Routine Production of 89Zr Using an Automated Module

Radiometals in Imaging and Therapy: Highlighting Two Decades of Research

The present article highlights the important progress made in the last two decades in the fields of molecular imaging and radionuclide therapy. Advancements in radiometal-based positron emission tomography, single photon emission computerized tomography, and radionuclide therapy are illustrated in terms of their production routes and ease of radiolabeling. Applications in clinical diagnostic and radionuclide therapy are considered, including human studies under clinical trials; their current stages of clinical translations and findings are summarized. Because the metalloid astatine is used for imaging and radionuclide therapy, it is included in this review. In regard to radionuclide therapy, both beta-minus (β-) and alpha (α)-emitting radionuclides are discussed by highlighting their production routes, targeted radiopharmaceuticals, and current clinical translation stage.

Synthesis of Modular Desferrioxamine Analogues and Evaluation of Zwitterionic Derivatives for Zirconium Complexation

The natural siderophore desferrioxamine B (DFOB) has been used for targeted PET imaging with 89 Zr before. However, Zr-DFOB has a limited stability and a number of derivatives have been developed with improved chelation properties for zirconium. We describe the synthesis of pseudopeptidic analogues of DFOB with azido side chains. These are termed AZA-DFO (hexadentate) and AZA-DFO* (octadentate) and are assembled via a modular synthesis from Orn-β-Ala and Lys-β-Ala. Nine different chelators have been conjugated to zwitterionic moieties by copper-catalyzed azide-alkyne cycloaddition (CuAAC). The resulting water-soluble chelators form Zr complexes under mild conditions (room temperature for 90 min). Transchelation assays with 1000-fold excess of EDTA and 300-fold excess of DFOB revealed that a short spacing of hydroxamates in (Orn-β-Ala)3-4 leads to improved complex stability compared to a longer spacing in (Lys-β-Ala)3-4 . We found that the alignment of amide groups in the pseudopeptide backbone and the presence of zwitterionic sidechains did not compromise the stability of the Zr-complexes with our chelators. We believe that the octadentate derivative AZA-DFO* is particularly valuable for the preparation of new Zr-chelators for targeted imaging which combine tunable pharmacokinetic properties with high complex stability and fast Zr-complexation kinetics.

A new targetry system for production of zirconium-89 radioisotope with Cyclone-30 cyclotron

In this study, an efficient method for targetry and production of zirconium-89 radioisotope (89Zr) with Cyclone-30 cyclotron was developed. The preparation of a highly pure compressed yttrium oxide target material and design of a target made by copper for better heat transfer was performed. Electrodeposition of target with gold was done to prevent the entry of metallic impurities (copper, zinc and other trace metal elements). Nuclear reaction cross sections for optimization of production with new target and irradiation parameters of the target were evaluated. The prepared 89Zr in the form of [89Zr] Zr-oxalate had high radionuclidic purity (>99.9%) and a low chemical impurity concentration (<0.1 ppm for copper and zinc elements). The yield of 89Zr radioisotope production via the reaction of 89Y(p,n)89Zr was measured to be 77 ± 9.5 MBq/μAh (time of irradiation = 3, the current 20–30 µA). [89Zr] Zr-oxalate specific-activity was in the range 2.319641 × 104–3.479443 × 104 MBq/mmol of Oxalate.

Anion exchange and extraction chromatography tandem column isolation of zirconium-89 (89Zr) from cyclotron bombarded targets using an automated fluidic platform

The long-lived positron emitter ⁸⁹Zr is a highly promising nuclide employed in diagnostic Positron Emission Tomography (PET) imaging. Methods of radiochemical processing to obtain ⁸⁹Zr for clinical use are traditionally performed with a single hydroxamate resin column. Herein, we present a tandem column purification method for the preparation of high-purity ⁸⁹Zr from cyclotron bombarded natural Y metal foils. The primary column is a macroporous, strongly basic anion exchange resin on styrene divinylbenzene co-polymer. The secondary microcolumn, with an internal volume of 33 μL, is packed with an extraction chromatography resin (ExCR) loaded with di-(2-ethylhexyl)phosphoric acid (HDEHP). A condition of "inverted selectivity" is presented, wherein the ⁸⁹Zr elution from the primary column is synonymous with the load condition on the secondary column. The ability to transfer ⁸⁹Zr from one column to the next allows two sequential purification steps to be performed prior to the final elution of the ⁸⁹Zr product. This approach assures delivery of high purity ⁸⁹Zr. The tandem column purification process has been implemented into a prototype automated fluidic system. Optimization of the method is presented, followed by evaluation of the process using seven cyclotron bombarded Y metal foil targets. Once optimized, we found that 93.7 ± 2.3% of the ⁸⁹Zr present in the foils was recovered in the secondary column elution fraction (0.8 M oxalic acid). Radiochromatograms of the product elution peaks enabled determination of full width at half-maximum (FWHM) and ⁸⁹Zr collection yields as a function of volume. Because of the small size of the secondary microcolumn, a ⁸⁹Zr product volume of ∼0.28 mL is reported, which provides a substantially increased nuclide concentration over traditional methods. Finally, we evaluated the transchelation of the resulting ⁸⁹Zr oxalate product to deferoxamine mesylate (DFOM) salt. We observed effective specific activities (ESA) and bindable metals concentrations ([M_B]) that exceed those reported by the traditional single hydroxamate column method.

