18F-5-Fluoroaminosuberic Acid as a Potential Tracer to Gauge Oxidative Stress in Breast Cancer Models

The Role of Amino Acids in the Diagnosis, Risk Assessment, and Treatment of Breast Cancer: A Review

This review summarizes the role of amino acids in the diagnosis, risk assessment, imaging, and treatment of breast cancer. It was shown that the content of individual amino acids changes in breast cancer by an average of 10-15% compared with healthy controls. For some amino acids (Thr, Arg, Met, and Ser), an increase in concentration is more often observed in breast cancer, and for others, a decrease is observed (Asp, Pro, Trp, and His). The accuracy of diagnostics using individual amino acids is low and increases when a number of amino acids are combined with each other or with other metabolites. Gln/Glu, Asp, Arg, Leu/Ile, Lys, and Orn have the greatest significance in assessing the risk of breast cancer. The variability in the amino acid composition of biological fluids was shown to depend on the breast cancer phenotype, as well as the age, race, and menopausal status of patients. In general, the analysis of changes in the amino acid metabolism in breast cancer is a promising strategy not only for diagnosis, but also for developing new therapeutic agents, monitoring the treatment process, correcting complications after treatment, and evaluating survival rates.

The emerging roles of MAPK-AMPK in ferroptosis regulatory network

Ferroptosis, a newform of programmed cell death, driven by peroxidative damages of polyunsaturated-fatty-acid-containing phospholipids in cellular membranes and is extremely dependent on iron ions, which is differs characteristics from traditional cell death has attracted greater attention. Based on the curiosity of this new form of regulated cell death, there has a tremendous progress in the field of mechanistic understanding of ferroptosis recent years. Ferroptosis is closely associated with the development of many diseases and involved in many diseases related signaling pathways. Not only a variety of oncoproteins and tumor suppressors can regulate ferroptosis, but multiple oncogenic signaling pathways can also have a regulatory effect on ferroptosis. Ferroptosis results in the accumulation of large amounts of lipid peroxides thus involving the onset of oxidative stress and energy stress responses. The MAPK pathway plays a critical role in oxidative stress and AMPK acts as a sensor of cellular energy and is involved in the regulation of the energy stress response. Moreover, activation of AMPK can induce the occurrence of autophagy-dependent ferroptosis and p53-activated ferroptosis. In recent years, there have been new advances in the study of molecular mechanisms related to the regulation of ferroptosis by both pathways. In this review, we will summarize the molecular mechanisms by which the MAPK-AMPK signaling pathway regulates ferroptosis. Meanwhile, we sorted out the mysterious relationship between MAPK and AMPK, described the crosstalk among ferroptosis and MAPK-AMPK signaling pathways, and summarized the relevant ferroptosis inducers targeting this regulatory network. This will provide a new field for future research on ferroptosis mechanisms and provide a new vision for cancer treatment strategies. Video Abstract.

Comparative Evaluation of [18F]5-Fluoroaminosuberic Acid and (4S)-4-3-[18F]fluoropropyl)-l-Glutamate as System xC--Targeting Radiopharmaceuticals

System [Formula: see text] is an appealing biomarker for targeting oxidative stress with oncologic PET imaging and can serve as an alternative PET biomarker to other metabolic indicators. In this paper, we report a direct comparison of 2 ¹⁸F-labeled amino acid radiopharmaceuticals targeting system [Formula: see text], [¹⁸F]5-fluoroaminosuberic acid ([¹⁸F]FASu) and (4S)-4-(3-[¹⁸F]fluoropropyl)-l-glutamate ([¹⁸F]FSPG), in terms of their uptake specificity and ability to image glioma and lung cancer xenografts in vivo. Methods: Both tracers were synthesized according to previously published procedures. In vitro uptake specificity assays were conducted using prostate (PC-3), glioblastoma (U-87), colorectal (HT-29), ovarian (SKOV3), breast (MDA-MB-231), and lung cancer (A549) cell lines. PET/CT imaging and biodistribution studies were conducted in immunocompromised mice bearing U-87 or A549 xenografts. Results: In vitro cell uptake assays showed that the tracers accumulated in cancer cells in a time-dependent manner and that the uptake of [¹⁸F]FASu was blocked by the system [Formula: see text] inhibitor sulfasalazine and rose bengal, but not by system L inhibitor 2-aminobicyclo-(2,2,1)-heptane-2-carboxylic acid, system [Formula: see text] inhibitor L-trans-pyrrolidine-2,4-dicarboxylic acid, or l-serine, which is a substrate for transporter systems A, ACS, B⁰, and B^0,+ Conversely, [¹⁸F]FSPG uptake decreased significantly in the presence of an excess of L-trans-pyrrolidine-2,4-dicarboxylic acid in 2 of 3 tested cell lines, indicating some reliance on system [Formula: see text] in these cells. In an in vivo setting, [¹⁸F]FASu and [¹⁸F]FSPG generated good-contrast PET images in U-87 and A549 tumor-bearing mice. Tracer accumulation in A549 tumors was 5.0 ± 0.8 percentage injected dose (%ID)/g ([¹⁸F]FASu, n ≥ 5) and 6.3 ± 1.3 %ID/g ([¹⁸F]FSPG, n ≥ 6, P = 0.7786), whereas U-87 xenografts demonstrated uptake of 6.1 ± 2.4 %ID/g ([¹⁸F]FASu, n ≥ 4) and 11.2 ± 4.1 %ID/g ([¹⁸F]FSPG, n ≥ 4, P = 0.0321) at 1 h after injection. Conclusion: [¹⁸F]FSPG had greater in vitro uptake than [¹⁸F]FASu in all cell lines tested; however, our results indicate that residual uptake differences exist between [¹⁸F]FSPG and [¹⁸F]FASu, suggesting alternative transporter activity in the cell lines tested. In vivo studies demonstrated the ability of both [¹⁸F]FASu and [¹⁸F]FSPG to image glioblastoma (U-87) and non-small cell lung cancer (A549) xenografts.

