Modifying the in vitro accumulation of BMS181321, a technetium-99m-nitroimidazole, with unlabelled nitroaromatics

Untiring Pursuit for Glucarate-Based Molecular Imaging Probes

Glucarate, a physiologic end-product of the D-glucuronic acid pathway in mammals, is a six-carbon dicarboxylic acid with a wide range of uses. Glucarate-based molecular imaging probes including [^99mTc]glucarate and [¹⁸F]glucarate have been developed and demonstrated to have infarct/necrosis-avid and/or tumor-seeking properties, showing potential applications in early detection of myocardial infarction, evaluation of tissue viability, monitoring of therapeutic effectiveness, and noninvasive imaging of certain tumors including drug-resistant ones. The mechanism by which [^99mTc]glucarate localizes in acute necrotic tissues has been demonstrated to be largely attributable to its binding to the positively charged histones, which become accessible after the disruption of the cell and nuclear membranes as a result of irreversible damage, while the tumor-seeking mechanism of [^99mTc]glucarate has been found to be closely related to glucose transporter 5 expression. Moreover, the recently developed [¹⁸F]glucarate provides a new alternative probe for positron emission tomography imaging and may have potential advantages over [^99mTc]glucarate. In this review, we present the untiring pursuit for glucarate-based molecular imaging probes as infarct/necrosis-avid agent and/or tumor-seeking agent. Moreover, the limitations and the prospects for future research of glucarate-based molecular probes are also discussed.

Accumulation of technetium-99m glucarate: in vitro cell cultures and in vivo tumour models

99mTc-glucarate is an investigational radiopharmaceutical which has been shown to accumulate in acute cerebral and myocardial injuries and in some tumours. In the present work, a survey of possible factors affecting the cellular accumulation of 99mTc-glucarate was carried out in cell lines and strains in vitro and in murine tumours in vivo. Accumulation was enhanced under hypoxic conditions in 12 of the 16 human and murine cell lines and strains studied, and inhibited in the presence of nitroimidazoles. At temperatures lower than 37 degrees C, accumulation was reduced, but a hypoxic/aerobic differential was maintained. Aerobic accumulation of 99mTc-glucarate was enhanced by cyanide. In transplanted tumours in mice, 99mTc-glucarate showed high tumour/muscle and tumour/blood ratios at early times after injection. Pharmacological enhancement of the extent of hypoxia by the administration of hydralazine or nitro-L-arginine resulted in significantly increased accumulation of 99mTc-glucarate in the tumour. The in vitro and in vivo properties of 99mTc-glucarate suggest that it may be useful for tumour imaging in the clinic, although the exact mechanism(s) by which it localizes in tumours remains unknown.

Flux through multicellular layers of a technetium-99m-nitroimidazole for imaging hypoxia

BRU59-21 is a technetium-99m-nitroimidazole being investigated as a noninvasive marker of tumor hypoxia. Metabolic depletion of BRU59-21, which is used at picomolar concentrations, could limit its ability to reach all hypoxic tumor cells. The multicellular layer (MCL) system, an in vitro model of the extravascular space, was used to assess the ability of BRU59-21 to diffuse to, and beyond, the target population of hypoxic cells. The flux of radioactivity through the MCL system was dependent on the oxygen concentration in the gas phase. Decreased flux and increased metabolism of BRU59-21 were observed under hypoxic compared with aerobic conditions. Analysis of the radioactivity, which passes through the hypoxic MCL, revealed that a proportion of the radioactivity was unmetabolized BRU59-21, but a significant fraction was free pertechnetate. The oxygen dependency of the flux of BRU59-21 required the presence of the nitroimidazole group and was not observed at 4 degrees C, indicating an enzymatic process is required to observe this effect. These findings suggest that metabolic depletion of BRU59-21 is not a major limit to its ability to reach hypoxic cells, but drug metabolism resulting in release of the radioactive label may reduce the ability of BRU59-21 to selectively label hypoxic cells in solid tumors.

Cellular accumulation and retention of the technetium-99m-labelled hypoxia markers BRU59-21 and butylene amine oxime

BRU59-21 and 99mTc-butylene amine oxime (BnAO, HL91) are being evaluated for imaging hypoxia in tumors. Both tracers: 1) rapidly reached a plateau in aerobic Chinese hamster ovary cells in vitro but continuously accumulated in hypoxic cells; 2) ceased to accumulate when hypoxic cells were exposed to air; 3) showed approximately 40% retention upon washing the cells; 4) showed selective hypoxic accumulation only at 37 degrees C; 5) accumulation could be modulated by addition of electron-affinic compounds; and 6) exhibited higher accumulation in cells which overexpress cytochrome P450 reductase. Both BRU59-21 and 99mTc-BnAO share properties making them suitable for hypoxia imaging.

