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Buckle T, Rietbergen DDD, de Wit-van der Veen L, Schottelius M. Lessons learned in application driven imaging agent design for image-guided surgery. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06791-x. [PMID: 38900308 DOI: 10.1007/s00259-024-06791-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
To meet the growing demand for intraoperative molecular imaging, the development of compatible imaging agents plays a crucial role. Given the unique requirements of surgical applications compared to diagnostics and therapy, maximizing translational potential necessitates distinctive imaging agent designs. For effective surgical guidance, exogenous signatures are essential and are achievable through a diverse range of imaging labels such as (radio)isotopes, fluorescent dyes, or combinations thereof. To achieve optimal in vivo utility a balanced molecular design of the tracer as a whole is required, which ensures a harmonious effect of the imaging label with the affinity and specificity (e.g., pharmacokinetics) of a pharmacophore/targeting moiety. This review outlines common design strategies and the effects of refinements in the molecular imaging agent design on the agent's pharmacological profile. This includes the optimization of affinity, pharmacokinetics (including serum binding and target mediated background), biological clearance route, the achievable signal intensity, and the effect of dosing hereon.
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Affiliation(s)
- Tessa Buckle
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - Daphne D D Rietbergen
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
- Section Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda de Wit-van der Veen
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Margret Schottelius
- Translational Radiopharmaceutical Sciences, Department of Nuclear Medicine and Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Rue du Bugnon 25A, Agora, Lausanne, CH-1011, Switzerland.
- Agora, pôle de recherche sur le cancer, Lausanne, Switzerland.
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Hamdy FC, Lamb AD, Tullis IDC, Verrill C, Rombach I, Rao SR, Colling R, Barber PR, Volpi D, Barbera-Martin L, Lopez JF, Omer A, Hewitt A, Lovell S, Niederer J, Lambert A, Snoeck J, Thomson C, Leslie T, Bryant RJ, Mascioni A, Jia F, Torgov M, Wilson I, Gudas J, Wu AM, Olafsen T, Vojnovic B. First-in-man study of the PSMA Minibody IR800-IAB2M for molecularly targeted intraoperative fluorescence guidance during radical prostatectomy. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06713-x. [PMID: 38853153 DOI: 10.1007/s00259-024-06713-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/10/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Prostate-specific membrane antigen (PSMA) is increasingly used to image prostate cancer in clinical practice. We sought to develop and test a humanised PSMA minibody IAB2M conjugated to the fluorophore IRDye 800CW-NHS ester in men undergoing robot-assisted laparoscopic radical prostatectomy (RARP) to image prostate cancer cells during surgery. METHODS The minibody was evaluated pre-clinically using PSMA positive/negative xenograft models, following which 23 men undergoing RARP between 2018 and 2020 received between 2.5 mg and 20 mg of IR800-IAB2M intravenously, at intervals between 24 h and 17 days prior to surgery. At every step of the procedure, the prostate, pelvic lymph node chains and extra-prostatic surrounding tissue were imaged with a dual Near-infrared (NIR) and white light optical platform for fluorescence in vivo and ex vivo. Histopathological evaluation of intraoperative and postoperative microscopic fluorescence imaging was undertaken for verification. RESULTS Twenty-three patients were evaluated to optimise both the dose of the reagent and the interval between injection and surgery and secure the best possible specificity of fluorescence images. Six cases are presented in detail as exemplars. Overall sensitivity and specificity in detecting non-lymph-node extra-prostatic cancer tissue were 100% and 65%, and 64% and 64% respectively for lymph node positivity. There were no side-effects associated with administration of the reagent. CONCLUSION Intraoperative imaging of prostate cancer tissue is feasible and safe using IR800-IAB2M. Further evaluation is underway to assess the benefit of using the technique in improving completion of surgical excision during RARP. REGISTRATION ISCRCTN10046036: https://www.isrctn.com/ISRCTN10046036 .
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Affiliation(s)
- Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK.
- Oxford University Hospitals NHS Trust, Oxford, UK.
| | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ines Rombach
- Oxford Clinical Trials Research Unit and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- University of Sheffield, School of Medicine and Population Health, Sheffield, UK
| | - Srinivasa R Rao
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
| | - Richard Colling
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Paul R Barber
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Davide Volpi
- Department of Oncology, University of Oxford, Oxford, UK
| | | | - J Francisco Lopez
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Altan Omer
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Aimi Hewitt
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
| | - Shelagh Lovell
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jane Niederer
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Adam Lambert
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
| | - Joke Snoeck
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
| | - Claire Thomson
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
| | - Tom Leslie
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Fang Jia
- ImaginAb, Inc, Inglewood, CA, USA
| | | | | | | | - Anna M Wu
- Beckman Research Institute, City of Hope, Duarte, CA, 91010, USA
| | - Tove Olafsen
- Beckman Research Institute, City of Hope, Duarte, CA, 91010, USA
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Jiao J, Zhang J, Wen W, Qin W, Chen X. Prostate-specific membrane antigen-targeted surgery in prostate cancer: Accurate identification, real-time diagnosis, and precise resection. Theranostics 2024; 14:2736-2756. [PMID: 38773975 PMCID: PMC11103491 DOI: 10.7150/thno.95039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/11/2024] [Indexed: 05/24/2024] Open
Abstract
Radical prostatectomy (RP) combined with pelvic lymph node dissection (PLND) is the first step in multimodal treatment of prostate cancer (PCa) without distant metastases. For a long time, the surgical resection range has been highly dependent on the surgeon's visualization and experience with preoperative imaging. With the rapid development of prostate-specific membrane antigen positron emission tomography and single-photon emission computed tomography (PSMA-PET and PSMA-SPECT), PSMA-targeted surgery has been introduced for a more accurate pathological diagnosis and complete resection of positive surgical margins (PSMs) and micro-lymph node metastases (LNMs). We reviewed PSMA-targeted surgeries, including PSMA-PET-guided prostatic biopsy (PSMA-TB), PSMA-targeted radio-guided surgery (PSMA-RGS), PSMA-targeted fluorescence-guided surgery (PSMA-FGS), and multi-modality/multi-targeted PSMA-targeted surgery. We also discuss the strengths and challenges of PSMA-targeted surgery, and propose that PSMA-targeted surgery could be a great addition to existing surgery protocols, thereby improving the accuracy and convenience of surgery for primary and recurrent PCa in the near future.
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Affiliation(s)
- Jianhua Jiao
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
- Innovation Center for Tumor Immunocytology Therapy Technology, Xijing Innovation Research Institute, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jingjing Zhang
- Departments of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119074, Singapore
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore
- Nanomedicine Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Theranostics Center of Excellenece, Yong Loo Lin School of Medicine, National University of Singapore, 11 Biopolis Way, Helios, Singapore 138667, Singapore
| | - Weihong Wen
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, Shaanxi, China
| | - Weijun Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
- Innovation Center for Tumor Immunocytology Therapy Technology, Xijing Innovation Research Institute, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaoyuan Chen
- Departments of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119074, Singapore
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore
- Nanomedicine Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology, and Research (A*STAR), 61 Biopolis Drive, Proteos, 138673, Singapore, Singapore
- Theranostics Center of Excellenece, Yong Loo Lin School of Medicine, National University of Singapore, 11 Biopolis Way, Helios, Singapore 138667, Singapore
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Declerck NB, Huygen C, Mateusiak L, Stroet MCM, Hernot S. The GEM-handle as convenient labeling strategy for bimodal single-domain antibody-based tracers carrying 99mTc and a near-infrared fluorescent dye for intra-operative decision-making. Front Immunol 2023; 14:1285923. [PMID: 38035094 PMCID: PMC10684908 DOI: 10.3389/fimmu.2023.1285923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Intra-operative fluorescence imaging has demonstrated its ability to improve tumor lesion identification. However, the limited tissue penetration of the fluorescent signals hinders the detection of deep-lying or occult lesions. Integrating fluorescence imaging with SPECT and/or intra-operative gamma-probing synergistically combines the deep tissue penetration of gamma rays for tumor localization with the precision of fluorescence imaging for precise tumor resection. In this study, we detail the use of a genetically encoded multifunctional handle, henceforth referred to as a GEM-handle, for the development of fluorescent/radioactive bimodal single-domain antibody (sdAb)-based tracers. A sdAb that targets the urokinase plasminogen activator receptor (uPAR) was engineered to carry a GEM-handle containing a carboxy-terminal hexahistidine-tag and cysteine-tag. A two-step labeling strategy was optimized and applied to site-specifically label IRDye800CW and 99mTc to the sdAb. Bimodal labeling of the sdAbs proved straightforward and successful. 99mTc activity was however restricted to 18.5 MBq per nmol fluorescently-labeled sdAb to prevent radiobleaching of IRDye800CW without impeding SPECT/CT imaging. Subsequently, the in vivo biodistribution and tumor-targeting capacity of the bimodal tracer were evaluated in uPAR-positive tumor-bearing mice using SPECT/CT and fluorescence imaging. The bimodal sdAb showed expected renal background signals due to tracer clearance, along with slightly elevated non-specific liver signals. Four hours post-injection, both SPECT/CT and fluorescent images achieved satisfactory tumor uptake and contrast, with significantly higher values observed for the anti-uPAR bimodal sdAb compared to a control non-targeting sdAb. In conclusion, the GEM-handle is a convenient method for designing and producing bimodal sdAb-based tracers with adequate in vivo characteristics.
