Radioimmunotherapy of infection with Bi-labeled antibodies

Review of proposed different irradiation methods to inactivate food-processing viruses and microorganisms

Coronaviruses, which have been enveloped nonsegmented positive-sense RNA viruses, were first mentioned in the mid-1960s and can attack people as well as a wide range of animals (including mammals and birds). Three zoonotic coronaviruses have been identified as the cause of large-scale epidemics over the last two decades: Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and swine acute diarrhea syndrome (SADS). Epithelial cells in the respiratory and gastrointestinal tract are the principal targeted cells, and viral shedding occurs via these systems in diverse ways such as through fomites, air, or feces. Patients infected with the novel coronavirus (2019-nCoV) reported having visited the Wuhan seafood wholesale market shortly before disease onset. The clinical data on established 2019-nCoV cases reported so far indicate a milder disease course than that described for patients with SARS-CoV or MERS-CoV. This study aimed to review radiation inactivation of these viruses in the food industry in three sections: visible light, ionizing radiation (alpha ray, beta ray, X-ray, gamma ray, neutron, plasma, and ozone), and nonionizing radiation (microwave, ultraviolet, infrared, laser light, and radiofrequency). Due to the obvious possibility of human-to-human and animal-to-human transmission, using at least one of these three methods in food processing and packaging during coronavirus outbreaks will be critical for preventing further outbreaks at the community level.

Emerging Preclinical and Clinical Applications of Theranostics for Nononcological Disorders

Studies in nuclear medicine have shed light on molecular imaging and therapeutic approaches for oncological and nononcological conditions. Using the same radiopharmaceuticals for diagnosis and therapeutics of malignancies, the theranostics approach, has improved clinical management of patients. Theranostic approaches for nononcological conditions are recognized as emerging topics of research. This review focuses on preclinical and clinical studies of nononcological disorders that include theranostic strategies. Theranostic approaches are demonstrated as possible in the clinical management of infections and inflammations. There is an emerging need for randomized trials to specify the factors affecting validity and efficacy of theranostic approaches in nononcological diseases.

Measurement of 227Ac impurity in 225Ac using decay energy spectroscopy

²²⁵Ac is a valuable medical radionuclide for targeted α therapy, but ²²⁷Ac is an undesirable byproduct of an accelerator-based synthesis method under investigation. Sufficient detector sensitivity is critical for quantifying the trace impurity of ²²⁷Ac, with the ²²⁷Ac/²²⁵Ac activity ratio predicted to be approximately 0.15% by end-of-bombardment (EOB). Superconducting transition edge sensor (TES) microcalorimeters offer high resolution energy spectroscopy using the normal-to-superconducting phase transition to measure small changes in temperature. By embedding ²²⁵Ac production samples in a gold foil thermally coupled to a TES microcalorimeter we can measure the decay energies of the radionuclides embedded with high resolution and 100% detection efficiency. This technique, known as decay energy spectroscopy (DES), collapses several peaks from α decays into single Q-value peaks. In practice there are more complex factors in the interpretation of data using DES, which we will discuss herein. Using this technique we measured the EOB ²²⁷Ac impurity to be (0.142 ± 0.005)% for a single production sample. This demonstration has shown that DES is a useful tool for quantitative measurements of complicated spectra.

Improved safety and efficacy of 213Bi-DOTATATE-targeted alpha therapy of somatostatin receptor-expressing neuroendocrine tumors in mice pre-treated with L-lysine

Background

Targeted alpha therapy (TAT) offers advantages over current β-emitting conjugates for peptide receptor radionuclide therapy (PRRT) of neuroendocrine tumors. PRRT with ¹⁷⁷Lu-DOTATATE or ⁹⁰Y-DOTATOC has shown dose-limiting nephrotoxicity due to radiopeptide retention in the proximal tubules. Pharmacological protection can reduce renal uptake of radiopeptides, e.g., positively charged amino acids, to saturate in the proximal tubules, thereby enabling higher radioactivity to be safely administered. The aim of this preclinical study was to evaluate the therapeutic effect of ²¹³Bi-DOTATATE with and without renal protection using L-lysine in mice. Tumor uptake and kinetics as a function of injected mass of peptide (range 0.03–3 nmol) were investigated using ¹¹¹In-DOTATATE. These results allowed estimation of the mean radiation absorbed tumor dose for ²¹³Bi-DOTATATE. Pharmacokinetics and dosimetry of ²¹³Bi-DOTATATE was determined in mice, in combination with renal protection. A dose escalation study with ²¹³Bi-DOTATATE was performed to determine the maximum tolerated dose (MTD) with and without pre-administration of l-lysine as for renal protection. Neutrophil gelatinase-associated lipocalin (NGAL) served as renal biomarker to determine kidney injury.

Results

The maximum mean radiation absorbed tumor dose occurred at 0.03 nmol and the minimum at 3 nmol. Similar mean radiation absorbed tumor doses were determined for 0.1 and 0.3 nmol with a mean radiation absorbed dose of approximately 0.5 Gy/MBq ²¹³Bi-DOTATATE. The optimal mass of injected peptide was found to be 0.3 nmol. Tumor uptake was similar for ¹¹¹In-DOTATATE and ²¹³Bi-DOTATATE at 0.3 nmol peptide. Lysine reduced the renal uptake of ²¹³Bi-DOTATATE by 50% with no effect on the tumor uptake. The MTD was <13.0 ± 1.6 MBq in absence of l-lysine and 21.7 ± 1.9 MBq with l-lysine renal protection, both imparting an LD₅₀ mean renal radiation absorbed dose of 20 Gy. A correlation was found between the amount of injected radioactivity and NGAL levels.

Conclusions

The therapeutic potential of ²¹³Bi-DOTATATE was illustrated by significantly decreased tumor burden and improved overall survival. Renal protection with l-lysine immediately prior to TAT with ²¹³Bi-DOTATATE prolonged survival providing substantial evidence for pharmacological nephron blockade to mitigate nephrotoxicity.

Electronic supplementary material

The online version of this article (doi:10.1186/s13550-016-0240-5) contains supplementary material, which is available to authorized users.

Cancer radioimmunotherapy

Targeting of radionuclides with antibodies, or radioimmunotherapy, has been an active field of research spanning nearly 50 years, evolving with advancing technologies in molecular biology and chemistry, and with many important preclinical and clinical studies illustrating the benefits, but also the challenges, which all forms of targeted therapies face. There are currently two radiolabeled antibodies approved for the treatment of non-Hodgkin lymphoma, but radioimmunotherapy of solid tumors remains a challenge. Novel antibody constructs, focusing on treatment of localized and minimal disease, and pretargeting are all promising new approaches that are currently under investigation.