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Ching L, Bourne M, Kearney T, Choudhury K, Zwart AL, Danner MT, Suy S, Esposito G, Collins S. Distinguishing Physiological Ureter Uptake From an Involved Lymph Node in Staging Prostate-Specific Membrane Antigen (PSMA) Scans: Implications for Radiation Planning. Cureus 2024; 16:e63105. [PMID: 39055460 PMCID: PMC11271162 DOI: 10.7759/cureus.63105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Prostate-specific membrane antigen (PSMA) imaging has become a mainstay diagnostic tool in staging unfavorable primary prostate cancer (PC) and identifying sites of recurrence in previously treated PC. One of the biggest pitfalls of PSMA imaging is rapid radionucleotide excretion in the urine via the kidneys, ureters, and bladder. The positron-emission tomography (PET) images obtained show increased radiotracer activity in these structures, which can occlude or even mimic true malignant disease. We describe the diagnostic challenges encountered in differentiating benign versus malignant disease with PSMA scans. A 78-year-old male presented to our outpatient radiation oncology office with high-risk prostate cancer. His medical history was significant for ulcerative colitis (UC). Magnetic resonance imaging (MRI) revealed an enlarged prostate and a Prostate Imaging Reporting and Data System (PI-RADS) class 4 lesion. A subsequent transperineal biopsy confirmed unilateral Gleason 8 adenocarcinoma. A PSMA PET scan was read as increased uptake in the right prostate and a left external iliac node. The patient, having been initially informed of a positive lymph node metastasis, sought a second opinion,resulting in a CT urogram that revealed physiologic ureteral uptake. We were thus able to avoid lymph node radiation and morbidity to the surrounding bowel, already chronically inflamed with ulcerative colitis. This study demonstrates the potential for misinterpretation of PSMA uptake in the ureter as lymph node metastases. We discuss how peri-uretic activity can hinder accurate visualization of pelvic lymph node metastases. This study highlights the need for careful image interpretation of PSMA uptake patterns in order to avoid diagnostic errors and unnecessary radiation to at-risk organs in prostate cancer management.
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Affiliation(s)
- Lauren Ching
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Matthew Bourne
- Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Tim Kearney
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Karbi Choudhury
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Alan L Zwart
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Malika T Danner
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Simeng Suy
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Giuseppe Esposito
- Nuclear Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Sean Collins
- Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, USA
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Machulkin AE, Petrov SA, Bodenko V, Larkina MS, Plotnikov E, Yuldasheva F, Tretyakova M, Bezverkhniaia E, Zyk NY, Stasyuk E, Zelchan R, Majouga AG, Tolmachev V, Orlova A, Beloglazkina EK, Yusubov MS. Synthesis and Preclinical Evaluation of Urea-Based Prostate-Specific Membrane Antigen-Targeted Conjugates Labeled with 177Lu. ACS Pharmacol Transl Sci 2024; 7:1457-1473. [PMID: 38751647 PMCID: PMC11092120 DOI: 10.1021/acsptsci.4c00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024]
Abstract
177Lu-labeled small-molecule prostate-specific membrane antigen (PSMA) targeted tracers are therapeutic agents for metastatic castration-resistant prostate cancer. Optimizing molecular design holds the potential to further enhance the pharmacokinetic properties of PSMA-targeted agents while preserving their potent therapeutic effects. In this study, six novel N-[N-[(S)-1,3-dicarboxypropyl]carbamoyl]-(S)-l-lysine (DCL) urea-based PSMA ligand 2,2',2″,2‴-(1,4,7,10-tetraazacyclododecane-1,4,7,10-tetrayl)tetraacetic acid conjugates were synthesized. These conjugates feature polypeptide linkers containing the Phe-Phe peptide sequence and an aromatic fragment at the ε-NH-Lys group of the DCL fragment. The synthesis yielded products with satisfactory yields ranging from 60% to 72%, paving the way for their preclinical evaluation. The labeling of the new variants of urea-based PSMA inhibitors provided a radiochemical yield of over 95%. The 177Lu-labeled conjugates demonstrated specific and moderate affinity binding to PSMA-expressing human cancer cells PC3-pip in vitro and specific accumulation in PSMA-expressing xenografts in vivo. Based on the results, both the lipophilicity and the type of substituent in the linker significantly influence the binding properties of the PSMA inhibitor and its biodistribution profile. Specifically, the studied variants containing a bromine substituent or a hydroxyl group introduced into the aromatic fragment of the phenylalanyl residue in DCL exhibit higher affinities to PSMA compared to variants with only a chlorine-substituted aromatic fragment or variants without any substituents. The [177Lu]Lu-13C with the bromine substituent was characterized by the highest activity accumulation in blood, salivary glands, muscle, bone, and gastrointestinal tract and had inasmuch as an unfavorable pharmacokinetic profile. The negative charge of the carboxyl group in the phenyl moiety of the [177Lu]Lu-13A variant has demonstrated a positive effect on reducing the retention of activity in the liver and the kidneys (the ratio of tumor to kidneys was 1.3-fold). Low accumulation in normal tissues in vivo indicates that this novel PSMA-targeting inhibitor is a promising radioligand.
