IntroductionRenal cell carcinoma (RCC) represents cancer originating from the renal epithelium and accounts for > 90% of cancers in the kidney. Prostate-specific membrane antigen (PSMA) is overexpressed in tumor-associated neovascular endothelial cells of many solid tumors, including metastatic RCC. Although studied in several small clinical studies, PSMA-based imaging and therapy have not been pursued rigorously in preclinical RCC. This study aimed to evaluate the preclinical performance of PSMA-based radiotheranostic agents in a relevant murine model.MethodsA PSMA-overexpressing murine cell line, PSMA+ RENCA, was developed by lentiviral transduction. PSMA-based theranostic agents, 68Ga-L1/177Lu-L1/225Ac-L1, were synthesized in high radiochemical yield and purity following our reported methods. Immunocompetent BALB/c mice were used for flank and orthotopic tumor inoculation. 68Ga-L1 was evaluated in small animal PET/CT imaging in flank and PET/MR imaging in orthotopic models. Cell viability studies were conducted for 177Lu-L1 and 225Ac-L1. Proof-of-concept treatment studies were performed using 225Ac-L1 (0, 37 kBq, 2 kBq × 37 kBq, 1 week apart) using PSMA+ RENCA in the flank model.ResultsCellular uptake of 68Ga-L1, 177Lu-L1, and 225Ac-L1 confirmed the specificity of the agents to PSMA+ RENCA cells rather than to RENCA (wt) cells, which are low in PSMA expression. The uptake in PSMA+ RENCA cells at 1 h for 68Ga-L1 (49.0% incubated dose [ID] ± 3.6%ID/million cells), 177Lu-L1 (22.1%ID ± 0.5%ID)/million cells), and 225Ac-L1 (4.1% ± 0.2% ID)/million cells), respectively, were higher than the RENCA (wt) cells (~ 1%ID–2%ID/million cells). PET/CT images displayed > 7-fold higher accumulation of 68Ga-L1 in PSMA+ RENCA compared to RENCA (wt) in flank implantation at 1 h. A twofold higher accumulation of 68Ga-L1 was observed in orthotopic tumors than in normal kidneys during 1–3 h postinjection. High lung uptake was observed with 68Ga-L1 PET/MR imaging 3 weeks after orthotopic implantation of PSMA+ RENCA due to spontaneous lung metastases. The imaging data were further confirmed by immunohistochemical characterization. 225Ac-L1 (0-37 kBq) displayed a dose-dependent reduction of cell proliferation in the PSMA+ RENCA cells after 48 h incubation; ~ 40% reduction in the cells with treated 37 kBq compared to vehicle (p < 0.001); however, no effect was observed with 177Lu-L1 (0–3700 kBq) up to 144 h postinoculation, suggesting lower efficacy of β-particle-emitting radiations in cellular studies compared to α-particle-emitting 225Ac-L1. Animals treated with 225Ac-L1 at 1 week posttumor inoculation in flank models displayed significant tumor growth delay (p < 0.03) and longer median survival of 21 days and 24 days for the treatment groups 37 kBq and 2 kBq × 37 kBq, respectively, compared to the vehicle group (12 days).ConclusionThe results suggest that a theranostic strategy targeting PSMA, employing PET and α-emitting radiopharmaceuticals, enabled tumor growth control and enhanced survival in a relevant immunocompetent murine model of RCC. These studies provide the rationale for clinical studies of PSMA-targeted theranostic agents in patients with RCC.