Target manufacturing by Spark Plasma Sintering for efficient 89Zr production

Zirconium-89 (⁸⁹Zr) is an emerging radionuclide for positron emission tomography (PET), with nuclear properties suitable for imaging slow biological processes in cellular targets. The ⁸⁹Y(p,n)⁸⁹Zr nuclear reaction is commonly exploited as the main production route with medical cyclotrons accelerating low-energy (< 20 MeV) and low-current (< 100 μA) proton beams. Usually, natural yttrium solid targets manufactured by different methods, including yttrium electrodeposition, yttrium sputtering, compressed yttrium powders, and foils, were employed. In this study, the Spark Plasma Sintering (SPS) technique has been investigated, for the first time, to manufacture yttrium solid targets for an efficient ⁸⁹Zr radionuclide yield. The natural yttrium disc was bonded to a niobium backing plate using a commercial SPS apparatus and a prototype machine assembled at the University of Pavia. The resulting targets were irradiated in a TR19 cyclotron with a 12 MeV proton beam at 50 μA. A dedicated dissolution module, obtained from a commercial system, was used to develop an automated process for the purification and recovery of the produced ⁸⁹Zr radionuclide. The production yield and recovery efficiency were measured and compared to ⁸⁹Zr produced by irradiating standard yttrium foils. SPS manufactured targets withstand an average heat power density of approximately 650 W∙cm^-2 for continuous irradiation up to 5 h without visible damage. A saturation yield of 14.12 ± 0.38 MBq/μAh was measured. The results showed that the obtained ⁸⁹Zr production yield and quality were comparable to similar data obtained using standard yttrium foil targets. In conclusion, the present work demonstrates that the SPS technique might be a suitable technical manufacturing solution aimed at high-yield ⁸⁹Zr radioisotope production.

Cyclotron Production of PET Radiometals in Liquid Targets: Aspects and Prospects

The present review describes the methodological aspects and prospects of the production of Positron Emission Tomography (PET) radiometals in a liquid target using low-medium energy medical cyclotrons. The main objective of this review is to delineate and discuss the critical factors involved in the liquid target production of radiometals, including type of salt solution, solution composition, beam energy, beam current, the effect of irradiation duration (length of irradiation) and challenges posed by in-target chemistry in relation with irradiation parameters. We also summarize the optimal parameters for the production of various radiometals in liquid targets. Additionally, we discuss the future prospects of PET radiometals production in the liquid targets for academic research and clinical applications. Significant emphasis has been given to the production of ⁶⁸Ga using liquid targets due to the growing demand for ⁶⁸Ga labeled PSMA vectors, [⁶⁸Ga]- Ga-DOTATATE, [⁶⁸Ga]Ga-DOTANOC and some upcoming ⁶⁸Ga labeled radiopharmaceuticals. Other PET radiometals included in the discussion are ⁸⁶Y, ⁶³Zn and ⁸⁹Zr.

Development and in vitro evaluation of new bifunctional 89Zr-chelators based on the 6-amino-1,4-diazepane scaffold for immuno-PET applications

INTRODUCTION

Combination of hydroxamate bearing side chains with the 6-amino-1,4-diazepane scaffold provides a promising strategy for fast and stable 89Zr-labeling of antibodies. Following this approach, we hereby present the development, labeling kinetics and in vitro complex stability of three resulting bifunctional chelator derivatives both stand-alone and coupled to a model protein in comparison to different linear deferoxamine (DFO) derivatives.

METHODS

The novel 89Zr-chelator Hy3ADA5 was prepared via amide-coupling of separately synthesized 6-amino-1,4-diazepane-6-pentanoic acid and hydroxamate-containing side chains. Two further bifunctional derivatives were synthesized by extending the resulting system with either a squaramide- or p-isothiocyanatophenyl moiety for simplified binding to proteins. After coupling to a model antibody and purification, the resulting immunoconjugates as well as the unbound chelator derivatives were 89Zr-labeled at room temperature (RT) and neutral pH. For comparison, different DFO derivatives were analogously coupled, purified and radiolabeled. In vitro complex stability of the resulting radioconjugates was investigated in phosphate buffered saline (PBS) and human serum at 37 °C over a period of 7 days.

RESULTS

89Zr-labeling of the novel unbound Hy3ADA5 derivatives indicated rapid complexation kinetics resulting in high radiochemical conversions (RCC) of 84-94% after 90 min. Similar or even faster radiolabeling with slightly increased maximum yields was obtained using the DFO-analogues. Initially, [89Zr]Zr-DFO*-p-Ph-NCS showed a delayed formation, nevertheless reaching almost quantitative complexation. Radiolabeling of the corresponding immunoconjugates Hy3ADA5-SA-mAb and Hy3ADA5-p-Ph-NCS-mAb resulted in 82.0 ± 1.1 and 89.2 ± 0.7% RCC, respectively after 90 min representing high but slightly lower labeling efficiency compared to the DFO- and DFO*-functionalized analogues. All examined radioimmunoconjugates showed very high in vitro complex stability both in human serum and PBS, providing no significant release of the radiometal. In the case of unbound chelators, however, the p-Ph-NCS-functionalized derivatives indicated considerable instability in human serum already after 1 h.