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Affiliation(s)
- Aleksei E. Machulkin
- Department
of Chemistry, M.V. Lomonosov Moscow State
University, Leninskie
Gory 1-3, Moscow 119991, Russian Federation
- Department
for Biochemistry, People’s Friendship
University of Russia Named after Patrice Lumumba (RUDN University), Moscow 117198, Russia
| | - Stanislav A. Petrov
- Department
of Chemistry, M.V. Lomonosov Moscow State
University, Leninskie
Gory 1-3, Moscow 119991, Russian Federation
| | - Vitalina Bodenko
- Research
Centrum for Oncotheranostics, Research School of Chemistry and Applied
Biomedical Sciences, Tomsk Polytechnic University, Tomsk 634050, Russia
- Scientific
and Educational Laboratory of Chemical and Pharmaceutical Research, Siberian State Medical University, Tomsk 634050, Russia
| | - Mariia S. Larkina
- Research
Centrum for Oncotheranostics, Research School of Chemistry and Applied
Biomedical Sciences, Tomsk Polytechnic University, Tomsk 634050, Russia
- Department
of Pharmaceutical Analysis, Siberian State
Medical University, Tomsk 634050, Russia
| | - Evgenii Plotnikov
- Research
Centrum for Oncotheranostics, Research School of Chemistry and Applied
Biomedical Sciences, Tomsk Polytechnic University, Tomsk 634050, Russia
- Mental
Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634014, Russia
| | - Feruza Yuldasheva
- Research
Centrum for Oncotheranostics, Research School of Chemistry and Applied
Biomedical Sciences, Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Maria Tretyakova
- Research
Centrum for Oncotheranostics, Research School of Chemistry and Applied
Biomedical Sciences, Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Ekaterina Bezverkhniaia
- Research
Centrum for Oncotheranostics, Research School of Chemistry and Applied
Biomedical Sciences, Tomsk Polytechnic University, Tomsk 634050, Russia
- Department
of Medicinal Chemistry, Uppsala University, Uppsala 75183, Sweden
| | - Nikolay Yu. Zyk
- Department
of Chemistry, M.V. Lomonosov Moscow State
University, Leninskie
Gory 1-3, Moscow 119991, Russian Federation
| | - Elena Stasyuk
- School of
Nuclear Science and Engineering, Tomsk Polytechnic
University, Tomsk 634050, Russia
| | - Roman Zelchan
- Research
Centrum for Oncotheranostics, Research School of Chemistry and Applied
Biomedical Sciences, Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Alexander G. Majouga
- Dmitry
Mendeleev University of Chemical Technology of Russia, Miusskaya sq. 9, Moscow 125047, Russian Federation
| | - Vladimir Tolmachev
- Department
of Immunology, Genetics and Pathology, Uppsala
University, Uppsala 75185, Sweden
| | - Anna Orlova
- Department
of Medicinal Chemistry, Uppsala University, Uppsala 75183, Sweden
| | - Elena K. Beloglazkina
- Department
of Chemistry, M.V. Lomonosov Moscow State
University, Leninskie
Gory 1-3, Moscow 119991, Russian Federation
| | - Mekhman S. Yusubov
- Research
Centrum for Oncotheranostics, Research School of Chemistry and Applied
Biomedical Sciences, Tomsk Polytechnic University, Tomsk 634050, Russia
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Froehner M, Görner M, Merkle L, Kopka K, Zöphel K. 18Fluorine Prostate-specific Membrane Antigen 1007 Positron Emission Tomography for High-risk Prostate Cancer. Urology 2024; 187:96-97. [PMID: 38423393 DOI: 10.1016/j.urology.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany.
