, HBED-CC-NI (2,2'-(ethane-1,2-diylbis((2-hydroxy-5-(3-((2-(2-nitro-1H-imidazol-1-yl)ethyl)amino)-3-oxopropyl)benzyl)-azanediyl))-diacetic acid, L₂ ), a derivative of HBED-CC, was designed and synthesized. Both L₁ and L₂ were radiolabelled by [^99mTc][Tc(CO)₃(H₂O)₃]⁺ successfully for the first time. In order to explore the coordination mode of metal and chelates, non-radioactive Re(CO)₃ L₁ and Re(CO)₃ L₂ were synthesized and characterized spectroscopically. Tc(CO)₃ L₁ and Tc(CO)₃ L₂ in solution were calculated by density functional theory and were analysed with radio-HPLC chromatograms. It showed that [^99mTc]Tc(CO)₃ L₂ forms two stable diastereomers in solution, which is similar to those of [⁶⁸Ga]Ga-HBED-CC complexes. Natural bond orbital analysis through the natural population charges revealed a charge transfer between [^99mTc][Tc(CO)₃]⁺ and L₁ or L₂ . The experimental results showed that tricarbonyl technetium might form stable complex with HBED-CC derivatives, which is useful for the future application of using HBED-CC as a bifunctional chelating agent in developing new ^99mTc-radiopharmaceuticals as diagnostic imaging agents.

Myocardial clearance of technetium-99m-teboroxime in reperfused injured canine myocardium

Background

Recent technical developments using solid-state technology have enabled rapid image acquisition with single photon emission computed tomography (SPECT) and have led to a renewed interest in technetium-99m-teboroxime (Tc-99m-teboroxime) as a myocardial imaging agent. Tc-99m-teboroxime has demonstrated high myocardial extraction, linear myocardial uptake relative to flow even at high flow rates, rapid uptake and clearance kinetics, and differential clearance in the setting of ischemia. However, the myocardial clearance kinetics of Tc-99m-teboroxime in a model of myocardial injury has not been previously reported. Thus, the purposes of this study were to use a canine model of ischemia-reperfusion to (1) compare Tc-99m-teboroxime clearance kinetics in normal and ischemic-reperfused myocardium and (2) assess the utility of Tc-99m-teboroxime clearance kinetics in determining the severity of injury following ischemia-reperfusion.

Methods

Thirteen dogs underwent left circumflex coronary artery (LCx) occlusion for either 30 min (IR30, n = 6) or 120 min (IR120, n = 7), followed by reperfusion, and finally Tc-99m-teboroxime administration 120 min after reperfusion. Microsphere blood flows were determined at baseline, during occlusion, after reperfusion, and before euthanasia. Post-mortem, area at risk was determined using Evans blue dye, and viability was determined using triphenytetrazolium chloride (TTC) staining. The hearts were then subdivided into 24 pieces and Tc-99m activity was measured in a well counter.

Results

TTC-determined infarct area as a percentage of total left ventricular myocardium was 1.1% ± 0.3% for the IR30 group and 7.5% ± 2.9% for the IR120 group (p < 0.05). During coronary occlusion, both the IR30 and IR120 groups demonstrated decreases in percent wall thickening in the ischemia-reperfusion zone (IRZ) as compared with the normal zone (NZ). In the IR30 group, percent wall thickening in the IRZ recovered during the reperfusion phase as compared with the NZ. In the IR120 group, percent wall thickening in the IRZ remained depressed during the reperfusion phase and through the end of the experiment as compared with the NZ. Final Tc-99m-teboroxime myocardial IRZ/NZ activity ratio was 0.94 ± 0.01 for the IR30 group, compared to 0.80 ± 0.01 for the IR120 group (p < 0.05).

Conclusions

Tc-99m-teboroxime demonstrates moderate differential clearance in a model of severe injury with 120 min of ischemia-reperfusion, but only minimal differential clearance in a model of mild injury with 30 min of ischemia-reperfusion. Thus, Tc-99m-teboroxime clearance kinetics may be helpful in differentiating normal and minimally injured from severely injured myocardium.

Mechanism of uptake and retention of F-18 BMS-747158-02 in cardiomyocytes: a novel PET myocardial imaging agent

BACKGROUND

BMS-747158-02 is a novel fluorine 18-labeled pyridazinone derivative designed for cardiac imaging. The uptake and retention mechanisms of F-18 BMS-747158-02 in cardiac myocytes were studied in vitro, and the biodistribution of F-18 BMS-747158-02 was studied in vivo in mice.