Oxidative stress in multiple sclerosis-Emerging imaging techniques

While conventional magnetic resonance imaging (MRI) is central to the evaluation of patients with multiple sclerosis, its role in detecting the pathophysiology underlying neurodegeneration is more limited. One of the common outcome measures for progressive multiple sclerosis trials, atrophy on brain MRI, is non-specific and reflects end-stage changes after considerable neurodegeneration has occurred. Identifying biomarkers that identify processes underlying neurodegeneration before it is irreversible and that reflect relevant neurodegenerative pathophysiology is an area of significant need. Accumulating evidence suggests that oxidative stress plays a major role in the pathogenesis of multiple neurodegenerative diseases, including multiple sclerosis. Imaging markers related to inflammation, myelination, and neuronal integrity have been areas of advancement in recent years but oxidative stress has remained an area of unrealized potential. In this article we will begin by reviewing the role of oxidative stress in the pathogenesis of multiple sclerosis. Chronic inflammation appears to be directly related to the increased production of reactive oxygen species and the effects of subsequent oxidative stress appear to be amplified by aging and accumulating disease. We will then discuss techniques in development used in the assessment of MS as well as other models of neurodegenerative disease in which oxidative stress is implicated. Multiple blood and CSF markers of oxidative stress have been evaluated in subjects with MS, but non-invasive imaging offers major upside in that it provides real-time assessment within the brain.

Evaluation of sulfone-labeled amino acid derivatives as potential PET agents for cancer imaging

INTRODUCTION

As one of the most important and frequently used molecular imaging techniques in the clinic, positron emission tomography (PET) features high sensitivity and specificity, which generally involves the use of PET contrast agents. Despite the exceptional promise, the availability of novel PET agents could limit its application and there is a clear need to develop new PET agents to improve our understanding of targets of interest and increase the diagnostic specificity.

METHODS

Based on the fact that amino acid transport and protein anabolism are increased in tumor tissues, a series of ¹⁸F-labeled amino acid analog was labeled with ¹⁸F by using [¹⁸F]fluoro-4-(vinylsulfonyl)benzene as the radionuclide linker. The obtained probes were subjected to in vitro and in vivo evaluation, including stability, cell line transport channel specificity, PET/CT imaging on tumor and inflammation bearing mice, and biodistribution.

RESULTS

Our data shows that [¹⁸F]2a had moderate decay corrected labeling yield (>42 %) and high radiochemical purity (>99 %). When tested in vivo, the uptake of [¹⁸F]2a was 1.5 ± 0.2%ID/g in NCI-H1975 tumors and 1.1 ± 0.2%ID/g in inflammatory tissues. In contrast, the values for [¹⁸F]FDG were 5.7 ± 0.2%ID/g and 4.8 ± 0.1%ID/g, respectively. The inflammatory lesion-to-muscle contrast is 2.4 for [¹⁸F]2a, which is 3.0 for [¹⁸F]FDG.

CONCLUSION

Clearly, [¹⁸F]2a hold the great potential for cancer imaging. Its application in distinguishing tumor from inflammatory lesion would still need to be investigated further.

Radiotracers for Nuclear Imaging of Reactive Oxygen Species: Advances Made So Far

Reactive oxygen species (ROS) are a cluster of highly reactive and short-lived oxygen-containing molecules that lead to metabolic disorders where production exceeds catabolism in an organism. Many specific radiotracers for positron/single-photon emission tomography have been developed to reveal the discrepancy of ROS levels in normal and damaged tissues and further clarify the relationship between ROS and diseases. This review summarizes the advances achieved for the development of ROS radiotracers to date. The structure design, radiosynthesis, and imaging performance of existing radiotracers are discussed with the individual ROS-response mechanisms highlighted.