Imaging hypoxia in tumors

For many years, it has been known that hypoxia affects the response to radiotherapy in human cancers. Hypoxic regions can develop as a tumor grows beyond the ability of its blood supply to deliver oxygen to the full extent of the tumor, exacerbated by vascular spasm or compression caused by increased interstitial fluid pressure. However, hypoxia is heterogeneous, and tumors that appear identical by clinical and radiographic criteria can vary greatly in their extent of hypoxia. Several invasive procedures to measure hypoxia in tumors have been developed and are predictive of response to therapy, but none of these is in routine clinical use because of technical complexity, inconvenience, and inability to obtain repeated measures. Noninvasive imaging with a hypoxia-directed radiopharmaceutical could be of great clinical utility. Most such radiopharmaceuticals under development use 2-nitroimidazole as the targeting moiety. 2-Nitroimidazole, which is selectively reduced and bound in hypoxic tissues, has been labeled with F-18, Cu-64/67, I-123, and Tc-99m. Of these, F-18-fluoromisonidazole and I-123-iodoazomycin arabinoside (IAZA) have been most widely studied clinically. Non-nitro-containing bioreductive complexes, such as the Cu-60/62/64 thiosemicarbazone ATSM and Tc-99m butylene amineoxime (BnAO or HL91), have also been evaluated. In particular, 1-123-IAZA and Cu-60-ATSM have shown correlation with response to radiotherapy in preliminary clinical studies. However, more preclinical studies comparing imaging with validated invasive methods and clinical studies with outcome measures are required. Nuclear medicine is poised to play an important role in optimizing the therapy of patients with hypoxic tumors.

Role of NADPH:cytochrome P450 reductase in the hypoxic accumulation and metabolism of BRU59-21, a technetium-99m-nitroimidazole for imaging tumor hypoxia

Nitroimidazoles labeled with technetium-99m are being investigated as non-invasive markers of tumor hypoxia. They are bioreductive compounds that require enzymatic reduction for retention in hypoxic cells, but little is known about the cellular factors affecting their accumulation in hypoxic cells. If the absolute accumulation of hypoxia markers is affected by enzyme levels, an inaccurate assessment of the hypoxic cell fraction in tumors may occur. BRU59-21, (99m)Tc-oxo[[3,3,9, 9-tetramethyl-6-[(2-nitro-1H-imidazol-1-yl)methyl]5-oxa-4, 8-diazadioximato]-(3-)-N,N',N",N"'] technetium (V), a technetium-99m-nitroimidazole that is being studied as a potential marker of tumor hypoxia, was used in the present study to evaluate the effect of NADPH:cytochrome P450 reductase (EC 1.6.2.4) levels on BRU59-21 accumulation and metabolism. Metabolism of BRU59-21 in hypoxic cellular lysates derived from Chinese hamster ovary cells overexpressing NADPH:cytochrome P450 reductase was 8-fold greater than in control cells. This effect required the presence of exogenous NADPH. The increased metabolism of BRU59-21 in lysates overexpressing NADPH:cytochrome P450 reductase was inhibited at 4 degrees and by the addition of NADPH:cytochrome P450 reductase inhibitors. The addition of inhibitors of other nitroreductase enzymes had no effect on BRU59-21 metabolism in these lysates. When the accumulation and metabolism of BRU59-21 were studied in stirred suspension cultures, it was found that cells overexpressing NADPH:cytochrome P450 reductase exhibited about a 3-fold increase in both the hypoxic metabolism and the accumulation of BRU59-21. These findings suggest that NADPH:cytochrome P450 reductase is an important enzyme in BRU59-21 metabolism in model systems of tumor hypoxia.

Studies of 99mTc-BnAO (HL-91): a non-nitroaromatic compound for hypoxic cell detection

PURPOSE

Solid tumours of similar type and stage can vary widely in their hypoxic cell fraction. Such cells may be prognostic for aggressive, metastatic, and radiation-resistant disease. A 99mtechnetium (99mTc)-labelled non-nitroaromatic agent, butyleneamine oxime (99mTc-BnAO) or HL-91 (Amersham International, Inc., Amersham, UK) has been evaluated both in vitro and in vivo for its possible efficacy as a noninvasive marker for the clinical detection of hypoxic cells in solid tumours.

MATERIALS AND METHODS

Suspension cultures of Chinese hamster ovary (CHO) cells under controlled levels of oxygen were used to measure the oxygen dependency of 99mTc-BnAO accumulation. V79 cells grown as multilayers on a semipermeable membrane served as an in vitro model for drug penetration through the extravascular space of the tumour. C3H mice bearing KHT-C leg tumours were the in vivo models for selective drug accumulation as a function of time after i.v. administration of 99mTc-BnAO.

RESULTS

99mTc accumulated selectively in hypoxic vs. aerobic cells, resulting in a 9 +/- 2-fold differential in radioactivity per cell at 4 h. The k(m) for this selective accumulation was 20 ppm of oxygen. The labelled drug was equally effective in penetrating the cellular multilayer under aerobic or hypoxic conditions. In vivo measurements indicated favourable labelling of solid tumours containing hypoxic cells with 1% of the total activity per g of tumour, a tumour-to-blood ratio of 1.2, and a tumour-to-muscle ratio of 4.6 at 4 to 6 h after drug administration. In contrast to more lipophilic 99mTc- labelled compounds, excretion was primarily via the urinary tract. Nitro-L-arginine selectively increased solid tumour labelling over normal tissue.

CONCLUSIONS

99mTc-BnAO or HL-91 is a promising agent for clinical studies of tumour hypoxia, although the mechanism of its selective hypoxic cell accumulation remains unexplained.