CONCLUSION

The novel chelator derivatives based on hydroxamate-functionalized 6-amino-1,4-diazepane revealed fast and high yielding 89Zr-labeling kinetics as well as high in vitro complex stability both stand-alone and coupled to an antibody. Therefore, Hy3ADA5 represents a promising tool for radiolabeling of biomolecules such as antibodies at mild conditions for immuno-PET applications.

Production of [89 Zr]Oxinate4 and cell radiolabeling for human use

[89 Zr]Oxinate4 is a Positron Emission Tomography (PET) tracer for cell radiolabeling that can enable imaging techniques to help better understand cell trafficking in various diseases. Although several groups have synthetized this compound for use in preclinical studies, there is no available data regarding the production of [89 Zr]Oxinate4 for human use. In this report, we describe the detailed production of [89 Zr]Oxinate4 under USP <823> and autologous leukocyte radiolabeling under USP <797>. The final product presented high radiochemical purity and stability at 24 h post synthesis (>99%) and passed in all quality control assays required for clinical use. [89 Zr]Oxinate4 did not compromise the white blood cells viability and did not show considerable cellular efflux up to 3 h post labeling. The translation of this technique into human use can provide insight into several disease mechanisms since [89 Zr]Oxinate4 has the potential to label any cell subset of interest.

Preclinical Evaluation of an Engineered Single-Chain Fragment Variable-Fragment Crystallizable Targeting Human CD44

Glycoprotein CD44 and alternative splice variants are overexpressed in many cancers and cancer stem cells. Binding of hyaluronic acid to CD44 activates cell signaling pathways, inducing cell proliferation, cell survival, and invasion. As such, CD44 is regarded as an excellent target for cancer therapy when this interaction can be blocked. In this study, we developed a CD44-specific antibody fragment and evaluated it for imaging CD44-positive cancers using PET. Methods: A human single-chain fragment variable (scFv) was generated by phage display, using the extracellular domain of recombinant human CD44. The specificity and affinity of the scFv-CD44 were evaluated using recombinant and tumor cell-expressed CD44. Epitope mapping of the putative CD44 binding site was performed via overlapping peptide microarray. The scFv-CD44 was reformatted into a bivalent scFv-Fc-CD44, based on human IgG₁-fragment crystallizable (Fc). The scFv-Fc-CD44 was radiolabeled with ⁶⁴Cu and ⁸⁹Zr. The purified reagents were injected into athymic nude mice bearing CD44-positive human tumors (MDA-MB-231, breast cancer, triple-negative). Biodistribution studies were performed at different times after injection of [⁶⁴Cu]Cu-NOTA-scFv-Fc-CD44 or [⁸⁹Zr]Zr-DFO-scFv-Fc-CD44. PET/CT imaging was conducted with [⁸⁹Zr]Zr-DFO-scFv-Fc-CD44 on days 1 and 7 after injection and compared with a scFv-Fc control antibody construct targeting glycophorin A. Results: Epitope mapping of the scFv binding site revealed a linear epitope within the extracellular domain of human CD44, capable of blocking binding to native hyaluronic acid. Switching from a monovalent scFv to a bivalent scFv-Fc format improved its binding affinity toward native CD44 on human breast cancer cells by nearly 200-fold. In vivo biodistribution data showed the highest tumor uptake and tumor-to-blood ratios for [⁸⁹Zr]Zr-DFO-scFv-Fc-CD44 between days 5 and 7. PET imaging confirmed excellent tumor specificity for [⁸⁹Zr]Zr-DFO-scFv-Fc-CD44 when compared with the control scFv-Fc. Conclusion: We developed a CD44-specific scFv-Fc construct that binds with nanomolar affinity to human CD44. When radiolabeled with ⁶⁴Cu or ⁸⁹Zr, it demonstrated specific uptake in CD44-expressing MDA-MB-231 tumors. The high tumor uptake (∼56% injected dose/g) warrants clinical investigation of [⁸⁹Zr]Zr-DFO-scFv-Fc-CD44 as a versatile PET imaging agent for patients with CD44-positive tumors.

Production and Semi-Automated Processing of 89Zr Using a Commercially Available TRASIS MiniAiO Module

The increased interest in ⁸⁹Zr-labelled immunoPET imaging probes for use in preclinical and clinical studies has led to a rising demand for the isotope. The highly penetrating 511 and 909 keV photons emitted by ⁸⁹Zr deliver an undesirably high radiation dose, which makes it difficult to produce large amounts manually. Additionally, there is a growing demand for Good Manufacturing Practices (GMP)-grade radionuclides for clinical applications. In this study, we have adopted the commercially available TRASIS mini AllinOne (miniAiO) automated synthesis unit to achieve efficient and reproducible batches of ⁸⁹Zr. This automated module is used for the target dissolution and separation of ⁸⁹Zr from the yttrium target material. The ⁸⁹Zr is eluted with a very small volume of oxalic acid (1.5 mL) directly over the sterile filter into the final vial. Using this sophisticated automated purification method, we obtained satisfactory amount of ⁸⁹Zr in high radionuclidic and radiochemical purities in excess of 99.99%. The specific activity of three production batches were calculated and was found to be in the range of 1351–2323 MBq/µmol. ICP-MS analysis of final solutions showed impurity levels always below 1 ppm.

