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Molecular imaging tools, both equipment and agents, continue to improve and evolve, offering multimodality imaging with greater sensitivity and high-resolution of biological processes in real time. This review summarizes some of these recent developments in preclinical hardware, wetware and software, and their impact on drug development. The focus is on the advances in non-invasive small animal imaging such as positron emission tomography (PET), computed tomography (CT) and solid state detectors in single photon emission tomography (SPECT), which, when combined with labeled tracers serving as biomarkers and functional probes in vivo, are demonstrating the potential to accelerate our understanding of disease and help select drug candidates for development.

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The intraoperative detection of cell injury and cell death is fundamental to human surgeries such as organ transplantation and resection. Because of low autofluorescence background and relatively high tissue penetration, invisible light in the 800 nm region provides sensitive detection of disease pathology without changing the appearance of the surgical field. In order to provide surgeons with real-time intraoperative detection of cell injury and death after ischemia/reperfusion (I/R), we have developed a bioactive derivative of human annexin V (annexin800), which fluoresces at 800 nm. Total fluorescence yield, as a function of bioactivity, was optimized in vitro, and final performance was assessed in vivo. In liver, intestine and heart animal models of I/R, an optimal signal to background ratio was obtained 30 min after intravenous injection of annexin800, and histology confirmed concordance between planar reflectance images and actual deep tissue injury. In summary, annexin800 permits sensitive, real-time detection of cell injury and cell death after I/R in the intraoperative setting, and can be used during a variety of surgeries for rapid assessment of tissue and organ status.

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Various tetradentate N3S ligands which contain pyridyl, morpholino, or imidazolyl moieties were prepared and labeled with technetium and rhenium. Metal complexation of the ligands occurred efficiently over the pH range from 2 to 11. Ligands possessing the S-THP (tetrahydropyranyl)-protected mercapto group labeled efficiently even under alkaline conditions, and among the three types of heterocyclic metal complexes, a marked difference in stability was observed; rhenium complexes decomposed to ReO4 whereas technetium complexes decomposed to TcO2/TcO4. In general, imidazolyl complexes of both technetium and rhenium were very stable in saline; less than 10% decomposition after 24 h. The technetium histidyl complex and technetium pyridyl complex were quite stable even under cysteine challenge; less than 10% decomposition after 24 h. The rhenium and technetium morpholino complexes were very unstable; greater than 10% decomposition after only 1 h in saline and greater than 25% decomposition in 1 h under cysteine challenge. Profound pharmacokinetic differences among these metal complexes were also observed in rat biodistribution studies. The neutral pyridyl complexes exhibited high blood and liver uptake and slow clearance from these tissues. The replacement of a hydroxyl group by a carboxyl group, which resulted in an anionic complex at physiological pH, resulted in a dramatic decrease in blood and liver uptake. The neutral imidazolyl complex exhibited marked reduction in blood uptake and much faster clearance from blood and liver compared to the neutral pyridyl complex. Finally, the anionic histidyl complex, which contains both the imidazolyl and carboxyl groups, had the most favorable pharmacokinetic properties in that it exhibited very low blood, liver, and kidney uptakes and a rapid clearance from the body via the renal system. The combination of the high stability and favorable pharmacokinetic properties of the imidazolyl complexes should render them useful for targeted delivery of the medically important isotopes.

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Rhenium is a radionuclide with physical and chemical properties suitable for radioimmunotherapy. Two Phase I trials were carried out using 186Re-labeled murine monoclonal antibodies. Patients with refractory metastatic epithelial carcinoma received single doses of either 186Re-labeled intact NR-LU-10, a pancarcinoma antibody, 25-120 mCi/m2 (n = 15) or 186Re-labeled F(ab')2 fragment of NR-CO-02, an anti-CEA variant antibody, 25-200 mCi/m2 (n = 31). Prior to radioimmunotherapy, tumor localization of antibody was confirmed by 99mTc-labeled NR-LU-10 Fab or 99mTc-labeled NR-CO-02 F(ab')2 imaging. Dose-limiting myelosuppression was observed at 120 mCi/m2 following 186Re-NR-LU-10 intact antibody and at 150 mCi/m2 following NR-CO-02 F(ab')2 fragment in heavily pretreated patients. In patients with minimal prior therapy, a maximum tolerated dose for NR-CO-02 F(ab')2 was not reached by 200 mCi/m2. Non-marrow toxicity was minimal. Human anti-mouse antibody developed in all patients receiving intact NR-LU-10, and in 86% patients receiving F(ab')2 NR-CO-02. One patient treated with 186Re NR-CO-02 achieved a partial response. We conclude that 186Re-labeled antibody can be safely administered with significant toxicity limited to marrow.

