Preclinical comparison of four [18F, natGa]rhPSMA-7 isomers: influence of the stereoconfiguration on pharmacokinetics

Introduction Radiohybrid (rh) ligands, a novel class of prostate-specific membrane antigen (PSMA)-targeted radiopharmaceuticals, can be labeled either with [F-18]fluorine via isotopic exchange or with radiometals (such as [Ga-68]Gallium, [Lu-177]Lutetium, [Ac-225]Actinium). Among these, [F-18, Ga-nat]rhPSMA-7 has recently entered clinical assessment. Aim Since [F-18, Ga-nat]rhPSMA-7 is composed of four stereoisomers ([F-18, Ga-nat]rhPSMA-7.1, -7.2, -7.3 and -7.4), we initiated a preclinical selection process to identify the isomer with the most favorable pharmacokinetics for further clinical investigation. Methods A synthetic protocol for enantiopure [F-19, Ga-nat]rhPSMA-7 isomers has been developed. The comparative evaluation of the four isomers comprised human serum albumin binding, lipophilicity, IC50, internalization and classical biodistribution studies and competition experiments in LNCaP tumor-bearing CB-17 SCID mice. In addition, a radio high-performance liquid chromatography-based method was developed allowing quantitative, intraindividual comparison of [F-18, Ga-nat]rhPSMA-7.1 to -7.4 in LNCaP tumor-bearing mice. Results Cell studies revealed high PSMA affinity and internalization for [F-18/19, Ga-nat]rhPSMA-7.2, -7.3 and -7.4, whereas [F-18/19, Ga-nat]rhPSMA-7.1 showed approximately twofold lower values. Although the biodistribution profile obtained was typical of PSMA inhibitors, it did not allow for selection of a lead candidate for clinical studies. Thus, an intraindividual comparison of all four isomers in LNCaP tumor-bearing mice was carried out by injection of a diastereomeric mixture, followed by analysis of the differential uptake and excretion pattern of each isomer. Based on its high tumor accumulation and low uptake in blood, liver and kidneys, [F-18, Ga-nat]rhPSMA-7.3 was identified as the preferred isomer and transferred into clinical studies. Conclusion [F-18, Ga-nat]rhPSMA-7.3 has been selected as a lead compound for clinical development of a [F-18]rhPSMA-based candidate. The intraindividual differential uptake and excretion analysis in vivo allowed for an accurate comparison and assessment of radiopharmaceuticals.