FLUKA simulation yields in a comparison with theoretical and experimental yields relevant to 89Zr produced in the 89Y(p,n) reaction

The high importance of zirconium-89 (T1/2 = 78.41 h) is related to its applications in medical imaging. It can be produced at low-energy cyclotrons by the reaction 89Y(p,n)89Zr. There exist several publications on its production at low and intermediate energies but there is discrepancy with simulated data. In this study we considered the experimental parameters for four different types of yttrium foil targets reported in literature. The experimental parameters considered were the target geometry, beam profile, and angle of the target relative to the beam during irradiation. The Monte-Carlo code FLUKA was used to calculate production yields. The resulting values obtained by FLUKA from pencil beam or spread energy beam were compared to the theoretical yields obtained from the excitation function and the experimental ones. The FLUKA prediction for 89Z-yield reached ≈50 MBq/μA · h which agrees to a high extent with experimental and theoretical yields reported for the different targets.

Radiometals for imaging and theranostics, current production, and future perspectives

The aim of this review is to make the reader familiar with currently available radiometals, their production modes, capacities, and quality concerns related to their medical use, as well as new emerging radiometals and irradiation technologies from the perspective of their diagnostic and theranostic applications. Production methods of ¹⁷⁷ Lu serve as an example of various issues related to the production yield, specific activity, radionuclidic and chemical purity, and production economy. Other radiometals that are currently used or explored for potential medical applications, with particular focus on their theranostic value, are discussed. Using radiometals for diagnostic imaging and therapy is on the rise. The high demand for radiometals for medical use prompts investigations towards using alternative irradiation reactions, while using existing nuclear reactors and accelerator facilities. This review discusses these production capacities and what is necessary to cover the growing demand for theranostic nuclides.

89Zr-DFO-Cetuximab as a Molecular Imaging Agent to Identify Cetuximab Resistance in Head and Neck Squamous Cell Carcinoma

Background: Despite the improvement in clinical outcomes for head and neck squamous cell carcinoma (HNSCC) as the result of cetuximab, patients may present with or develop resistance that increases tumor recurrence rates and limits clinical efficacy. Therefore, identifying those patients who are or become resistant is essential to tailor the best therapeutic approach. Materials and Methods: Cetuximab was conjugated to p-NCS-Bz-DFO and labeled with ⁸⁹Zr. The resistance model was developed by treating FaDu cells with cetuximab. Western blotting (WB) and specific binding assays were performed to evaluate epidermal growth factor receptor (EGFR) expression and ⁸⁹Zr-DFO-cetuximab uptake in FaDu cetuximab-resistant (FCR) and FaDu cetuximab-sensitive (FCS) cells. Positron emission tomography imaging and biodistribution were conducted in NU/NU nude mice implanted with FCR or FCS cells. Results: Cetuximab was successfully radiolabeled with ⁸⁹Zr (≥95%). Binding assays performed in FCR and FCS cells showed significantly lower ⁸⁹Zr-DFO-cetuximab uptake in FCR (p < 0.0001). WB suggests that the resistance mechanism is associated with EGFR downregulation (p = 0.038). This result is in agreement with the low uptake of ⁸⁹Zr-DFO-cetuximab in FCR cells. Tumor uptake of ⁸⁹Zr-DFO-cetuximab in FCR was significantly lower than FCS tumors (p = 0.0340). Conclusions: In this work, the authors showed that ⁸⁹Zr-DFO-cetuximab is suitable for identification of EGFR downregulation in vitro and in vivo. This radiopharmaceutical may be useful for monitoring resistance in HNSCC patients during cetuximab therapy.

Comparative Study with 89Y-foil and 89Y-pressed Targets for the Production of 89Zr †

Zirconium-89 (89Zr, t1/2 = 3.27 days) owns great potential in nuclear medicine, being extensively used in the labelling of antibodies and nanoparticules. 89Zr can be produced by cyclotron via an 89Y(p,n)89Zr reaction while using an 89Y-foil target. In this study, we investigated for the first time the use of 89Y-pressed target for the preparation of 89Zr-oxalate via a (p,n) reaction. We performed comparative studies with an 89Y-foil target mounted on custom-made target supports. A new automated cassette-based purification module was used to facilitate the purification and the fractionation of 89Zr-oxalate. The effective molar activity (EMA) was calculated for both approaches via titration with deferoxamine (DFO). The radionuclidic purity was determined by gamma-ray spectroscopy and the metal impurities were quantified by ICP-MS on the resulting 89Zr-oxalate solution. The cassette-based purification process leading to fractionation is simple, efficient, and provides very high EMA of 89Zr-oxalate. The total recovered activity was 81 ± 4% for both approaches. The highest EMA was found at 13.3 MeV and 25 μA for 0.25-mm thick 89Y-foil. Similar and optimal production yields were obtained at 15 MeV and 40 μA while using 0.50-mm thick 89Y-foil and pressed targets. Metallic impurities concentration was below the general limit of 10 ppm for heavy metals in the US and Ph.Eur for both 89Y-foil and pressed targets. Overall, these results show that the irradiation of 89Y-pressed targets is a very effective process, offering an alternative method for 89Zr production.