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Several radionuclides are being studied for use in radioimmunotherapy. Although 131I has been used most widely, there are several disadvantages to it including its large gamma-ray component, its rather long half-life, and its modest beta-particle energy. However, the beta-particle energy can be an advantage in very small tumors (less than 1-2 mm). 186Re has several potential advantages over 131I but it has never been directly compared with it experimentally. Dosimetry modeling predicted that 186Re would have a dose advantage over 131I at large tumor sizes but for tumors as small as 1 mm diameter, this advantage would be lost. In order to confirm these predictions experimentally, this study compared the relative efficacy of a pancarcinoma antibody, NR-LU-10 labeled with 186Re or 131I in 0.8-1.0 mm diameter LS174T human colon adenocarcinoma multicell spheroids. Spheroids were incubated for 90 hr at 37 degrees C and evaluated with clonogenic assay, autoradiography, and histology. When corrected for cumulative activity bound, both radionuclides were equally effective. Autoradiography demonstrated poor penetration of radionuclide into the depths of the spheroids. Because 186Re has a theoretical dose advantage in larger tumors and because it has been shown to be equivalent to 131I in tumors as small as 1 mm diameter, it may be superior to 131I in most clinical situations. However, in the treatment of micrometastases of less than 1 mm diameter, theoretical dosimetry modeling predicts that 131I or radionuclides with similar beta particle energies should be more effective.

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A 186Re-labeled monoclonal antibody (MAb), NR-LU-10, was used for the radioimmunotherapy of a subcutaneous human small cell lung carcinoma xenograft, SHT-1, in nude mice. Biodistribution with specific and irrelevant labeled MAb demonstrated peak tumor uptake of 8% and 3% of the injected dose/g at 2 days, respectively. Dosimetry analysis predicted tumor:whole-body radiation-absorbed dose ratios of 2.43:1 for NR-LU-10 and 0.62:1 for irrelevant MAb. Single-dose toxicity screening estimated a 50% lethal dose within 30 days of 600 microCi (880 cGy of whole-body radiation). As anticipated, a multiple-dose regimen of 490 microCi in four doses over 10 days (720 cGy of whole-body radiation, eight of eight surviving greater than 30 days) was less toxic than a single bolus dose of 430 microCi (644 cGy of whole-body radiation), six of eight surviving greater than 30 days). A multidose radioimmunotherapy regimen was initiated in nude mice bearing 66-mm3 tumors (total dose, 500 to 600 microCi). Complete remissions (greater than 140 days) were achieved in three of 16 mice, and the remainder showed a mean tumor growth delay of 53 days. Matched doses with irrelevant MAb produced one remission, one treatment-related death, and a mean growth delay of only 20 days in six of eight mice. Thus, in this nonoptimal radioimmunotherapy model, significant antitumor responses were observed using a mildly toxic multiple dosing regimen.

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Re-186 and Re-188 have been suggested for radioimmunotherapy because of their energetic beta particles, imageable gamma photons, and chemical properties similar to technetium. Because of this potential, these isotopes were evaluated before in vivo imaging was attempted. It was found that low-abundance, high-energy gamma photons present in these rhenium isotopes require a medium-energy collimator to yield optimal image resolution and count rate, which are critical factors in the performance of preliminary imaging studies on patients for antibody imaging and therapy.