METHODS AND RESULTS

Fluorine 19 BMS-747158-01 inhibited mitochondrial complex I (MC-I) in bovine heart submitochondrial particles with an IC(50) of 16.6 +/- 3 nmol/L that was comparable to the reference inhibitors of MC-1, rotenone, pyridaben, and deguelin (IC(50) of 18.2 +/- 6.7 nmol/L, 19.8 +/- 2.6 nmol/L, and 23.1 +/- 1.5 nmol/L, respectively). F-18 BMS-747158-02 had high uptake in monolayers of neonatal rat cardiomyocytes (10.3% +/- 0.7% of incubated drug at 60 minutes) that was inhibited by 200 nmol/L of rotenone (91% +/- 2%) and deguelin (89% +/- 3%). In contrast, an inactive pyridaben analog, P-070 (IC(50) value >4 micromol/L in MC-1 assay), did not inhibit the binding of F-18 BMS-747158-02 in cardiomyocytes. Uptake and washout kinetics for F-18 BMS-747158-02 in rat cardiomyocytes indicated that the time to half-maximal (t((1/2))) uptake was very rapid (approximately 35 seconds), and washout t((1/2)) for efflux of F-18 BMS-747158-02 was greater than 120 minutes. In vivo biodistribution studies in mice showed that F-18 BMS-747158-02 had substantial myocardial uptake (9.5% +/- 0.5% of injected dose per gram) at 60 minutes and heart-to-lung and heart-to-liver ratios of 14.1 +/- 2.5 and 8.3 +/- 0.5, respectively. Positron emission tomography imaging in the mouse allowed clear cardiac visualization and demonstrated sustained myocardial uptake through 55 minutes.

CONCLUSIONS

F-18 BMS-747158-02 is a novel positron emission tomography cardiac tracer targeting MC-I in cardiomyocytes with rapid uptake and slow washout. These characteristics allow fast and sustained accumulation in the heart.

Cellular uptake mechanisms of 99mTcN-NOET in cardiomyocytes from newborn rats: calcium channel interaction

BACKGROUND

Bis[N-ethoxy,N-ethyl(dithiocarbamato)]nitrido Tc (V) (TcN-NOET) is a new technetium complex proposed as a tracer of myocardial perfusion. However, its cellular uptake mechanisms are unknown, although membrane localization on rat heart preparations and preferential binding to polymorphonuclear neutrophils (PMNs) have been reported. Because of the central role of calcium in PMN actions, a relationship was hypothesized between this ion flux and TcN-NOET cellular uptake.

METHODS AND RESULTS

The mechanisms of cellular uptake of TcN-NOET were investigated in newborn rat cardiomyocytes by study of the effect of calcium channel modulators on tracer binding. Nifedipine had no effect on tracer uptake at 1 minute. However, verapamil 0.1 micromol/L and diltiazem 0.5 micromol/L induced a 40% decrease in uptake. Conversely, Bay K 8644 0.25 micromol/L increased TcN-NOET uptake by 73%. Alterations in other membrane ion transports failed to modify tracer uptake, indicating the specificity of the relationship between TcN-NOET uptake and calcium channels. Kinetic studies indicated that cellular net accumulation of the tracer was slow (t1/2=28.5 minutes) and retention was prolonged (84% of initial activity retained after 120 minutes of washout). The energy dependence of TcN-NOET uptake was investigated after 60 minutes of metabolic inhibition by iodoacetic acid plus rotenone. The ATP decrease was not associated with reduction in tracer uptake at 1 minute (114.9+/-21.9% of control, P=NS).

CONCLUSIONS

The decrease in uptake observed with verapamil and diltiazem, the increase with Bay K 8644, and the lack of effect with nifedipine suggest that TcN-NOET binds to L-type calcium channels in the open configuration, without entering cardiomyocytes. The kinetics of TcN-NOET accumulation and retention are slow, and the mechanism for cellular uptake is not energy-dependent. From a clinical point of view, the effect of concurrent treatment by calcium inhibitors on myocardial binding of TcN-NOET should be taken into account.