Redox Monitoring in Nuclear Medical Imaging

Significance: The imbalance in redox homeostasis is known as oxidative stress, which is relevant to many diseases such as cancer, arteriosclerosis, and neurodegenerative disorders. Overproduction of reactive oxygen species (ROS) is one of the factors that trigger the redox state imbalance in vivo. The ROS have high reactivity and impair biomolecules, whereas antioxidants and antioxidant enzymes, such as ascorbate and glutathione, reduce the overproduction of ROS to rectify the redox imbalance. Owing to this, redox monitoring tools have been developed to understand the redox fluctuations in oxidative stress-related diseases. Recent Advances: In an attempt to monitor redox substances, including ROS and radical species, versatile modalities have been developed, such as electron spin resonance, chemiluminescence, and fluorescence. In particular, many fluorescent probes have been developed that are selective for ROS. This has significantly contributed to understanding the relevance of ROS in disease onset and progression. Critical Issues: To date, the dynamics of ROS and radical fluctuation in in vivo redox states remain unclear, and there are a few methods for the in vivo detection of redox fluctuations. Future Directions: In this review, we summarize the development of radiolabeled probes for monitoring redox-relevant species by nuclear medical imaging that is applicable in vivo. In the future, translational research is likely to be advanced through the development of highly sensitive and in vivo applicable detection methods, such as nuclear medical imaging, to clarify the underlying dynamics of ROS, radicals, and redox substances in many diseases. Antioxid. Redox Signal. 36, 797-810.

Non-conventional and Investigational PET Radiotracers for Breast Cancer: A Systematic Review

Breast cancer is one of the most common malignancies in women, with high morbidity and mortality rates. In breast cancer, the use of novel radiopharmaceuticals in nuclear medicine can improve the accuracy of diagnosis and staging, refine surveillance strategies and accuracy in choosing personalized treatment approaches, including radioligand therapy. Nuclear medicine thus shows great promise for improving the quality of life of breast cancer patients by allowing non-invasive assessment of the diverse and complex biological processes underlying the development of breast cancer and its evolution under therapy. This review aims to describe molecular probes currently in clinical use as well as those under investigation holding great promise for personalized medicine and precision oncology in breast cancer.

Radionuclide-Based Imaging of Breast Cancer: State of the Art

Simple Summary

Breast cancer is one of the most commonly diagnosed malignant tumors, possessing high incidence and mortality rates that threaten women’s health. Thus, early and effective breast cancer diagnosis is crucial for enhancing the survival rate. Radionuclide molecular imaging displays its advantages for detecting breast cancer from a functional perspective. Noninvasive visualization of biological processes with radionuclide-labeled small metabolic compounds helps elucidate the metabolic state of breast cancer, while radionuclide-labeled ligands/antibodies for receptor-targeted radionuclide molecular imaging is sensitive and specific for visualization of the overexpressed molecular markers in breast cancer. This review focuses on the most recent developments of novel radiotracers as promising tools for early breast cancer diagnosis.

Abstract

Breast cancer is a malignant tumor that can affect women worldwide and endanger their health and wellbeing. Early detection of breast cancer can significantly improve the prognosis and survival rate of patients, but with traditional anatomical imagine methods, it is difficult to detect lesions before morphological changes occur. Radionuclide-based molecular imaging based on positron emission tomography (PET) and single-photon emission computed tomography (SPECT) displays its advantages for detecting breast cancer from a functional perspective. Radionuclide labeling of small metabolic compounds can be used for imaging biological processes, while radionuclide labeling of ligands/antibodies can be used for imaging receptors. Noninvasive visualization of biological processes helps elucidate the metabolic state of breast cancer, while receptor-targeted radionuclide molecular imaging is sensitive and specific for visualization of the overexpressed molecular markers in breast cancer, contributing to early diagnosis and better management of cancer patients. The rapid development of radionuclide probes aids the diagnosis of breast cancer in various aspects. These probes target metabolism, amino acid transporters, cell proliferation, hypoxia, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), gastrin-releasing peptide receptor (GRPR) and so on. This article provides an overview of the development of radionuclide molecular imaging techniques present in preclinical or clinical studies, which are used as tools for early breast cancer diagnosis.

Integrating metabolic reprogramming and metabolic imaging to predict breast cancer therapeutic responses

Metabolic reprogramming is not only an emerging hallmark of cancer, but also an essential regulator of cancer cell adaptation to the microenvironment. Metabolic imaging targeting metabolic signatures has been widely used for breast cancer diagnosis. However, limited implications have been explored for monitoring breast cancer therapy response, although metabolic plasticity is notably associated with therapy resistance. In this review, we focus on the metabolic alterations upon breast cancer therapy and their potential for evaluating breast cancer therapeutic responses. We summarize the metabolic network and regulatory changes upon breast cancer therapy in terms of cancer pathological and genetic differences and discuss the implications of metabolic imaging with various probes in selecting target beneficiaries for precision treatment.