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Biodistribution, pharmacokinetic, and radioimaging studies were performed with 186Re-labeled NR-LU-10 whole antibody in athymic nude mice bearing the LS174T tumor growing either s.c. or in an experimental hepatic metastasis model. NR-LU-10 is an IgG2b murine monoclonal antibody (MAb) that reacts with virtually all human tumors of epithelial origin. NR-BC-1, a IgG2b murine MAb that reacts with normal human B-cell and B malignancies, was used as an isotype-matched control. These MAbs were radiolabeled with 186Re (3.7-day physical half-life; 1.07-MeV beta particle and 137-keV gamma, 9% abundance) by a preformed chelate approach by using the triamide thiolate ligand system. 186Re-labeled NR-LU-10 (50 microCi) was injected into nude mice bearing LS174T tumors growing s.c. Biodistribution studies revealed that the LS174T tumor retained the highest concentration of 186Re-labeled NR-LU-10 (5.3% injected dose/g) at day 6. The tumor:blood ratio ranged from 0.1:1 to 10.8:1 by day 6, the last day of analysis. In contrast the tumor:blood ratio of 186Re-labeled NR-BC-1, the isotype-matched MAb control, was 1:1 on day 6. Pharmacokinetic analysis indicated that the t1/2 beta of NR-LU-10 for blood and other tissues ranged from 21 to 25 h, while the t1/2 beta for the LS174T tumor averaged 52 h. The area under the curve for tumor compared to blood was 2.8- to 5.7-fold higher than the area under the curve for all other tissues and organs. The mean residence time for NR-LU-10 in blood and all other organs ranged from 23 to 26 h, while the mean residence time for NR-LU-10 in the LS174T tumor was 72 h. Scintigraphic images revealed selective uptake of the 186Re-labeled NR-LU-10, but not of the 186Re-labeled NR-BC-1, at the LS174T tumor site. Studies in an experimental model of hepatic metastasis revealed a similar selective pattern of 186Re-labeled NR-LU-10 accumulation. Scintigraphic images of the LS174T tumor growing within the athymic nude mouse liver were obtained. The biodistribution, pharmacokinetic, and scintigraphic image results suggest that 186Re-labeled NR-LU-10 shows promise as a therapeutic agent for gastrointestinal cancer.

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A series of 15 nonreducible technetium-99m(III) complexes of formula tr-[99mTcL(Y)2]+ has been prepared by a general synthetic route based on reductive addition of Y to the technetium-99m (99mTc) intermediate [99mTcL(O)]+. In these complexes, selected for potential use as myocardial imaging agents, L represents one of the two tetradentate Schiff base ligands N,N'-ethylenebis(acetylacetone iminato), (en), or N,N'-propylene-1,2-bis(acetylacetone iminato), (pn), while Y represents a monodentate phosphine, phosphite or isonitrile ligand as exemplified by P(CH3)3, P(OCH3)3 and CN-C(CH3)3. Of these 15 complexes, several with octanol/saline partition coefficients in the range 0.04-20 exhibit significant myocardial uptake in rats and dogs. Of these, none exhibit detectable myocardial washout, providing strong support for the hypothesis that myocardial washout occurs only for those 99mTc(III) cations that undergo in vivo reduction to the neutral 99mTc(II) form. Evaluation of the prototypical complex tr-[99mTc(en)(P(CH3)3)2]+ in seven normal volunteers and patients establishes that it is only a mediocre myocardial imaging agent in man.

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The beta emitting isotopes 186Re and 188Re are logical choices on which to base therapeutic radiopharmaceuticals that might be expected to be analogous to diagnostic radiopharmaceuticals based on 99mTc. However, the chemistry of rhenium is sufficiently different from that of technetium so that the development of Re radiopharmaceuticals often cannot be predicated on the known chemistry and biological behavior of 99mTc radiopharmaceuticals. The relevant chemical differences involve the greater stability of the higher oxidation states of Re (and thus the greater tendency of reduced Re radiopharmaceuticals to undergo re-oxidation to perrhenate), and the greater substitution inertness of reduced Re complexes. These differences are illustrated in the preparation and use of 186Re (Sn)-HEDP and 99mTc(Sn)-HEDP diphosphonate radiopharmaceuticals designed, respectively, for palliative therapy and diagnosis of metastatic cancer to bone, and in the preparation and biodistribution of tr[186Re(DMPE)2Cl2]+ and [186Re(DMPE)3]+, analogs to the potential myocardial perfusion imaging agents tr-[99mTc(DMPE)2Cl2]+ and [99mTc(DMPE)3]+. [HEDP = (1-hydroxyethylidene)diphosphonate; DMPE = 1,2-bis(dimethylphosphino)ethane].