Myocardial uptake of thallium 201 and technetium 99m-labeled sestamibi after ischemia and reperfusion: comparison by quantitative dual-tracer autoradiography in rabbits

BACKGROUND

Myocardial scintigraphy with 99mTc-labeled sestamibi (99mTc-sestamibi) or 201Tl is used to assess regional perfusion in acute coronary syndromes associated with metabolic or functional abnormalities, such as acute coronary thrombosis with reperfusion and ischemia at rest. However, the initial uptake of these agents may be affected by a recent ischemic insult because the myocardial retention of these tracers depends on cellular metabolism.

METHODS AND RESULTS

Accordingly, 99mTc-sestamibi and 201Tl were injected simultaneously in rabbits after transient brief (10 to 15 minutes, group I) or prolonged (45 to 60 minutes, group II) coronary occlusion. Accumulated subendocardial and subepicardial 99mTc-sestamibi and corresponding 201Tl activity were determined from autoradiographs of 30 microns short-axis slices comounted with serial tissue standards. Circumferential 99mTc-sestamibi and 201Tl activity profiles closely overlapped in both groups. The initial global and segmental myocardial activity per unit blood flow within the ischemic zone did not differ from unity for either tracer regardless of the duration of the ischemic insult. The initial myocardial uptake of both 99mTc-sestamibi and 201Tl after an acute ischemic insult reflected predominantly coronary blood flow, independent of myocardial viability.

CONCLUSIONS

Thus this study supports the use of both 99mTc-sestamibi and 201Tl as perfusion probes in acute coronary syndromes characterized by acute occlusion and reperfusion.

Interaction of technetium 99m-labeled teboroxime with red blood cells reduces the compound's extraction and increases apparent cardiac washout

BACKGROUND

99mTc-labeled teboroxime shows high myocardial extraction in both in vivo animal and in vitro cell culture and isolated heart studies. Whereas in vivo studies show rapid myocardial clearance of teboroxime, in vitro cell culture and isolated heart studies show slower washout comparable to that of 201Tl. Binding of teboroxime to blood components may contribute to these conflicting results.

METHODS AND RESULTS

We measured teboroxime extraction in the isolated blood-perfused rabbit heart after injection in saline solution, brief incubation in red blood cell perfusate, or 4-hour incubation with human red blood cells. Teboroxime in saline solution showed high extraction (Emax = 0.89 +/- 0.02; Enet = 0.69 +/- 0.02), whereas brief incubation in perfusate (Emax = 0.60 +/- 0.06; Enet = 0.48 +/- 0.05) or prolonged incubation with human red blood cells (Emax = 0.43 +/- 0.09; Enet = 0.38 +/- 0.07) resulted in reduced extraction. Teboroxime clearance was similar for all groups and was slower than 201Tl clearance. Analysis of total residual cardiac teboroxime (comparable to external imaging) showed that teboroxime clearance was biexponential. Reduced extraction of teboroxime in red blood cells resulted in an increased size of the rapidly clearing (unextracted) fraction, giving the appearance of rapid myocardial washout.

CONCLUSIONS

Teboroxime has a high myocardial extraction. Binding to blood components reduces teboroxime extraction and increases the rate of cardiac teboroxime clearance.

Myocardial kinetics of radiolabeled perfusion agents: basis for perfusion imaging

The myocardial deposition of radiolabeled perfusion agents permits the noninvasive assessment of regional coronary blood flow. The design of imaging protocols and the optimal interpretation of clinical perfusion studies are based on an understanding of the kinetics of blood-tissue exchange for these compounds. Thallium 201 and the technetium 99m-labeled compounds sestamibi, teboroxime, and tetrofosmin show differing myocardial extraction and retention. This review focuses on studies that used cell culture, isolated heart, and intact animal models that form the basis of our current understanding of the myocardial kinetics of these imaging agents.

Comparison of teboroxime and thallium for the reversibility of exercise-induced myocardial perfusion defects

To determine the optimal technique for the scintigraphic detection of exercise-induced myocardial perfusion defects, we compared teboroxime scanning to both stress/redistribution thallium imaging and the thallium reinjection method following exercise in 35 patients. The overall concordance for the presence of a perfusion defect between teboroxime and thallium scanning was 91% (p < 0.01) and 89% when teboroxime was compared with stress/reinjection thallium imaging (p < 0.01). More segments per scan with fixed defects were observed with redistribution imaging than with teboroxime or thallium reinjection (2.9 vs 2.0 vs 1.9; p < 0.02). Additionally, more transient defects were present with teboroxime than thallium, but less than with reinjection imaging. One half of the 52 fixed perfusion abnormalities on stress/redistribution thallium imaging demonstrated reversibility with both teboroxime imaging and thallium reinjection scanning, but less than 50% of these segments were concordant. Teboroxime allows for improved detection of reversible perfusion defects compared with stress/redistribution thallium scanning, but more ischemia is noted with thallium reinjection. The variation in the detection of segmental ischemic defects between teboroxime scintigraphy and thallium reinjection scanning probably reflects different physiologic properties and imaging protocols of these perfusion agents.