Robust and Facile Automated Radiosynthesis of [18F]FSPG on the GE FASTlab

Purpose

(S)-4-(3-¹⁸F-Fluoropropyl)-ʟ-Glutamic Acid ([¹⁸F]FSPG) is a radiolabeled non-natural amino acid that is used for positron emission tomography (PET) imaging of the glutamate/cystine antiporter, system x_C^-, whose expression is upregulated in many cancer types. To increase the clinical adoption of this radiotracer, reliable and facile automated procedures for [¹⁸F]FSPG production are required. Here, we report a cassette-based method to produce [¹⁸F]FSPG at high radioactivity concentrations from low amounts of starting activity.

Procedures

An automated synthesis and purification of [¹⁸F]FSPG was developed using the GE FASTlab. Optimization of the reaction conditions and automated manipulations were performed by measuring the isolated radiochemical yield of [¹⁸F]FSPG and by assessing radiochemical purity using radio-HPLC. Purification of [¹⁸F]FSPG was conducted by trapping and washing of the radiotracer on Oasis MCX SPE cartridges, followed by a reverse elution of [¹⁸F]FSPG in phosphate-buffered saline. Subsequently, the [¹⁸F]FSPG obtained from the optimized process was used to image an animal model of non-small cell lung cancer.

Results

The optimized protocol produced [¹⁸F]FSPG in 38.4 ± 2.6 % radiochemical yield and >96 % radiochemical purity with a molar activity of 11.1 ± 7.7 GBq/μmol. Small alterations, including the implementation of a reverse elution and an altered Hypercarb cartridge, led to significant improvements in radiotracer concentration from <10 MBq/ml to >100 MBq/ml. The improved radiotracer concentration allowed for the imaging of up to 20 mice, starting with just 1.5 GBq of [¹⁸F]Fluoride.

Conclusions

We have developed a robust and facile method for [¹⁸F]FSPG radiosynthesis in high radiotracer concentration, radiochemical yield, and radiochemical purity. This cassette-based method enabled the production of [¹⁸F]FSPG at radioactive concentrations sufficient to facilitate large-scale preclinical experiments with a single prep of starting activity. The use of a cassette-based radiosynthesis on an automated synthesis module routinely used for clinical production makes the method amenable to rapid and widespread clinical translation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11307-021-01609-w.

18F-Labeled dihydromethidine: positron emission tomography radiotracer for imaging of reactive oxygen species in intact brain

Dihydromethidine (DHM) labeled with 18F at the para position of the peripheral benzene ring was designed as a positron emission tomography (PET) radiotracer for non-invasive imaging of reactive oxygen species (ROS). This compound readily crosses the blood-brain barrier and is oxidized by ROS, and the oxidation product is retained intracellularly. PET imaging of ROS-producing rat brain microinfused with sodium nitroprusside identified specific brain regions with high ROS concentrations. This tracer should be useful for studies of the pathophysiological roles of ROS, and in the diagnosis of neurodegenerative diseases.

Microenvironment Stimulated Bioresponsive Small Molecule Carriers for Radiopharmaceuticals

The widespread and successful use of radiopharmaceuticals in diagnosis, treatment, and therapeutic monitoring of cancer and other ailments has spawned significant literature. The transition from untargeted to targeted radiopharmaceuticals reflects the various stages of design and development. Targeted radiopharmaceuticals bind to specific biomarkers, get fixed, and highlight the disease site. A new subset of radioprobes, the bioresponsive radiopharmaceuticals, has been developed in recent years. These probes generally benefit from signal enhancement after undergoing molecular changes due to the fluctuations in the environment (pH, redox, or enzymatic activity) at the site of interest. This review presents a comprehensive overview of bioresponsive radioimaging probes covering the basis, application, and scope of development.

Initial evaluation of (4S)-4-(3-[18F]fluoropropyl)-L-glutamate (FSPG) PET/CT imaging in patients with head and neck cancer, colorectal cancer, or non-Hodgkin lymphoma

Purpose

(4S)-4-(3-[¹⁸F]Fluoropropyl)-l-glutamic acid ([¹⁸F]FSPG) measures system x_C⁻ transporter activity and shows promise for oncologic imaging. We present data on tumor uptake of this radiopharmaceutical in human subjects with head and neck cancer (HNC), colorectal cancer (CRC), and non-Hodgkin lymphoma (NHL).

Methods

A total of 15 subjects with HNC (n = 5), CRC (n = 5), or NHL (n = 5) were recruited (mean age 66.2 years, range 44–87 years). 301.4 ± 28.1 MBq (8.1 ± 0.8 mCi) of [¹⁸F]FSPG was given intravenously to each subject, and 3 PET/CT scans were obtained 0–2 h post-injection. All subjects also had a positive [¹⁸F]FDG PET/CT scan within 1 month prior to the [¹⁸F]FSPG PET scan. Semi-quantitative and visual comparisons of the [¹⁸F]FSPG and [¹⁸F]FDG scans were performed.

