Preclinical and clinical study on [(18)F]DRKXH1: a novel β-amyloid PET tracer for Alzheimer’s disease

BACKGROUND: The deposition of β-amyloid (Aβ) in the brain is a biomarker of Alzheimer’s disease (AD). Highly sensitive Aβ positron emission tomography (PET) imaging plays an essential role in diagnosing and evaluating the therapeutic effects of AD. AIM: To synthesize a new Aβ tracer [(18)F]DRKXH1 (5-(4-(6-(2-[18]fluoroethoxy)ethoxy)imidazo[1,2-alpha]pyridin-2-yl)phenyl) and evaluate the tracer performance by biodistribution analysis, in vivo small-animal PET-CT dynamic scan, ex vivo and in vitro autoradiography, and PET in human subjects. METHODS: [(18)F]DRKXH1 was synthesized automatically by the GE FN module. Log D (pH 7.4) and biodistribution of [(18)F]DRKXH1 were investigated. Small-animal-PET was used for [(18)F]DRKXH1 and [(18)F]AV45 imaging study in AD transgenic mice (APPswe/PSEN1dE9) and age-matched normal mice. The distribution volume ratios (DVR) and standardized uptake value ratios (SUVRs) were calculated with the cerebellum as the reference region. The deposition of Aβ plaques in the brain of AD transgenic mice was determined by ex vivo autoradiography and immunohistochemistry. In vitro autoradiography was performed in the postmortem brain sections of AD patients and healthy controls. Two healthy control subjects and one AD patient was subjected to in vivo PET study using [(18)F]DRKXH1. RESULTS: The yield of [(18)F]DRKXH1 was 40%, and the specific activity was 156.64 ± 11.55 GBq/μmol. [(18)F]DRKXH1 was mainly excreted through the liver and kidney. The small-animal PET study showed high initial brain uptake and rapid washout of [(18)F]DRKXH1. The concentration of [(18)F]DRKXH1 was detected in the cortex and hippocampus of AD transgenic mice brain. The cortex DVR of AD transgenic mice was higher than that of WT mice (P < 0.0001). Moreover, the SUVRs of AD transgenic mice were higher than those of WT mice based on the 0–60-min dynamic scanning. In vitro autoradiography showed a significant concentration of tracer in the Aβ plaque-rich areas in the brain of AD transgenic mice. The DVR value of [(18)F]-DRKXH1 is higher than that of [(18)F]-AV45 (1.29 ± 0.05 vs. 1.05 ± 0.08; t = 5.33, P = 0.0003). Autoradiography of postmortem human brain sections showed [(18)F]DRKXH1-labeled Aβ plaques in the AD brain. The AD patients had high retention in cortical regions, while healthy control subjects had uniformly low radioactivity uptake. CONCLUSIONS: [(18)F]DRKXH1 is an Aβ tracer with high sensitivity in preclinical study and has the potential for in vivo detection of the human brain. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00259-021-05421-0.