The relationship between myocardial retention of technetium-99m teboroxime and myocardial blood flow

OBJECTIVES

The aim of this study was to define the temporal changes in the relationship between technetium-99m teboroxime tissue retention and myocardial blood flow in a canine model.

BACKGROUND

Technetium-99m teboroxime is a new neutral lipophilic myocardial perfusion agent. It is known to be highly extracted by the myocardium but to have a rapid clearance rate.

METHODS

A wide range of myocardial blood flow was induced in each experiment by regional coronary occlusion and dipyridamole infusion. Myocardial retention of technetium-99m teboroxime was determined by in vitro tissue counting at 1, 2 or 5 min after injection of the tracer. Tracer retention was correlated with microsphere-determined blood flow and the data were fitted to nonlinear functions.

RESULTS

Correlation coefficients for these functions were 0.92, 0.95 and 0.95 at 1, 2, and 5 min, respectively. At 1 min after injection, the relationship of technetium-99m teboroxime retention to blood flow was linear over a wide flow range, becoming nonlinear at flow rates greater than 4.5 ml/min per g. After 5 min the retention-flow relationship was linear only to 2.5 ml/min per g, above which little change in retention was noted. Normalized myocardial retention, expressed as a percent of the retention at 1 ml/min per g, was also calculated. At flow rates of 1, 2, 3, 4 and 5 ml/min per g, normalized retention was 100, 169, 228, 277 and 317% at 1 min and 100, 171, 217, 239 and 237% at 5 min after injection.

CONCLUSIONS

At 1 min after injection, the relationship of technetium-99m teboroxime myocardial retention to blood flow is well maintained over a wide range of flow. However, after only 5 min, tracer retention underestimates flow changes at moderate and high flow rates. Thus, rapid acquisition protocols are necessary to fully exploit the potential of this promising new tracer in the evaluation of myocardial perfusion.

Comparison of neutral and cationic myocardial perfusion agents: characteristics of accumulation in cultured cells

Uptake and washout kinetics of two new neutral lipophilic technetium-99m-labeled boronic acid adducts of technetium tris(dioxime) (BATO complexes) were studied in monolayers of contractile chick heart cells and compared to the cationic myocardial perfusion agents, 99mTc(CNCH2C(CH3)2OCH3)6+ (Tc-MIBI) and 201Tl+. 99mTcCl(CDOH)2(CDO)(BCH3), where CDO = cyclohexanedione dioxime (CDO-MeB), had a 7-fold greater net accumulation than Tc-MIBI and the most rapid unidirectional washout with a fast initial phase and a slower secondary component. Incubation with cationic membrane transport inhibitors or metabolic inhibitors had little or modest influence, respectively, on uptake of these BATO complexes. Studies with NIH 3T3 fibroblasts indicated that the neutral complexes did not show myocyte specific accumulation.

Physiological basis of myocardial perfusion imaging with the technetium 99m agents

In recent years, several technetium 99m-labeled myocardial perfusion agents have been under investigation to determine their utility in assessing regional myocardial blood flow and cellular viability. 99mTc sestamibi (2-methoxyisobutyl isonitrile), one of the most promising of these agents, is a lipophilic cation that is sequestered largely within mitochondria by the large negative transmembrane potential. Experimental studies have shown that this agent is taken up in the myocardium in proportion to blood flow, but like other diffusible radionuclides underestimates flow at high flow rates. Fractional extraction (Emax) for 99mTc sestamibi is lower than that for thallium 201, but net myocardial uptake is comparable between the two radionuclides. Compared with 201Tl, 99mTc sestamibi does not significantly redistribute. Studies have shown that 99mTc sestamibi uptake after reperfusion, preceded by varying periods of coronary occlusion, reflects the degree of myocardial salvage and viability. 99mTc teboroxime, another promising new perfusion agent, is a boronic acid adduct of technetium dioxime complexes. Emax of 99mTc teboroxime is higher than Emax for 201Tl, but myocardial washout is very rapid (half-life = 21 minutes). Myocardial uptake is proportional to regional flow as found with 99mTc sestamibi and 201Tl.

