Synthesis and preclinical evaluation of novel (99m)Tc-labeled PSMA ligands for radioguided surgery of prostate cancer

BACKGROUND: Radioguided surgery (RGS) has recently emerged as a valuable new tool in the management of recurrent prostate cancer (PCa). After preoperative injection of a (99m)Tc-labeled prostate-specific membrane antigen (PSMA) inhibitor, radioguided intraoperative identification and resection of lesions is facilitated by means of suitable γ-probes. First clinical experiences show the feasibility of RGS and suggest superiority over conventional lymph node dissection in recurrent PCa. However, commonly used [(99m)Tc]Tc-PSMA-I&S exhibits slow whole-body clearance, thus hampering optimal tumor-to-background ratios (TBR) during surgery. We therefore aimed to develop novel (99m)Tc-labeled, PSMA-targeted radioligands with optimized pharmacokinetic profile to increase TBR at the time of surgery. METHODS: Three (99m)Tc-labeled N4-PSMA ligands were preclinically evaluated and compared to [(99m)Tc]Tc-PSMA-I&S. PSMA affinity (IC(50)) and internalization were determined on LNCaP cells. Lipophilicity was assessed by means of the distribution coefficient logD(7.4) and an ultrafiltration method was used to determine binding to human plasma proteins. Biodistribution studies and static µSPECT/CT-imaging were performed at 6 h p.i. on LNCaP tumor-bearing CB17-SCID mice. RESULTS: The novel N4-PSMA tracers were readily labeled with [(99m)Tc]TcO(4)(−) with RCP > 95%. Comparable and high PSMA affinity was observed for all [(99m)Tc]Tc-N4-PSMA-ligands. The ligands showed variable binding to human plasma and medium to low lipophilicity (logD(7.4) − 2.6 to − 3.4), both consistently decreased compared to [(99m)Tc]Tc-PSMA-I&S. Biodistribution studies revealed comparable tumor uptake among all [(99m)Tc]Tc-N4-PSMA-ligands and [(99m)Tc]Tc-PSMA-I&S, while clearance from most organs was superior for the novel tracers. Accordingly, increased TBR were achieved. [(99m)Tc]Tc-N4-PSMA-12 showed higher TBR than [(99m)Tc]Tc-PSMA-I&S for blood and all evaluated tissue. In addition, a procedure suitable for routine clinical production of [(99m)Tc]Tc-N4-PSMA-12 was established. Labeling with 553 ± 187 MBq was achieved with RCP of 98.5 ± 0.6% (n = 10). CONCLUSION: High tumor accumulation and favorable clearance from blood and non-target tissue make [(99m)Tc]Tc-N4-PSMA-12 an attractive tracer for RGS, possibly superior to currently established [(99m)Tc]Tc-PSMA-I&S. Its GMP-production according to a method presented here and first clinical investigations with this novel radioligand is highly recommended. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13550-022-00942-7.