| | - Matthias Görner
- Department of Nuclear Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Lennart Merkle
- Department of Nuclear Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Klaus Kopka
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; Faculty of Chemistry and Food Chemistry, School of Science, Technical University Dresden, Dresden, Germany
| | - Klaus Zöphel
- Department of Nuclear Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
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Faghihi H, Mozafari MR, Bumrungpert A, Parsaei H, Taheri SV, Mardani P, Dehkharghani FM, Pudza MY, Alavi M. Prospects and Challenges of Synergistic Effect of Fluorescent Carbon Dots, Liposomes and Nanoliposomes for Theragnostic Applications. Photodiagnosis Photodyn Ther 2023:103614. [PMID: 37201772 DOI: 10.1016/j.pdpdt.2023.103614] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/20/2023]
Abstract
The future of molecular-level therapy, efficient medical diagnosis, and drug delivery relies on the effective theragnostic function which can be achieved by the synergistic effect of fluorescent carbon dots (FCDs) liposomes (L) and nanoliposomes. FCDs act as the excipient navigation agent while liposomes play the role of the problem-solving agent, thus the term "theragnostic" would describe the effect of LFCDs properly. Liposomes and FCDs share some excellent at-tributes such as being nontoxic and biodegradable and they can represent a potent delivery system for pharmaceutical compounds. They enhance the therapeutic efficacy of drugs via stabilizing the encapsulated material by circumventing barriers to cellular and tissue uptake. These agents facilitate long-term drug biodistribution to the intended locations of action while eliminating systemic side effects. This manuscript reviews recent progress with liposomes, nanoliposomes (collectively known as lipid vesicles) and fluorescent carbon dots, by exploring their key characteristics, applications, characterization, performance, and challenges. An extensive and intensive understanding of the synergistic interaction between liposomes and FCDs sets out a new research pathway to an efficient and theragnostic / theranostic drug delivery and targeting diseases such as cancer.
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Affiliation(s)
- Homa Faghihi
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Iran University of Medical Sciences, Tehran 15459-13487, Iran.
| | - M R Mozafari
- Australasian Nanoscience and Nanotechnology Initiative (ANNI), Monash University LPO, Clayton, VIC 3168, Australia.
| | - Akkarach Bumrungpert
- Research Center of Nutraceuticals and Natural Products for Health & Anti-Aging, College of Integrative Medicine, Dhurakij Pundit University, Bangkok 10210, Thailand.
| | - Houman Parsaei
- Student Research Committee and Department of Anatomy, Semnan University of Medical Sciences, Semnan, Iran.
| | - Seyed Vahid Taheri
- Student Research Committee and Department of Anatomy, Semnan University of Medical Sciences, Semnan, Iran.
| | - Parisa Mardani
- Australasian Nanoscience and Nanotechnology Initiative (ANNI), Monash University LPO, Clayton, VIC 3168, Australia
| | - Farnaz Mahdavi Dehkharghani
- Australasian Nanoscience and Nanotechnology Initiative (ANNI), Monash University LPO, Clayton, VIC 3168, Australia
| | - Musa Yahaya Pudza
- Department of Chemical and Environmental Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
| | - Mehran Alavi
- Department of Biological Science, Faculty of Science, University of Kurdistan, Sanandaj, Kurdistan, 6617715175, Iran.
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Shah H, Ravi P, Sonpavde G, Jacene H. Lutetium Lu 177 vipivotide tetraxetan for metastatic castration-resistant prostate cancer. Expert Rev Anticancer Ther 2022; 22:1163-1175. [PMID: 36305305 DOI: 10.1080/14737140.2022.2139679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION 177Lu-vipivotide tetraxetan is a radiopharmaceutical that selectively targets prostate-specific membrane antigen (PSMA) and delivers beta-radiations to kill prostate cancer cells. AREAS COVERED Extensive experience outside the United States as well as randomized phase II and phase III data demonstrate that 177Lu-vipivotide tetraxetan is a safe, generally well tolerated, and effective therapy for men with mCRPC. 177Lu-vipivotide tetraxetan was approved by the FDA in March 2022 for the treatment of PSMA-positive metastatic castration-resistant prostate cancer (mCRPC) after androgen receptor pathway inhibition and taxane-based chemotherapy based on the results of the VISION trial. EXPERT OPINION This review discusses the development and studies leading to the approval of 177Lu-vipivotide tetraxetan. In all, 177Lu-vipivotide tetraxetan is an exciting new tool in the arsenal for men with mCRPC after novel androgen pathway inhibitors and at least one taxane chemotherapy. Optimal selection of patients, sequencing of 177Lu-vipivotide tetraxetan with the other agents available to treat mCRPC, and the use of dosimetry are current areas of interest with great potential and opportunities for further individual patient optimization using the tools of theranostics.
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Affiliation(s)
- Hina Shah
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Praful Ravi
- Harvard Medical School, Boston, MA, USA.,The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Guru Sonpavde
- Harvard Medical School, Boston, MA, USA.,The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Heather Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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The Role of Radiolabeled Monoclonal Antibodies in Cancer Imaging and ADC Treatment. Cancer J 2022; 28:446-453. [DOI: 10.1097/ppo.0000000000000625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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