Results

[¹⁸F]FSPG showed strong uptake in all but one HNC subject. The lack of surrounding brain uptake facilitated tumor delineation in the HNC patients. [¹⁸F]FSPG also showed tumor uptake in all CRC subjects, but variable uptake in the NHL subjects. While the absolute [¹⁸F]FDG SUV values were comparable or higher than [¹⁸F]FSPG, the tumor-to-background SUV ratios were greater with [¹⁸F]FSPG than [¹⁸F]FDG.

Conclusions

[¹⁸F]FSPG PET/CT showed promising results across 15 subjects with 3 different cancer types. Concordant visualization was mostly observed between [¹⁸F]FSPG and [¹⁸F]FDG PET/CT images, with some inter- and intra-individual uptake variability potentially reflecting differences in tumor biology. The tumor-to-background ratios were greater with [¹⁸F]FSPG than [¹⁸F]FDG in the cancer types evaluated. Future studies based on larger numbers of subjects and those with a wider array of primary and recurrent or metastatic tumors are planned to further evaluate the utility of this novel tracer.

Clinical Evaluation of (4S)-4-(3-[18F]Fluoropropyl)-L-glutamate (18F-FSPG) for PET/CT Imaging in Patients with Newly Diagnosed and Recurrent Prostate Cancer

PURPOSE

(4S)-4-(3-[¹⁸F]Fluoropropyl)-L-glutamic acid (¹⁸F-FSPG) is a radiopharmaceutical for PET imaging of system x_C ^- activity, which can be upregulated in prostate cancer. We present data on the first evaluation of patients with newly diagnosed or recurrent prostate cancer with this radiopharmaceutical.

EXPERIMENTAL DESIGN

Ten patients with primary and 10 patients with recurrent prostate cancer were enrolled in this prospective multicenter study. After injection of 300 MBq of ¹⁸F-FSPG, three whole-body PET/CT scans were obtained. Visual analysis was compared with step-section histopathology when available as well as other imaging studies and clinical outcomes. Metabolic parameters were measured semiquantitatively. Expression levels of xCT and CD44 were evaluated by IHC for patients with available tissue samples.

RESULTS

¹⁸F-FSPG PET showed high tumor-to-background ratios with a relatively high tumor detection rate on a per-patient (89%) and per-lobe (87%) basis. The sensitivity was slightly higher with imaging at 105 minutes in comparison with 60 minutes. The maximum standardized uptake values (SUV_max) for cancer was significantly higher than both normal (P < 0.005) and benign pathology (P = 0.011), while there was no significant difference between normal and benign pathology (P = 0.120). In the setting of recurrence, agreement with standard imaging was demonstrated in 7 of 9 patients (78%) and 13 of 18 lesions (72%), and revealed true local recurrence in a discordant case. ¹⁸F-FSPG accumulation showed moderate correlation with CD44 expression.

CONCLUSIONS

¹⁸F-FSPG is a promising tumor imaging agent for PET that seems to have favorable biodistribution and high cancer detection rate in patients with prostate cancer. Further studies are warranted to determine the diagnostic value for both initial staging and recurrence, and how it compares with other investigational radiotracers and conventional imaging modalities.

Synthesis, radiosynthesis, and positron emission tomography neuroimaging using 5-[18 F]fluoro-L-amino suberate

System xc- (Sxc -) has emerged as a new biological target for PET studies to detect oxidative and excitotoxic stress. Notably, applications have, thus far, been limited to tumour imaging although Sxc- ) may play a major role in neurodegeneration. The synthesis procedures of tosylate precursor and its translation to Sxc - PET tracer 5[18F]fluoro-L-amino suberate by manual and automated radiosyntheses are described. A brain-PET study has been conducted to evaluate the tracer uptake into brain in healthy mice.

18F-labeled ethisterone derivative for progesterone receptor targeted PET imaging of breast cancer

PURPOSE

A novel radiolabeled probe 1‑(17‑[¹⁸F]fluoro‑3,6,9,12,15‑pentaoxaheptadecyl‑1H‑1,2,3‑triazole testosterone ([¹⁸F]FPTT) was synthesized and evaluated for PET imaging of progesterone receptor (PR)-positive breast cancer.

METHODS

The ethinyl group of ethisterone, a PR targeting pharmacophore, was coupled with azide modified PEG-OTs by click chemistry to obtain the labeling precursor. The final [¹⁸F]FPTT was synthesized by a one-step nucleophilic substitution reaction with ¹⁸F. The in vitro stabilities of [¹⁸F]FPTT in saline or rat serum were determined after 2 h incubation. Then the in vitro cell binding, ex vivo biodistribution and in vivo imaging of [¹⁸F]FPTT were further investigated to evaluate the PR targeting ability and feasibility for the diagnosis of PR-positive breast cancer with PET imaging.

