Preclinical evaluation of 68Ga- and 177Lu-labeled integrin αvβ6-targeting radiotheranostic peptides

Rationale: The integrin α_vβ₆, an epithelial-specific cell surface receptor, is overexpressed on numerous malignancies, including the highly lethal pancreatic ductal adenocarcinomas (PDAC). Here, we developed and tested a novel α_vβ₆-targeting peptide, DOTA-5G (1) radiolabeled with gallium-68 for positron emission tomography/computed tomography (PET/CT) imaging, and lutetium-177 for treatment. With the goal to develop a radiotheranostic, further modifications were made for increased circulation time, renal recycling, and tumor uptake, yielding DOTA-ABM-5G (2). Methods: Peptides 1 and 2 were synthesized on solid phase and their affinity for αvβ6 assessed by ELISA. The peptides were radiolabeled with gallium-68 and lutetium-177. In vitro cell binding, internalization, and efflux of ⁶⁸Ga-1 and ¹⁷⁷Lu-2 were evaluated in α_vβ₆ (+) BxPC-3 human pancreatic cancer cells. PET/CT imaging of ⁶⁸Ga-1 and ⁶⁸Ga-2 was performed in female nu/nu mice bearing subcutaneous BxPC-3 tumors. Biodistribution was performed for ⁶⁸Ga-1 (1 and 2 h p.i.), ⁶⁸Ga-2 (2 and 4 h p.i.), and ¹⁷⁷Lu-1 and ¹⁷⁷Lu-2 (1, 24, 48, and 72 h p.i.). The ¹⁷⁷Lu-2 biodistribution data were extrapolated for human dosimetry data estimates using OLINDA/EXM 1.1. Therapeutic efficacy of ¹⁷⁷Lu-2 was evaluated in mice bearing BxPC-3 tumors. Results: Peptides 1 and 2 demonstrated high affinity for α_vβ₆ by ELISA. ⁶⁸Ga-1, ⁶⁸Ga-2, ¹⁷⁷Lu-1 and ¹⁷⁷Lu-2 were synthesized in high radiochemical purity (RCP). Rapid in vitro binding and internalization of ⁶⁸Ga-1 and ¹⁷⁷Lu-2 were observed in BxPC-3 cells. PET/CT imaging and biodistribution studies demonstrated uptake in BxPC-3 tumors. Introduction of the ABM in ¹⁷⁷Lu-2 resulted in a 5-fold increase in tumor uptake and retention over time. Based on the extended dosimetry data the dose-limiting organ for ¹⁷⁷Lu-2 are the kidneys. Treatment with ¹⁷⁷Lu-2 prolonged survival. Conclusion: ⁶⁸Ga-1 and ¹⁷⁷Lu-2 demonstrated high affinity for the integrin α_vβ₆ both in vitro and in vivo, were rapidly internalized into BxPC-3 cells, and were stable in mouse and human serum. Both radiotracers showed favorable pharmacokinetics in pre-clinical studies with predominantly renal excretion and good tumor-to-normal tissue ratios. Favorable human dosimetry data suggest the potential of ¹⁷⁷Lu-2 as a treatment for PDAC.