Introduction: Prostate cancer (PC) is the second most common cancer and the fifth most frequent cause of cancer death among men. Prostate -specific membrane antigen (PSMA) expression is associated with aggressive PC, with expression in over 90% of patients with metastatic disease. Those characteristics have led to its use for PC diagnosis and therapies with radiopharmaceuticals, antibody -drug conjugates, and nanoparticles. Despite these advancements, none of the current therapeutics are curative and show some degree of toxicity. Here we present the synthesis and preclinical evaluation of a multimodal, PSMA-targeted dendrimer-drug conjugate (PTDDC), synthesized using poly(amidoamine) (PAMAM) dendrimers. PT-DDC was designed to enable imaging of drug delivery, providing valuable insights to understand and enhance therapeutic response. Methods: The PT-DDC was synthesized through consecutive conjugation of generation -4 PAMAM dendrimers with maytansinoid-1 (DM1) a highly potent antimitotic agent, Cy5 infrared dye for optical imaging, 2,2 ',2"-(1,4,7-triazacyclononane-1,4,7-triyl)triacetic acid (NOTA) chelator for radiolabeling with copper -64 and positron emission tomography tomography/computed tomography (PET/ CT), lysine -urea -glutamate (KEU) PSMA-targeting moiety and the remaining terminal primary amines were capped with butane1,2-diol. Non -targeted control dendrimer-drug conjugate (Ctrl-DDC) was formulated without conjugation of KEU. PT-DDC and CtrlDDC were characterized using high-performance liquid chromatography, matrix assisted laser desorption ionization mass spectrometry and dynamic light scattering. In vitro and in vivo evaluation of PT-DDC and Ctrl-DDC were carried out in isogenic human prostate cancer PSMA + PC3 PIP and PSMA - PC3 flu cell lines, and in mice bearing the corresponding xenografts. Results: PT-DDC was stable in 1xPBS and human blood plasma and required glutathione for DM1 release. Optical, PET/CT and biodistribution studies confirmed the in vivo PSMA-specificity of PT-DDC. PT-DDC demonstrated dose -dependent accumulation and cytotoxicity in PSMA + PC3 PIP cells, and also showed growth inhibition of the corresponding tumors. PT-DDC did not accumulate in PSMA - PC3 flu tumors and did not inhibit their growth. Ctrl-DDC did not show PSMA specificity. Conclusion: In this study, we synthesized a multimodal theranostic agent capable of delivering DM1 and a radionuclide to PSMA + tumors. This approach holds promise for enhancing image -guided treatment of aggressive, metastatic subtypes of prostate cancer.

Despite the significant progress achieved with PD-1/PD-L1 inhibitors in the treatment of metastatic renal cell carcinoma (mRCC), most patients ultimately progress. Targeted radiotheranostics offer a new potential approach. Although a radiotheranostic platform targeting the prostate-specific membrane antigen (PSMA) has been tested in mRCC in patients preliminarily, thorough preclinical optimization has not been reported. Prostate-specific membrane antigen (PSMA) is overexpressed in tumor-associated neovascular endothelial cells of many solid tumors, including metastatic RCC. Furthermore, radiopharmaceutical therapy using β- and α-particle emitting agents causes immunomodulation by inducing immunogenic cell death, and release of tumor-associated antigens, potentially enhancing inflammatory phenotype. Here, we investigated whether PSMA-based radiotheranostics can be utilized to improve the efficacy of PD-1 therapy. The PSMA+ RENCA model was developed by lentiviral transduction of RENCA (wt) cells and then characterized for basal and IFN-g induced PD-L1 expression. 68Ga-L1 and 225Ac-L1 were synthesized in high radiochemical yield and purity following our reported methods. Male and female BALB/c mice were used for tumor inoculation. 68Ga-L1 was evaluated in small animal PET/CT imaging in flank and PET/MR imaging in orthotopic implantation. A treatment study was conducted to assess the effect of combination therapy in seven groups in the flank tumors at 2 weeks post-inoculation: Control (saline); PD-1 (10 mg/kg); Anti-PD-1 (10 mg/kg)+axitinib (tyrosine kinase inhibitor, 5 mg/kg, oral gavage, for five days/wk); 225Ac-L1 (37 kBq); 225Ac-L1 (2×37 kBq, 1 wk apart); [225Ac-L1 (37 kBq)+PD-1 (10 mg/kg) and [225Ac-L1 2×37 kBq)+PD-1 (10 mg/kg)]. Therapeutic efficacy was assessed by tumor weight and time to progression of tumor volume doubling (TVD). To determine the mechanism of action of the 225Ac-L1/anti-PD-1 combination treatment, tumor-infiltrating lymphoid populations from tumor samples were collected at day 30, and Fluorescence-Activated Cell Sorting analysis was done with fluorochrome-labeled antibodies against CD45, CD3, CD8, IL10, and IL12. 