RESULTS

[¹⁸F]FPTT was obtained in high decay-corrected radiochemical yield (78 ± 9%) at the end of synthesis. It had high radiochemical purity (>98%) after HPLC purification and good in vitro stability. The molar activity of [¹⁸F]FPTT was calculated as 17 GBq/μmol. The microPET imaging of [¹⁸F]FPTT in tumor-bearing mice showed much higher tumor uptake in PR-positive MCF-7 tumor (3.9 ± 0.20%ID/g) than that of PR-negative MDA-MB-231 tumor (1.3 ± 0.08%ID/g). The high MCF-7 tumor uptake could be specifically inhibited by blocking with ethisterone (1.3 ± 0.11%ID/g) or [¹⁹F]FPTT (2.20 ± 0.17%ID/g), respectively. The biodistribution in estrogen-primed female SD rats of [¹⁸F]FPTT showed high uterus and ovary uptakes (8.31 ± 1.74%ID/g and 3.79 ± 0.82%ID/g at 1 h post-injection). The specific uptakes of uterus and ovary in normal rats were 3.52 ± 0.29%ID/g and 3.22 ± 0.50%ID/g respectively and could be inhibited by co-injecting of ethisterone.

CONCLUSION

A novel [¹⁸F]FPTT probe based on ethisterone modification could be a potential diagnostic agent for PR-positive breast cancer.

Cystine/glutamate antiporter xCT (SLC7A11) facilitates oncogenic RAS transformation by preserving intracellular redox balance

RAS genes are among the most mutated proto-oncogenes in human cancer. The mechanisms supporting RAS transformation are not fully understood, particularly regarding the relative contributions of oxidant versus antioxidant pathways. Here, we report that the cystine/glutamate transporter xCT is essential for RAS-induced tumorigenicity by enhancing antioxidant glutathione synthesis. Our findings uncover that RAS controls xCT transcription by downstream activation of ETS-1 to synergize with ATF4. This has clinical relevance since xCT expression is upregulated in human cancers exhibiting an activated RAS pathway. Therefore, oncogenic RAS transformation is supported by induction of an antioxidant program, highlighting xCT as a potential vulnerability for therapeutic targeting.

The RAS family of proto-oncogenes are among the most commonly mutated genes in human cancers and predict poor clinical outcome. Several mechanisms underlying oncogenic RAS transformation are well documented, including constitutive signaling through the RAF-MEK-ERK proproliferative pathway as well as the PI3K-AKT prosurvival pathway. Notably, control of redox balance has also been proposed to contribute to RAS transformation. However, how homeostasis between reactive oxygen species (ROS) and antioxidants, which have opposing effects in the cell, ultimately influence RAS-mediated transformation and tumor progression is still a matter of debate and the mechanisms involved have not been fully elucidated. Here, we show that oncogenic KRAS protects fibroblasts from oxidative stress by enhancing intracellular GSH levels. Using a whole transcriptome approach, we discovered that this is attributable to transcriptional up-regulation of xCT, the gene encoding the cystine/glutamate antiporter. This is in line with the function of xCT, which mediates the uptake of cystine, a precursor for GSH biosynthesis. Moreover, our results reveal that the ETS-1 transcription factor downstream of the RAS-RAF-MEK-ERK signaling cascade directly transactivates the xCT promoter in synergy with the ATF4 endoplasmic reticulum stress-associated transcription factor. Strikingly, xCT was found to be essential for oncogenic KRAS-mediated transformation in vitro and in vivo by mitigating oxidative stress, as knockdown of xCT strongly impaired growth of tumor xenografts established from KRAS-transformed cells. Overall, this study uncovers a mechanism by which oncogenic RAS preserves intracellular redox balance and identifies an unexpected role for xCT in supporting RAS-induced transformation and tumorigenicity.

Non-invasive Use of Positron Emission Tomography to Monitor Diethyl maleate and Radiation-Induced Changes in System xC- Activity in Breast Cancer

PURPOSE

The system x_C^- transporter is upregulated in cancer cells in response to oxidative stress (OS). 5-[¹⁸F]fluoroaminosuberic acid ([¹⁸F]FASu) has been reported as a novel positron emission tomography (PET) imaging agent, targeting system x_C^-. The goal of this study was to evaluate the utility of [¹⁸F]FASu in monitoring cellular response to diethyl maleate (DEM) and radiation-induced OS fluctuations.

PROCEDURES

[¹⁸F]FASu uptake by breast cancer cells was studied in correlation to OS biomarkers: glutathione (GSH) and reactive oxygen species (ROS), as well as transcriptional and translational levels of xCT (the functional subunit of x_C^-). System x_C^- inhibitor, sulfasalazine (SSZ), and small interfering RNA (siRNA) knockdown were used as negative controls. Radiotracer uptake was evaluated in three breast cancer models: MDA-MB-231, MCF-7, and ZR-75-1, at two-time points (1 h and 16 h) following OS induction. In vivo [¹⁸F]FASu imaging and biodistribution were performed using MDA-MB-231 xenograft-bearing mice at 16 and 24 h post-radiation treatment.

RESULTS

[¹⁸F]FASu uptake was positively correlated to intracellular GSH and SLC7A11 expression levels, and radiotracer uptake was induced both by radiation treatment and by DEM at time points longer than 3 h. In an in vivo setting, there was no statistically significant uptake difference between irradiated and control tumors.

