Towards the stable chelation of radium for biomedical applications with an 18-membered macrocyclic ligand
Targeted alpha therapy is an emerging strategy for the treatment of disseminated cancer. [ 223 Ra]RaCl 2 is the only clinically approved alpha particle-emitting drug, and it is used to treat castrate-resistant prostate cancer bone metastases, to which [ 223 Ra]Ra 2+ localizes. To specifically direct [ 223 Ra]Ra 2+ to non-osseous disease sites, chelation and conjugation to a cancer-targeting moiety is necessary. Although previous efforts to stably chelate [223Ra]Ra2+ for this purpose have had limited success, here we report a biologically stable radiocomplex with the 18-membered macrocyclic chelator macropa. Quantitative labeling of macropa with [ 223 Ra]Ra 2+ was accomplished within 5 min at room temperature with a radiolabeling efficiency of >95%, representing a significant advancement over conventional chelators such as DOTA and EDTA, which were unable to completely complex [ 223 Ra]Ra 2+ under these conditions. [ 223 Ra][Ra(macropa)] was highly stable in human serum and exhibited dramatically reduced bone and spleen uptake in mice in comparison to bone-targeted [ 223 Ra]RaCl 2 , signifying that [ 223 Ra][Ra(macropa)] remains intact in vivo. Upon conjugation of macropa to a single amino acid b-alanine as well as to the prostate-specific membrane antigen-targeting peptide DUPA, both constructs retained high affinity for 223 Ra, complexing >95% of Ra 2+ in solution. Furthermore, [ 223 Ra][Ra(macropa-b-alanine)] was rapidly cleared from mice and showed low 223 Ra bone absorption, indicating that this conjugate is stable under biological conditions. Unexpectedly, this stability was lost upon conjugation of macropa to DUPA, which suggests a role of targeting vectors in complex stability in vivo for this system. Nonetheless, our successful demonstration of efficient radiolabeling of the b-alanine conjugate with 223 Ra and its subsequent stability in vivo establishes for the first time the possibility of delivering [ 223 Ra]Ra 2+ to metastases outside of the bone using functionalized chelators, marking a significant expansion of the therapeutic utility of this radiometal in the clinic.