68Ga-L1 and 225Ac-L1 confirmed 10-fold and 2-fold higher uptake, respectively, in the PSMA+ RENCA cells compared to RENCA (wt) cells. PET imaging in the flank model displayed ~7-fold higher accumulation of 68Ga-L1 in PSMA+ RENCA than the RENCA (wt). Two-fold higher accumulation of 68Ga-L1 was observed in orthotopic tumors than the normal kidneys during 1-3 h post-injection. Significant lung metastases were detected with 68Ga-L1 PET at 3 weeks in mice with orthotopic tumors. A combination therapy study was conducted using anti-PD-1 and anti-PD-1+axitinib and compared the efficacy with 225Ac-L1 as a single agent (37 kBq and 2×37 kBq, 1 wk apart) and in combination with PD-1. Median TVD increased from 12 d (control) to 16 d (anti-PD-1), 16 d (anti-PD-1+axitinib), 24 d [225Ac-L1 (37 kBq) P<0.001], 24 d [225Ac-L1 (2 × 37 kBq) P<0.0001}, 30 d [anti-PD-1+225Ac-L1 (1×37 kBq) P<0.0001], and undefined, [anti-PD-1+225Ac-L1 2×37 kBq), P<0.0001], respectively. Furthermore, treatment with 225Ac-L1 (2×37 kBq, 1 wk) resulted in a significant lowering of tumor growth (P< 0.01) compared to control, whereas anti-PD-1 (vs. control) alone moderately reduced tumor growth. The combination of the treatment of [PD-1+225Ac-L1 (2×37 kBq), P=0.0001] was the most effective in enhancing tumor growth inhibition compared with the PD-1+axitinib group. Flow cytometry of tumor-infiltrating immune cells of the treatment groups PD-1+225Ac-L1(37 kBq) and PD-1+225Ac-L1 (2×37 kBq) revealed a higher proportion of effector CD3+CD8+ T cells, accompanied by a significant decline in the proportion of immunosuppressive and pro-tumoral CD8+IL10+ T cells and increase in antitumor CD8+IL12+ T cells compared to untreated and treatment control groups (PD-1 or PD-1+axitinib groups). Combining radiotheranostic platform, 68Ga-L1/225Ac-L1 with PD-1 therapy reduces tumor burden and improves TVD in a syngeic model of RCC. This is a promising option for metastatic RCC patients with low and heterogeneous PSMA expression. Translation of this method will be pursued actively. DOD CDMRP Funding: yes

1394 Objectives: Dynamic PET provides more accurate quantitative information and richer disease information than static PET. However, routine clinical application of dynamic PET imaging is limited by invasive arterial blood sampling (or manually annotated image-derived blood activity) for use as an input function. This study aimed to develop a deep learning-based method to directly estimate the input function from dynamic PET data without any manual assistance. Methods: Our study consists of two clinical datasets. The first group of data includes dynamic FDG scans performed on the United Imaging uMI 510 PET/CT system in the Chinese PLA General Hospital. 35 subjects (25 male, 10 females; 13 healthy; age 15-73y) were scanned. Image-derived blood activity was used as input function. The second dataset (n= 26 healthy subjects) includes 90-min dynamic brain data after bolus injection of 11C-DPA-713(DPA) performed on a Siemens HRRT PET system at Johns Hopkins University. All DPA PET data in this study were acquired from individuals with high affinity binding genotype for the 18 kDa translocator protein target and included input function data acquired through arterial blood sampling and radiometabolite measurements. There were 30 dynamic frames in each scan. The input function value for each dynamic frame was interpolated from the measured input function curve. Each dataset was split into 3 parts: 70% as training set, 20% as validation set and 10% as test set. Two deep learning networks, namely the raw model and the fine-tuned model were investigated. The raw model contains a down-sampling convolutional module to extract image features and a fully connected regression module to predict the input function. The 3-D dynamic image and reference image are stacked to form a two-channel 4-D input. For FDG tracer, the reference image refers to image reconstructed from data acquired in 0 to 20 minutes scan. For DPA, the mean image of all dynamic images served as the reference image. L1-loss is chosen as the loss function based on controlled experiment results. In the fine-tuned model, the 1-D vector acquired from the convolutional module are concatenated with medical information including patient’s age, weight, height, injected dose, frame time. Data augmentation methods such as random center crop & resize, rotation, translation and scaling were used in training fine-tuned model. The input function for DPA was normalized according to its integral value before reconstruction. Indirect voxel-based