Myocardial perfusion imaging with technetium-99m-labeled agents

Thallium-201 (201Tl) is suboptimal as a single-photon emitting agent for myocardial perfusion imaging, in view of its low-energy photons and long half-life. To circumvent these limitations, two new myocardial perfusion imaging agents labeled with technetium-99m (99mTc) have been developed. They are Tc-sestamibi and Tc-teboroxime. Clinical trials of myocardial perfusion with both tracers have shown results similar to those obtained with 201Tl for detection of coronary artery disease. Results to date indicate that Tc-sestamibi accurately detects and locates myocardial infarction and can accurately assess both left and right ventricular ejection fractions by the first-pass technique. In addition, research has shown that rest-stress studies can be performed on the same day and that Tc-sestamibi can be used to assess the results of thrombolytic therapy. Tc-teboroxime has excellent myocardial tracer uptake characteristics but is cleared very rapidly from the myocardium. These features make Tc-teboroxime well suited to rapid serial studies. These new technetium myocardial perfusion agents have just become available for routine clinical use and are likely to replace 201Tl in many of its clinical applications.

Experimental studies of the physiologic properties of technetium-99m agents: myocardial transport of perfusion imaging agents

The physiologic properties of new technetium-99m-labeled myocardial imaging agents (Tc-99m sestamibi, an isonitrile; and Tc-99m teboroxime, a boronic acid adduct of technetium dioxime) are discussed and compared to thallium-201 (Tl-201). Studies with isolated hearts, subcellular fractions and cell cultures indicate that Tc-99m sestamibi, Tc-99m teboroxime and Tl-201 do not share common transport or sequestration mechanisms. Although peak Tc-99m sestamibi myocardial extraction over time is about half that of Tl-201 at equivalent coronary blood flows, the amount of Tc-99m sestamibi that remains in the heart is similar to that of Tl-201 because of its higher retention efficiency. The high retention efficiency for Tc-99m sestamibi also results in minimal redistribution. In contrast, Tc-99m teboroxime myocardial extraction is higher than that of Tl-201, but its retention is less efficient, resulting in relatively rapid washout characteristics which may quickly result in tracer redistribution. During reperfusion after a no-flow period, Tc-99m sestamibi extraction and retention increase, but for Tc-99m teboroxime and Tl-201 these values tend to decrease. All tracers show adequate transport characteristics for perfusion imaging, and differences in transport and retention should lead to the development of new clinical protocols.

Comparison of SPECT using technetium-99m agents and thallium-201 and PET for the assessment of myocardial perfusion and viability

This report reviews the applications of tomographic imaging with current and new tracers in assessing myocardial perfusion and viability. Multiple studies with thallium-201 (TI-201) single photon emission computed tomography (SPECT) imaging for the detection of coronary artery disease (CAD) have demonstrated high sensitivity, high rates of normalcy and high reproducibility. In assessing viability, fixed defects are frequently detected in viable zones in 4-hour studies with TI-201 imaging. Redistribution imaging performed 18 to 72 hours after injection or reinjection of TI-201 before 4-hour redistribution imaging has been shown to improve accuracy of viability assessment. TI-201 SPECT studies are limited by the suboptimal physical properties of TI-201, which result in variable image quality. The 2 new technetium-99m (Tc-99m) - labeled myocardial perfusion tracers offer the ability to inject much higher amounts of radioactivity, making it possible to assess ventricular function as well as myocardial perfusion from the same injection of radiotracer. Tc-99m sestamibi has very slow myocardial clearance, which allows for prolonged imaging time and results in image quality superior to that obtained with TI-201 and Tc-99m teboroxime. The combination of minimal redistribution of Tc-99m sestamibi and high count rates makes gated SPECT imaging feasible, and also permits assessment of patients with acute ischemic syndromes by uncoupling the time of injection from the time of imaging. The combination of high image quality and first-pass exercise capabilities may lead to a choice of this agent over TI-201 for assessment of chronic CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiopharmaceuticals for imaging myocardial perfusion

A replacement for 201Tl used in myocardial perfusion imaging with a 99mTc-labeled complex is a long-sought goal. Now, at least three varieties of 99mTc-complexes are being made available for clinical studies. This review summarizes the development of these agents and presents basic research data accumulated in this area. Also, relevant clinical radiopharmaceutical protocols and relative merits of competing 99mTc-agents are discussed.