Tandem column isolation of zirconium-89 from cyclotron bombarded yttrium targets using an automated fluidic platform: Anion exchange to hydroxamate resin columns

The development of a tandem column purification method for the preparation of high-purity ⁸⁹Zr(IV) oxalate is presented. The primary column was a macroporous strongly basic anion exchange resin on styrene divinylbenzene co-polymer. The secondary column, with an internal volume of 33 μL, was packed with hydroxamate resin. A condition of inverted selectivity was developed, whereby the ⁸⁹Zr eluent solution for the primary column is equivalent to the ⁸⁹Zr load solution for the secondary column. The ability to transfer ⁸⁹Zr from one column to the next allows two sequential column clean-up methods to be performed prior to the final elution of the ⁸⁹Zr(IV) oxalate. This approach assures delivery of high purity ⁸⁹Zr product and assures a ⁸⁹Zr product that is eluted in a substantially smaller volume than is possible when using the traditionally-employed single hydroxamate resin column method. The tandem column purification process has been implemented into a prototype automated fluidic system. The system is configured with on-line gamma detection so column effluents can be monitored in near-real time. The automated method was tested using seven cyclotron bombarded Y foil targets. It was found that 95.1 ± 1.3% of the ⁸⁹Zr present in the foils was recovered in the secondary column elution fraction. Furthermore, elution peak analysis of several ⁸⁹Zr elution profile radiochromatograms made possible the determination of ⁸⁹Zr recovery as a function of volume; a ⁸⁹Zr product volume that contains 90% of the mean secondary column elution peak can be obtained in 0.29 ± 0.06 mL (representing 86 ± 5% of the ⁸⁹Zr activity in the target). This product volume represents a significant improvement in radionuclide product concentration over the predominant method used in the field. In addition to the reduced ⁸⁹Zr product elution volume, titrations of the ⁸⁹Zr product with deferoxamine mesylate salt across two preparatory methods resulted in mean effective specific activity (ESA) values of 279 and 340 T Bq·mmole^-1 and mean bindable metals concentrations ([M_B]) of 13.5 and 16.7 nmole·g^-1. These ESA and [M_B] values infer that the ⁸⁹Zr(IV) oxalate product resulting from this tandem column isolation method has the highest purity reported to date.

Evaluation of a chloride-based 89Zr isolation strategy using a tributyl phosphate (TBP)-functionalized extraction resin

INTRODUCTION

The remarkable stability of the ⁸⁹Zr-DOTA complex has been shown in recent literature. The formation of this complex appears to require ⁸⁹Zr-chloride as the complexation precursor rather than the more conventional ⁸⁹Zr-oxalate. In this work we present a method for the direct isolation of ⁸⁹Zr-chloride from irradiated ^natY foils.

METHODS

⁸⁹Zr, ⁸⁸Zr, and ⁸⁸Y were prepared by 16 MeV proton irradiation of ^natY foils and used for batch-extraction based equilibrium coefficient measurements for TBP and UTEVA resin. Radionuclidically pure ⁸⁹Zr was prepared by 14 MeV proton-irradiation of ^natY foils. These foils were dissolved in concentrated HCl, trapped on columns of TBP or UTEVA resin, and ⁸⁹Zr-chloride was eluted in <1 mL of 0.1 M HCl. For purposes of comparison, conventionally-isolated ⁸⁹Zr-oxalate was converted to ⁸⁹Zr-chloride by trapping, rinsing, and elution from a QMA cartridge into 1 M HCl. Trace metal analysis was performed on the resulting ⁸⁹Zr products.

RESULTS

Equilibrium coefficients for Y and Zr were similar between UTEVA and TBP resins across all HCl concentrations. K_d values of <10^-1 mL/g were observed for Y across all HCl concentrations. K_d values of >10³ mL/g were observed at HCl concentrations >9 M for Zr, falling to K_d values of <10⁰ mL/g at low HCl concentrations. ⁸⁹Zr-chloride was recovered from small columns of TBP in <1 mL of 0.1 M HCl with an overall recovery efficiency of 89 ± 3% (n = 3). An average Y/Zr separation factor of 1.5 × 10⁵ (n = 3) was obtained. Trace metal impurities, notably Fe, were higher in TBP-isolated ⁸⁹Zr-chloride compared with ⁸⁹Zr-chloride prepared using the conventional two-step procedure.

CONCLUSION

TBP-functionalized resin appears promising for the direct isolation of ⁸⁹Zr-chloride from irradiated ^natY targets. Excellent ⁸⁹Zr recovery efficiencies were obtained, and chemical purity was sufficient for proof-of-concept chelation studies.