CONCLUSION

[¹⁸F]FASu is a specific system x_C^- PET radiotracer and as such it can be used to monitor system x_C^- activity due to OS. As such, [¹⁸F]FASu has the potential to be used in therapy response monitoring by PET. Further optimization is required for in vivo application.

Assessment of Tumor Redox Status through (S)-4-(3-[18F]fluoropropyl)-L-Glutamic Acid PET Imaging of System xc - Activity

The cell's endogenous antioxidant system is vital to maintenance of redox homeostasis. Despite its central role in normal and pathophysiology, no noninvasive tools exist to measure this system in patients. The cystine/glutamate antiporter system xc - maintains the balance between intracellular reactive oxygen species and antioxidant production through the provision of cystine, a key precursor in glutathione biosynthesis. Here, we show that tumor cell retention of a system xc --specific PET radiotracer, (S)-4-(3-[18F]fluoropropyl)-L-glutamic acid ([18F]FSPG), decreases in proportion to levels of oxidative stress following treatment with a range of redox-active compounds. The decrease in [18F]FSPG retention correlated with a depletion of intracellular cystine resulting from increased de novo glutathione biosynthesis, shown through [U-13C6, U-15N2]cystine isotopic tracing. In vivo, treatment with the chemotherapeutic doxorubicin decreased [18F]FSPG tumor uptake in a mouse model of ovarian cancer, coinciding with markers of oxidative stress but preceding tumor shrinkage and decreased glucose utilization. Having already been used in pilot clinical trials, [18F]FSPG PET could be rapidly translated to the clinic as an early redox indicator of tumor response to treatment. SIGNIFICANCE: [18F]FSPG PET imaging provides a sensitive noninvasive measure of tumor redox status and provides an early marker of tumor response to therapy.See related commentary by Lee et al., p. 701.

Amino Acid Metabolism as a Target for Breast Cancer Imaging

Amino acids are an alternate energy source to glucose, and amino acid metabolism is up-regulated in multiple malignancies, including breast cancers. Multiple amino acid radiotracers have been used to image breast cancer with unique strengths and weaknesses. ¹¹C-methionine uptake correlates with S-phase fraction in breast cancer and may be useful for evaluation of treatment response. Invasive lobular breast cancers may demonstrate greater ¹⁸F-fluciclovine avidity than ¹⁸F-fluorodeoxyglucose. Thus, different histologic subtypes of breast cancer may use diverse metabolic pathways and may be better imaged by different tracers.

Development of a Positron Emission Tomography Radiotracer for Imaging Elevated Levels of Superoxide in Neuroinflammation

Reactive oxygen species (ROS) are believed to play a major role in the proinflammatory, M1-polarized form of neuroinflammation. However, it has been difficult to assess the role of ROS and their role in neuroinflammation in animal models of disease because of the absence of probes capable of measuring their presence with the functional imaging technique positron emission tomography (PET). This study describes the synthesis and in vivo evaluation of [¹⁸F]ROStrace, a radiotracer for imaging superoxide in vivo with PET, in an LPS model of neuroinflammation. [¹⁸F]ROStrace was found to rapidly cross the blood–brain barrier (BBB) and was trapped in the brain of LPS-treated animals but not the control group. [¹⁸F]ox-ROStrace, the oxidized form of [¹⁸F]ROStrace, did not cross the BBB. These data suggest that [¹⁸F]ROStrace is a suitable radiotracer for imaging superoxide levels in the central nervous system with PET.

Amino Acid Transporters and Glutamine Metabolism in Breast Cancer

Amino acid transporters are membrane transport proteins, most of which are members of the solute carrier families. Amino acids are essential for the survival of all types of cells, including tumor cells, which have an increased demand for nutrients to facilitate proliferation and cancer progression. Breast cancer is the most common malignancy in women worldwide and is still associated with high mortality rates, despite improved treatment strategies. Recent studies have demonstrated that the amino acid metabolic pathway is altered in breast cancer and that amino acid transporters affect tumor growth and progression. In breast cancer, glutamine is one of the key nutrients, and glutamine metabolism is closely related to the amino acid transporters. In this review, we focus on amino acid transporters and their roles in breast cancer. We also highlight the different subsets of upregulated amino acid transporters in breast cancer and discuss their potential applications as treatment targets, cancer imaging tracers, and drug delivery components. Glutamine metabolism as well as its regulation and therapeutic implication in breast cancer are also discussed.