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Cardiac scintigraphy was performed in six patients with a documented previous myocardial infarction, in one patient with mitral regurgitation, and in four healthy volunteers following administration of 99mTc-tris-DMPE. An intense early blood pool phase permitted gated blood pool scintigraphy and left ventricular ejection fraction calculation. A myocardial phase 12-14 h later permitted myocardial perfusion imaging. The rest myocardial perfusion image quality with 99mTc-tris-DMPE appeared to be superior to the resting image quality obtained with 99mTc-dichloro-DMPE but was inferior to the resting image quality obtained with 201Tl.

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The preparation of "no-carrier-added" [99mTc(DMPE)2X2]+ (X = Cl, Br) in greater than 95% radiochemical purity, suitable for in vivo evaluation as a myocardial imaging agent, is described. Reaction parameters that lead to the formation of the desired products, as well as those that lead to the formation of the major impurities, are delineated. These 99mTc species are characterized by HPLC using the known 99Tc analogs as standards. Myocardial images obtained in mongrel dogs with [99mTc(DMPE)2X2]+ (X = Cl, Br) are briefly discussed.

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Technetium-99m DMPE (99mTc-DMPE) is a newly synthesized myocardial perfusion imaging agent that shows intense myocardial accumulation in the dog. In the present study, dosimetry and potential clinical usefulness of this agent were assessed in four human subjects. Absorbed radiation doses were low, with the highest doses consisting of 200 mrad/mCi (54 microGy/MBq) to the gallbladder and 160 mrad/mCi (43 microGy/MBq) to the liver. No evidence of clinical toxicity was found. Technetium-99m DMPE did image the myocardium, but the ratio of target to nontarget activity was less favorable than that observed in the dog. Intense hepatic 99mTc-DMPE activity interfered with clinical imaging of the cardiac apex in two of the four subjects. We conclude that the prototype radiopharmaceutical, 99mTc-DMPE, is capable of myocardial perfusion imaging in man but the planar myocardial images produced are of inferior quality compared with 201Tl myocardial images. Further work is justified to develop related compounds to overcome the clinical limitations described.

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After intravenous administration of Tc-99m DMPE the flow-dependent kinetics were studied in dogs during induced ischemia and during induced maximal reactive hyperemia. A control group was also studied. Mean time-activity curves obtained from the myocardial wall were compared within the same intervention group and also with other groups. During reactive hyperemia, there was a rapid and absolute increase in uptake followed by a rapid washout, whereas during ischemia there was a slow and decreased uptake followed by a slow washout. The magnitude of Tc-99m DMPE uptake during reactive hyperemia was slightly less than that of Tl-201, but the decreased uptake with ischemia was about equal for the two agents. Following maximal uptake in the myocardium the effective half-life of Tc-99m DMPE was one-third to one-fourth that of Tl-201. The similar kinetics of Tc-99m DMPE compared to Tl-201 suggests its usefulness in the evaluation of ischemic heart disease.

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Newly synthesized Tc-99m dichlorobis(1,2-dimethylphosphino)ethane (DMPE) was investigated as a myocardial imaging agent with respect to its kinetics (dependent on both time and regional coronary blood flow), its percent organ uptake, and its imaging characteristics in the anesthetized dog. Most of these data are compared with those of Tl-201. Blood clearance of the two agents is essentially the same. Compared with Tl-201, Tc-99m DMPE shows faster overall kinetics, higher heart-to-lung ratio, equally good correlation with a wide range of regional blood flows, and higher liver uptake. At the time of peak myocardial uptake, the mean heart uptake of Tl-201 is 4.3%, compared with 2.9% for Tc-99m DMPE, yet only 0.9% uptake of Tc-99m DMPE is found in the lung as compared with 3.3% for Tl-201. These differences result in a heart-to-lung ratio of 2:1 for Tc-99m DMPE and 1:1 for Tl-201, based on the data obtained from the time-activity curve. The quantitative findings are supported by the superior quality of Tc-99m DMPE images of both normal and infarcted dog heart. The high hepatic uptake of Tc-99m DMPE is not a serious problem if images are obtained within 5-60 min after dose. These basic kinetic studies suggest that Tc-99m DMPE is a promising myocardial imaging agent.

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