Recent Advances in Zirconium-89 Chelator Development

The interest in zirconium-89 (⁸⁹Zr) as a positron-emitting radionuclide has grown considerably over the last decade due to its standardized production, long half-life of 78.2 h, favorable decay characteristics for positron emission tomography (PET) imaging and its successful use in a variety of clinical and preclinical applications. However, to be utilized effectively in PET applications it must be stably bound to a targeting ligand, and the most successfully used ⁸⁹Zr chelator is desferrioxamine B (DFO), which is commercially available as the iron chelator Desferal^®. Despite the prevalence of DFO in ⁸⁹Zr-immuno-PET applications, the development of new ligands for this radiometal is an active area of research. This review focuses on recent advances in zirconium-89 chelation chemistry and will highlight the rapidly expanding ligand classes that are under investigation as DFO alternatives.

Targeting HER2 in Nuclear Medicine for Imaging and Therapy

Since its discovery, the human epidermal growth factor 2 (HER2) has been extensively studied. Presently, there are 2 standard diagnostic techniques to assess HER2 status in biopsies: immunohistochemistry and fluorescence in situ hybridization. While these techniques have played an important role in the treatment of patients with HER2-positive cancer, they both require invasive biopsies for analysis. Moreover, the expression of HER2 is heterogeneous in breast cancer and can change over the course of the disease. Thus, the degree of HER2 expression in the small sample size of biopsied tumors at the time of analysis may not represent the overall status of HER2 expression in the whole tumor and in between tumor foci in the metastatic setting as the disease progresses. Unlike biopsy, molecular imaging using probes against HER2 allows for a noninvasive, whole-body assessment of HER2 status in real time. This technique could potentially select patients who may benefit from HER2-directed therapy and offer alternative treatments to those who may not benefit. Several antibodies and small molecules against HER2 have been labeled with different radioisotopes for nuclear imaging and/or therapy. This review presents the most recent advances in HER2 targeting in nuclear medicine focusing on preclinical and clinical studies.

Development of 89Zr-Ontuxizumab for in vivo TEM-1/endosialin PET applications

PURPOSE

The complexity of sarcoma has led to the need for patient selection via in vivo biomarkers. Tumor endothelial marker-1 (TEM-1) is a cell surface marker expressed by the tumor microenvironment. Currently MORAb-004 (Ontuxizumab), an anti-TEM-1 humanized monoclonal antibody, is in sarcoma clinical trials. Development of positron emission tomography (PET) for in vivo TEM-1 expression may allow for stratification of patients, potentially enhancing clinical outcomes seen with Ontuxizumab.

RESULTS

Characterization of cell lines revealed clear differences in TEM-1 expression. One high expressing (RD-ES) and one low expressing (LUPI) cell line were xenografted, and mice were injected with 89Zr-Ontuxizumab. PET imaging post-injection revealed that TEM-1 was highly expressed and readily detectable in vivo only in RD-ES. In vivo biodistribution studies confirmed high radiopharmaceutical uptake in tumor relative to normal organs.

EXPERIMENTAL DESIGN

Sarcoma cell lines were characterized for TEM-1 expression. Ontuxizumab was labeled with 89Zr and evaluated for immunoreactivity preservation. 89Zr-Ontuxizumab was injected into mice with high or null expressing TEM-1 xenografts. In vivo PET imaging experiments were performed.

CONCLUSION

89Zr-Ontuxizumab can be used in vivo to determine high versus low TEM-1 expression. Reliable PET imaging of TEM-1 in sarcoma patients may allow for identification of patients that will attain the greatest benefit from anti-TEM-1 therapy.

Modeling and experimental data of zirconium-89 production yield

The radionuclide zirconium-89 can be employed for the positron emission tomography (PET). In this study ⁸⁹Zr excitation function via ⁸⁹Y(p,n)⁸⁹Zr reaction was calculated by the TALYS-1.8 code based on microscopic level density model. The formation of ⁸⁹Zr was simulated using the Monte Carlo simulation code MCNPX to calculate the integral yield in the ⁸⁹Y target body for threshold up to 40MeV incident-proton energy. The target thickness was based on calculation of the stopping power using the SRIM-2013 code matched to any incident-proton energy. The production yield of the ⁸⁹Zr simulated with the Monte Carlo method for the ⁸⁹Y(p,n)⁸⁹Zr, ⁸⁹Y(d,2n)⁸⁹Zr, ^natSr(α,xn)⁸⁹Zr and ^natZr(p,pxn)⁸⁹Zr reactions and the results were in good agreement with published experimental results for the optimum energy range. An experimental yield of 53.1MB/µA for the 15MeV proton-induced on Y₂O₃ powder as a disk-target obtained for 1h irradiation at the AMIRS cyclotron.