reconstruction methods were used: Patlak analysis with start time (t*) of 20 minutes for Ki (FDG) and Logan analysis with t* of 30 minutes for VT (DPA). To investigate the performance of the proposed method, the root mean square error (RMSE) was calculated between the parametric images reconstructed with true and predicted input function. Results: The predicted input function shows similarity in shape to the standard input function. The prediction error in early stage was larger than in later stage, especially for the peak values in early stage. The fine-tuned model enhances prediction accuracy in the early stage, while the improvement in later stage was not obvious. The visual quality of reconstructed Ki and VT parametric image of the fine-tuned model was apparently better than that of raw model. The RMSE of the fine-tuned model was much lower than the raw model. Conclusions: The proposed fine-tuned deep learning-based method was able to estimate the input function directly from dynamic images. The high accuracy of the reconstructed parametric image using the predicted input function supports pursuit of this method for clinical application. In future work we will investigate to further improve the accuracy of the predicted input function. Support: The research was supported by the National Natural Science Foundation of China (No. 81727807, No.11575096, No. 11605008) and National Key Research and Development (R&D) Plan of China (Grant ID. 2019YFF0302503 and 2016YFC0105405).

Prostate-specific membrane antigen (PSMA)-based low-molecular-weight agents using beta(β)-particle-emitting radiopharmaceuticals is a new treatment paradigm for patients with metastatic castration-resistant prostate cancer. Although results have been encouraging, there is a need to improve the tumor residence time of current PSMA-based radiotherapeutics. Albumin-binding moieties have been used strategically to enhance the tumor uptake and retention of existing PSMA-based investigational agents. Previously, we developed a series of PSMA-based, β-particle-emitting, low-molecular-weight compounds. From this series, 177Lu-L1 was selected as the lead agent because of its reduced off-target radiotoxicity in preclinical studies. The ligand L1 contains a PSMA-targeting Lys-Glu urea moiety with an N-bromobenzyl substituent in the ε-amino group of Lys. Here, we structurally modified 177Lu-L1 to improve tumor targeting using two known albumin-binding moieties, 4-(p-iodophenyl) butyric acid moiety (IPBA) and ibuprofen (IBU), and evaluated the effects of linker length and composition. Six structurally related PSMA-targeting ligands (Alb-L1–Alb-L6) were synthesized based on the structure of 177Lu-L1. The ligands were assessed for in vitro binding affinity and were radiolabeled with 177Lu following standard protocols. All 177Lu-labeled analogs were studied in cell uptake and selected cell efficacy studies. In vivo pharmacokinetics were investigated by conducting tissue biodistribution studies for 177Lu-Alb-L2–177Lu-Alb-L6 (2 h, 24 h, 72 h, and 192 h) in male NSG mice bearing human PSMA+ PC3 PIP and PSMA− PC3 flu xenografts. Preliminary therapeutic ratios of the agents were estimated from the area under the curve (AUC0-192h) of the tumors, blood, and kidney uptake values. Compounds were obtained in >98% radiochemical yields and >99% purity. PSMA inhibition constants (Kis) of the ligands were in the ≤10 nM range. The long-linker-based agents, 177Lu-Alb-L4 and 177Lu-Alb-L5, displayed significantly higher tumor uptake and retention (p < 0.001) than the short-linker-bearing 177Lu-Alb-L2 and 177Lu-Alb-L3 and a long polyethylene glycol (PEG) linker-bearing agent, 177Lu-Alb-L6. The area under the curve (AUC0-192h) of the PSMA+ PC3 PIP tumor uptake of 177Lu-Alb-L4 and 177Lu-Alb-L5 were >4-fold higher than 177Lu-Alb-L2, 177Lu-Alb-L3, and 177Lu-Alb-L6, respectively. Also, the PSMA+ PIP tumor uptake (AUC0-192h) of 177Lu-Alb-L2 and 177Lu-Alb-L3 was ~1.5-fold higher than 177Lu-Alb-L6. However, the lowest blood AUC0-192h and kidney AUC0-192h were associated with 177Lu-Alb-L6 from the series. Consequently, 177Lu-Alb-L6 displayed the highest ratios of AUC(tumor)-to-AUC(blood) and AUC(tumor)-to-AUC(kidney) values from the series. Among the other agents, 177Lu-Alb-L4 demonstrated a nearly similar ratio of AUC(tumor)-to-AUC(blood) as 177Lu-Alb-L6. The tumor-to-blood ratio was the dose-limiting therapeutic ratio for all of the compounds. Conclusions: 177Lu-Alb-L4 and 177Lu-Alb-L6 showed high tumor uptake in PSMA+ tumors and tumor-to-blood ratios. The data suggest that linker length and composition can be modulated to generate an optimized therapeutic agent.