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Affiliation(s)
| | | | | | | | - Sophie Hernot
- Molecular Imaging and Therapy Laboratory (MITH), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Sharma S, Cwiklinski K, Sykes DE, Mahajan SD, Chevli K, Schwartz SA, Aalinkeel R. Use of Glycoproteins-Prostate-Specific Membrane Antigen and Galectin-3 as Primary Tumor Markers and Therapeutic Targets in the Management of Metastatic Prostate Cancer. Cancers (Basel) 2022; 14:cancers14112704. [PMID: 35681683 PMCID: PMC9179331 DOI: 10.3390/cancers14112704] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Prostate specific membrane antigen and galectins are proteins expressed on cell surface and their expression is associated with cancer growth and spread. The goal of this research was to look at the pattern of these two glycoproteins in the human prostate cancer microenvironment. Prostate specific membrane antigen and galectins-1,3 and 8 were the most frequently detected glycoproteins in various phases of this disease. Furthermore, prostate specific membrane antigen and galectin-3 expression are good indicators of tumor aggressiveness, and their combined expression can be valuable tool for prostate cancer diagnosis and treatment in future. Together, our findings reveal a tightly regulated “Prostate specific membrane antigen-galectin-pattern” that accompanies disease in prostate cancer and point to a key role for combined prostate specific membrane antigen and galectin-3 inhibitors in prostate cancer treatment along with standard chemotherapy. Abstract Galectins and prostate specific membrane antigen (PSMA) are glycoproteins that are functionally implicated in prostate cancer (CaP). We undertook this study to analyze the “PSMA-galectin pattern” of the human CaP microenvironment with the overarching goal of selecting novel-molecular targets for prognostic and therapeutic purposes. We examined CaP cells and biopsy samples representing different stages of the disease and found that PSMA, Gal-1, Gal-3, and Gal-8 are the most abundantly expressed glycoproteins. In contrast, other galectins such as Gal-2, 4–7, 9–13, were uniformly expressed at lower levels across all cell lines. However, biopsy samples showed markedly higher expression of PSMA, Gal-1 and Gal-3. Independently PSA and Gleason score at diagnosis correlated with the expression of PSMA, Gal-3. Additionally, the combined index of PSMA and Gal-3 expression positively correlated with Gleason score and was a better predictor of tumor aggressiveness. Together, our results recognize a tightly regulated “PSMA-galectin- pattern” that accompanies disease in CaP and highlight a major role for the combined PSMA and Gal-3 inhibitors along with standard chemotherapy for prostate cancer treatment. Inhibitor combination studies show enzalutamide (ENZ), 2-phosphonomethyl pentanedioic acid (2-PMPA), and GB1107 as highly cytotoxic for LNCaP and LNCaP-KD cells, while Docetaxel (DOC) + GB1107 show greater efficacy in PC-3 cells. Overall, 2-PMPA and GB1107 demonstrate synergistic cytotoxic effects with ENZ and DOC in various CaP cell lines.
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Affiliation(s)
- Satish Sharma
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Clinical and Translational Research Center, 875 Ellicott St., Buffalo, NY 14203, USA; (S.S.); (K.C.); (D.E.S.); (S.D.M.); (S.A.S.)
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA;
| | - Katherine Cwiklinski
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Clinical and Translational Research Center, 875 Ellicott St., Buffalo, NY 14203, USA; (S.S.); (K.C.); (D.E.S.); (S.D.M.); (S.A.S.)
| | - Donald E. Sykes
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Clinical and Translational Research Center, 875 Ellicott St., Buffalo, NY 14203, USA; (S.S.); (K.C.); (D.E.S.); (S.D.M.); (S.A.S.)
| | - Supriya D. Mahajan
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Clinical and Translational Research Center, 875 Ellicott St., Buffalo, NY 14203, USA; (S.S.); (K.C.); (D.E.S.); (S.D.M.); (S.A.S.)
| | - Kent Chevli
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA;
| | - Stanley A. Schwartz
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Clinical and Translational Research Center, 875 Ellicott St., Buffalo, NY 14203, USA; (S.S.); (K.C.); (D.E.S.); (S.D.M.); (S.A.S.)
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA;
| | - Ravikumar Aalinkeel
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Clinical and Translational Research Center, 875 Ellicott St., Buffalo, NY 14203, USA; (S.S.); (K.C.); (D.E.S.); (S.D.M.); (S.A.S.)
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA;
- Correspondence: ; Tel.: +1-716-888-4778
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