Utilization of GEANT to calculation of production yield for 89Zr by charge particles interaction on 89Y, natZr and natSr

The ⁸⁹Zr, is one of the radionuclide with near-ideal properties for PET due to its suitable half-life and decay properties. The cross-section of ⁸⁹Zr via ⁸⁹Y(p,n)⁸⁹Zr, ⁸⁹Y(d,2n)⁸⁹Zr, ^natSr(α,xn)⁸⁹Zr and ^natZr(p,pxn)⁸⁹Zr, were calculated by the TALYS-1.8 code to predict the optimum range of charge particle energy. The Monte Carlo code GEANT4 was used to simulate the formation of ⁸⁹Zr in the target body. The simulated ⁸⁹Zr yield was in good agreement with published experimental results in the optimum energy range. According to the calculations, the ⁸⁹Y(p,n)⁸⁹Zr was superior to the other reactions useful to medical application.

[89Zr]Trastuzumab: Evaluation of Radiation Dosimetry, Safety, and Optimal Imaging Parameters in Women with HER2-Positive Breast Cancer

PURPOSE

The purpose of the present study is to evaluate safety, human radiation dosimetry, and optimal imaging time of [89Zr]trastuzumab in patients with HER2-positive breast cancer.

PROCEDURES

Twelve women with HER2-positive breast cancer underwent [89Zr]trastuzumab positron emission tomography (PET)/X-ray computed tomography (CT) twice within 7 days post-injection. Biodistribution data from whole-torso PET/CT images and organ time-activity curves were created using data from all patients. Human dosimetry was calculated using OLINDA with the adult female model.

RESULTS

High-quality images and the greatest tumor-to-nontumor contrast were achieved with images performed 5 ± 1 day post-injection. Increased [89Zr]trastuzumab uptake was seen in at least one known lesion in ten patients. The liver was the dose-limiting organ (retention of ∼12 % of the injected dose and average dose of 1.54 mSv/MBq). The effective dose was 0.47 mSv/MBq. No adverse effects of [89Zr]trastuzumab were encountered.

CONCLUSION

[89Zr]trastuzumab was safe and optimally imaged at least 4 days post-injection. The liver was the dose-limiting organ.

Spot-welding solid targets for high current cyclotron irradiation

Zirconium-89 finds broad application for use in positron emission tomography. Its cyclotron production has been limited by the heat transfer from yttrium targets at high beam currents. A spot welding technique allows a three-fold increase in beam current, without affecting ⁸⁹Zr quality. An yttrium foil, welded to a jet-cooled tantalum support base accommodates a 50µA proton beam degraded to 14MeV. The resulting activity yield of 48±4 MBq/(μA∙hr) now extends the outreach of ⁸⁹Zr for a broader distribution.

Microfluidic Preparation of a 89Zr-Labeled Trastuzumab Single-Patient Dose

(89)Zr-labeled antibodies are being investigated in several clinical trials; however, the time requirement for synthesis of clinical doses can hinder patient throughput because of scheduling difficulties. Additionally, low specific activity due to poor labeling efficiency can require larger amounts of the radiopharmaceutical to be administered, possibly leading to adverse side effects. Here, we describe the design and evaluation of a microfluidic reactor capable of synthesizing a single clinical dose of (89)Zr-labeled antibody. (89)Zr-labeled trastuzumab was chosen for this validation because it is currently being evaluated in clinical trials for imaging human epidermal growth factor receptor 2-positive cancer patients.

METHODS

A microreactor fabricated from polydimethylsiloxane/glass was silanated with trimethoxy(octadecyl) silane to reduce antibody adsorption. Desferrioxamine-p-benzyl-isothiocyanate (DFO-Bz-NCS) was conjugated to trastuzumab in an 8:1 molar ratio following the literature procedures using aseptic techniques. Radiolabeling was performed by pumping (89)Zr-oxalate and DFO-Bz-trastuzumab into the microfluidic reactor at a total rate of 20 μL/min in ratios varying from 1:37 to 1:592 mg:MBq at 37°C to achieve optimal labeling.

RESULTS

Silanated reactors showed low antibody adsorption in comparison to unmodified reactors (95% monoclonal antibody recovered vs. 0% recovered). Labeling of the modified trastuzumab was shown to be achievable at a specific activity above the reported literature value of 220 MBq/mg. A high radiochemical purity was achieved without an incubation period at specific activities of less than 148 MBq/mg; however, specific activities up to 592 MBq/mg could be achieved with an incubation period. Clinical doses were able to be prepared and passed all quality control guidelines set by the Food and Drug Administration. Samples were sterile, colorless, and radiochemically pure (100%); maintained the ability to bind to the intended receptor; formed a minimal amount of aggregates (1%-4%); and were completed within 45-60 min.

CONCLUSION

(89)Zr-labeled trastuzumab for use in a clinical setting was synthesized in a microfluidic reactor in under an hour while reducing the amount of handling required by a technician. Use of this compact platform not only could enable the use of radiolabeled antibodies to become a common practice, but also could spread the use of radiolabeled antibodies beyond locations with cyclotron facilities.