The inherent instability of nucleic acids within serum and the tumor microenvironment necessitates a suitable vehicle for non-viral gene delivery to malignant lesions. A specificity-conferring mechanism is also often needed to mitigate off-target toxicity. In the present study, we report a stable and efficient redox-sensitive nanoparticle system with a unique core–shell structure as a DNA carrier for cancer theranostics. Thiolated polyethylenimine (PEI-SH) is complexed with DNA through electrostatic interactions to form the core, and glycol chitosan-modified with succinimidyl 3-(2-pyridyldithio)propionate (GCS-PDP) is grafted on the surface through a thiolate-disulfide interchange reaction to form the shell. The resulting nanoparticles, GCS-PDP/PEI-SH/DNA nanoparticles (GNPs), exhibit high colloid stability in a simulated physiological environment and redox-responsive DNA release. GNPs not only show a high and redox-responsive cellular uptake, high transfection efficiency, and low cytotoxicity in vitro, but also exhibit selective tumor targeting, with minimal toxicity, in vivo, upon systemic administration. Such a performance positions GNPs as viable candidates for molecular-genetic imaging and theranostic applications.

We developed a theranostic radiopharmaceutical that engages two key cell surface proteases, fibroblast activation protein alpha (FAP) and prostate-specific membrane antigen (PSMA), each frequently overexpressed within the tumor microenvironment (TME). The latter is also expressed in most prostate tumor epithelium. To engage a broader spectrum of cancers for imaging and therapy, we conjugated small-molecule FAP and PSMA-targeting moieties using an optimized linker to provide 64Cu-labeled compounds. We synthesized FP-L1 and FP-L2 using two linker constructs attaching the FAP and PSMA-binding pharmacophores. We determined in vitro inhibition constants (Ki) for FAP and PSMA. Cell uptake assays and flow cytometry were conducted in human glioma (U87), melanoma (SK-MEL-24), prostate cancer (PSMA + PC3 PIP and PSMA − PC3 flu), and clear cell renal cell carcinoma lines (PSMA + /PSMA − 786-O). Quantitative positron emission tomography/computed tomography (PET/CT) and tissue biodistribution studies were performed using U87, SK-MEL-24, PSMA + PC3 PIP, and PSMA + 786-O experimental xenograft models and the KPC genetically engineered mouse model of pancreatic cancer. 64Cu-FP-L1 and 64Cu-FP-L2 were produced in high radiochemical yields (> 98

Fibroblast activation protein (FAP) has become a favored target for imaging and therapy of malignancy. We have synthesized and characterized two new (4-quinolinoyl)-glycyl-2-cyanopyrrolidine-based small molecules for imaging of FAP, QCP01 and [111In]QCP02, using optical and single-photon computed tomography/CT, respectively. Binding of imaging agents to FAP was assessed in six human cancer cell lines of different cancer types: glioblastoma (U87), melanoma (SKMEL24), prostate (PC3), NSCLC (NCIH2228), colorectal carcinoma (HCT116), and lung squamous cell carcinoma (NCIH226). Mouse xenograft models were developed with FAP-positive U87 and FAP-negative PC3 cells to test pharmacokinetics and binding specificity in vivo. QCP01 and [111In]QCP02 demonstrated nanomolar inhibition of FAP at Ki values of 1.26 and 16.20 nM, respectively. Both were selective for FAP over DPP-IV, a related serine protease. Both enabled imaging of FAP-expressing tumors specifically in vivo. [111In]QCP02 showed high uptake at 18.2 percent injected dose per gram in the U87 tumor at 30 min post-administration.