Cell-surface marker discovery for lung cancer

Lung cancer is the leading cause of cancer deaths in the United States. Novel lung cancer targeted therapeutic and molecular imaging agents are needed to improve outcomes and enable personalized care. Since these agents typically cannot cross the plasma membrane while carrying cytotoxic payload or imaging contrast, discovery of cell-surface targets is a necessary initial step. Herein, we report the discovery and characterization of lung cancer cell-surface markers for use in development of targeted agents. To identify putative cell-surface markers, existing microarray gene expression data from patient specimens were analyzed to select markers with differential expression in lung cancer compared to normal lung. Greater than 200 putative cell-surface markers were identified as being overexpressed in lung cancers. Ten cell-surface markers (CA9, CA12, CXorf61, DSG3, FAT2, GPR87, KISS1R, LYPD3, SLC7A11 and TMPRSS4) were selected based on differential mRNA expression in lung tumors vs. non-neoplastic lung samples and other normal tissues, and other considerations involving known biology and targeting moieties. Protein expression was confirmed by immunohistochemistry (IHC) staining and scoring of patient tumor and normal tissue samples. As further validation, marker expression was determined in lung cancer cell lines using microarray data and Kaplan–Meier survival analyses were performed for each of the markers using patient clinical data. High expression for six of the markers (CA9, CA12, CXorf61, GPR87, LYPD3, and SLC7A11) was significantly associated with worse survival. These markers should be useful for the development of novel targeted imaging probes or therapeutics for use in personalized care of lung cancer patients.

Fluorine-18 labeled amino acids for tumor PET/CT imaging

Tumor glucose metabolism and amino acid metabolism are usually enhanced, ¹⁸F-FDG for tumor glucose metabolism PET imaging has been clinically well known, but tumor amino acid metabolism PET imaging is not clinically familiar. Radiolabeled amino acids (AAs) are an important class of PET/CT tracers that target the upregulated amino acid transporters to show elevated amino acid metabolism in tumor cells. Radiolabeled amino acids were observed to have high uptake in tumor cells but low in normal tissues and inflammatory tissues. The radionuclides used in labeling amino acids include ¹⁵O, ¹³N, ¹¹C, ¹²³I, ¹⁸F and ⁶⁸Ga, among which the most commonly used is ¹⁸F [1]. Available data support the use of certain ¹⁸F-labeled AAs for PET/CT imaging of gliomas, neuroendocrine tumors, prostate cancer and breast cancer [2, 3]. With the progress of the method of ¹⁸F labeling AAs [4-6], ¹⁸F-labeled AAs are well established for tumor PET/CT imaging. This review focuses on the current status of key clinical applications of 18F-labeled AAs in tumor PET/CT imaging.

Small Molecule PET Tracers for Transporter Imaging

As the field of PET has expanded and an ever-increasing number and variety of compounds have been radiolabeled as potential in vivo tracers of biochemistry, transporters have become important primary targets or facilitators of radiotracer uptake and distribution. A transporter can be the primary target through the development of a specific high-affinity radioligand: examples are the multiple high-affinity radioligands for the neuronal membrane neurotransmitter or vesicular transporters, used to image nerve terminals in the brain. The goal of a radiotracer might be to study the function of a transporter through the use of a radiolabeled substrate, such as the application of 3-O-[¹¹C]methyl]glucose to measure rates of glucose transport through the blood-brain barrier. In many cases, transporters are required for radiotracer distributions, but the targeted biochemistries might be unrelated: an example is the use of 2-deoxy-2-[¹⁸F]FDG for imaging glucose metabolism, where initial passage of the radiotracer through cell membranes requires the action of specific glucose transporters. Finally, there are transporters such as p-glycoprotein that function to extrude small molecules from tissues, and can effectively work against successful uptake of radiotracers. The diversity of structures and functions of transporters, their importance in human health and disease, and their role in therapeutic drug disposition suggest that in vivo imaging of transporter location and function will continue to be a point of emphasis in PET radiopharmaceutical development. In this review, the variety of transporters and their importance for in vivo PET radiotracer development and application are discussed. Transporters have thus joined the other major protein targets such as G-protein coupled receptors, ligand-gated ion channels, enzymes, and aggregated proteins as of high interest for understanding human health and disease.

Metabolic Imaging of Glutamine in Cancer

Glucose and glutamine are the most abundant nutrients for producing energy and building blocks in normal and tumor cells. Increased glycolysis in tumors, the Warburg Effect, is the basis for ¹⁸F-FDG PET imaging. Cancer cells can also be genetically reprogrammed to use glutamine. 5-¹¹C-(2S)-glutamine and ¹⁸F-(2S,4R)4-fluoroglutamine may be useful complementary tools to measure changes in tumor metabolism. In glioma patients, the tracer ¹⁸F-(2S,4R)4-fluoroglutamine showed tumor-to-background contrast different from that of ¹⁸F-FDG and differences in uptake in glioma patients with clinical progression of disease versus stable disease (tumor-to-brain ratio > 3.7 in clinically active glioma tumors, minimal or no specific uptake in clinically stable tumors). These preliminary results suggest that ¹⁸F-(2S,4R)4-fluoroglutamine PET may be a new tool for probing in vivo metabolism of glutamine in cancer patients and for guiding glutamine-targeted therapeutics. Further studies of uptake mechanism, and comparison of kinetics for ¹⁸F-(2S,4R)4-fluoroglutamine versus the ¹¹C-labeled native glutamine, will be important and enlightening.