Evaluation of (89)Zr-pertuzumab in Breast cancer xenografts

Pertuzumab is a monoclonal antibody that binds to HER2 and is used in combination with another HER2–specific monoclonal antibody, trastuzumab, for the treatment of HER2+ metastatic breast cancer. Pertuzumab binds to an HER2 binding site distinct from that of trastuzumab, and its affinity is enhanced when trastuzumab is present. We aim to exploit this enhanced affinity of pertuzumab for its HER2 binding epitope and adapt this antibody as a PET imaging agent by radiolabeling with ⁸⁹Zr to increase the sensitivity of HER2 detection in vivo. Here, we investigate the biodistribution of ⁸⁹Zr-pertuzumab in HER2–expressing BT-474 and HER2–nonexpressing MDA-MB-231 xenografts to quantitatively assess HER2 expression in vivo. In vitro cell binding studies were performed resulting in retained immunoreactivity and specificity for HER2–expressing cells. In vivo evaluation of ⁸⁹Zr-pertuzumab was conducted in severely combined immunodeficient mice, subcutaneously inoculated with BT-474 and MDA-MB-231 cells. ⁸⁹Zr-pertuzumab was systemically administered and imaged at 7 days postinjection (p.i.) followed by terminal biodistribution studies. Higher tumor uptake was observed in BT-474 compared to MDA-MB-231 xenografts with 47.5 ± 32.9 and 9.5 ± 1.7% ID/g, respectively at 7 days p.i (P = 0.0009) and blocking studies with excess unlabeled pertuzumab showed a 5-fold decrease in BT-474 tumor uptake (P = 0.0006), confirming the in vivo specificity of this radiotracer. Importantly, we observed that the tumor accumulation of ⁸⁹Zr-pertuzumab was increased in the presence of unlabeled trastuzumab, at 173 ± 74.5% ID/g (P = 0.01). Biodistribution studies correlate with PET imaging quantification using max SUV (r = 0.98, P = 0.01). Collectively, these results illustrate that ⁸⁹Zr-pertuzumab as a PET imaging agent may be beneficial for the quantitative and noninvasive assessment of HER2 expression in vivo especially for patients undergoing trastuzumab therapy.

Zirconium-89 labeled antibodies: a new tool for molecular imaging in cancer patients

Antibody based positron emission tomography (immuno-PET) imaging is of increasing importance to visualize and characterize tumor lesions. Additionally, it can be used to identify patients who may benefit from a particular therapy and monitor the therapy outcome. In recent years the field is focused on ⁸⁹Zr, a radiometal with near ideal physical and chemical properties for immuno-PET. In this review we will discuss the production of  ⁸⁹Zr, the bioconjugation strategies, and applications in (pre-)clinical studies of  ⁸⁹Zr-based immuno-PET in oncology. To date, ⁸⁹Zr-based PET imaging has been investigated in a wide variety of cancer-related targets. Moreover, clinical studies have shown the feasibility for ⁸⁹Zr-based immuno-PET to predict and monitor treatment, which could be used to tailor treatment for the individual patient. Further research should be directed towards the development of standardized and robust conjugation methods and improved chelators to minimize the amount of released Zr⁴⁺ from the antibodies. Additionally, further validation of the imaging method is required. The ongoing development of new ⁸⁹Zr-labeled antibodies directed against novel tumor targets is expected to expand applications of  ⁸⁹Zr-labeled immuno-PET to a valuable method in the medical imaging.

H6phospa-trastuzumab: bifunctional methylenephosphonate-based chelator with 89Zr, 111In and 177Lu

The acyclic chelator H6phospa and the bifunctional derivative p-SCN-Bn-H6phospa have been synthesized using nosyl protection chemistry and evaluated with (89)Zr, (111)In, and (177)Lu. The p-SCN-Bn-H6phospa derivative was successfully conjugated to trastuzumab with isotopic dilution assays indicating 3.3 ± 0.1 chelates per antibody and in vitro cellular binding assays indicating an immunoreactivity value of 97.9 ± 2.6%. Radiolabeling of the H6phospa-trastuzumab immunoconjugate was achieved with (111)In in 70-90% yields at room temperature in 30 minutes, while (177)Lu under the same conditions produced more inconsistent yields of 40-80%. Stability experiments in human serum revealed the (111)In-phospa-trastuzumab complex to be 52.0 ± 5.3% intact after 5 days at 37 °C, while the (177)Lu-phospa-trastuzumab to be only 2.0 ± 0.3% intact. Small animal SPECT/CT imaging using mice bearing subcutaneous SKOV-3 ovarian cancer xenografts was performed, and it was found that (111)In-phospa-trastuzumab successfully identified and delineated small (~2 mm in diameter) tumors from surrounding tissues, despite visible uptake in the kidneys and bone due to moderate chelate instability. As predicted from stability assays in serum, the (177)Lu-phospa-trastuzumab conjugate served as a negative control and displayed no tumor uptake, with high uptake in bones indicating rapid and complete radiometal dissociation and suggesting a potential application of H6phospa in transient lanthanide chelation for bone-delivery. Radiolabeling with (89)Zr was attempted, but even with elevated temperatures of 37 °C, the maximum observed radiometal incorporation over 18 hours was 12%. It can be concluded from this work that H6phospa is not superior to the previously studied H4octapa for use with (111)In and (177)Lu, but improvements in (89)Zr radiolabeling were observed over H4octapa, suggesting H6phospa to be an excellent starting point for elaboration of (89)Zr-based radiopharmaceutical development. To our knowledge, H6phospa is the best desferrioxamine alternative for (89)Zr radiolabeling to be studied to date.